Total hip arthroplasty in high dislocated and severely dysplastic septic hip sequelae

Total hip arthroplasty for sequelae of childhood hip disorders: Current review of management to achieve hip centre restoration

Adults requiring total hip arthroplasty (THA) for childhood disorder sequelae present with shortening, limp, pain, and altered gait. THA, which can be particularly challenging due to altered anatomy, requires careful planning, assessment, and computed tomography evaluation. Preoperative templating is essential to establish the appropriate acetabular and femoral size. Information regarding neck length and offset is needed to ensure the proper options are available at THA. Hip centre restoration must be planned preoperatively and achieved intraoperatively with appropriate exposure, identification, and stable fixation with optimum-size components. Identifying the actual acetabular floor is essential as changes include altered anatomy, distortion of the margins and version changes. Proximal femur changes include anatomical variation, decreased canal diameter, cortical thickness, changes in anteversion, and metaphyseal and diaphyseal mismatch. Preoperative assessment should consist of limb assessment for variations due to prior surgical procedures. Evaluation of the shortening pattern with the relationship of the lesser trochanter to the teardrop would help identify and plan for subtrochanteric shortening osteotomy, especially in high-riding hips. The surgical approach must ensure adequate exposure and soft tissue release to achieve restoration of the anatomical hip centre. The femoral components may require modularity to enable restoration of anteversion and optimum fixation.

Clinical outcomes of proximal femoral reconstruction technique combined with THA in the treatment of high dislocation secondary to septic arthritis: a retrospective single-center study

PURPOSE

The aim of this retrospective study was to examine the clinical outcomes and complications of proximal femur reconstruction (PFR) combined with total hip arthroplasty (THA) in patients with high hip dislocation secondary to septic arthritis (SA).

METHODS

Between September 2016 to September 2021, we performed a series of 15 consecutive PFR combined with THA on patients with high dislocation of the hip secondary to SA, of these,12 hips were reviewed retrospectively, with a mean follow-up of 2.5 years (range, 1.5-6 years). The mean age of the patients at the time of surgery was 52 years (range, 40-70 years).

RESULTS

All patients were followed up. At 1-year postoperative follow-up, the median HHS increased from 32.50 preoperatively to 79.50 postoperatively. The median VAS decreased from 7 before surgery to 2 at 1 year after surgery. The median LLD reduced from 45 mm preoperatively to 8 mm at 1 year after surgery. The mean operative time 125 ± 15 min (range 103-195 min). Mean estimated blood loss was500 ± 105ml (range 450-870 ml). Mean hospital days 9.5 days (range 6-15 days). Two patients developed nerve injuries that improved after nutritional nerve treatment. One patient had recurrent postoperative dislocation and underwent reoperation, with no recurrence dislocation during the follow-up. There were no cases of prosthesis loosening during the follow-up period. One patient developed acute postoperative periprosthetic joint infection (PJI) that was treated with Debridement, Antibiotics and Implant Retention (DAIR) plus anti-infective therapy, with no recurrence during 2 years of follow-up.

CONCLUSION

This study indicates PFR combined with THA shows promise as a technique to manage high hip dislocation secondary to SA, improving early outcomes related to pain, function, and limb length discrepancy.

Survival Analysis of Total Hip Arthroplasty for High Hip Dislocation Secondary to Developmental Dysplasia or Septic Arthritis of the Hip

BACKGROUND

This retrospective study was conducted to know clinical and radiographic outcomes, complication rate, and survival of THA in patients with high hip dislocation secondary to developmental dysplasia(DDH) or septic arthritis of the hip(SSH).

METHODS

Between March 2005 and September 2014, there were consecutive series of 53 THAs in patients with a highly dislocated hip secondary to DDH or SSH. Of these, 48 hips (DDH 24 and SSH 24) were reviewed at a mean follow-up of 7.9 years(range, 5.0-14.3 years). The mean age at the time of THA was 39.1 years(range, 18.0-59.0 years).

RESULTS

Intraoperative blood loss, total drainage and blood transfusion amounts, and mean time to greater trochanter union were significantly lower in the DDH group than in the SSH group (P = .001, P = .039 and P = .014, and P = .015, respectively). No significant difference in Kaplan-Meier survivorship was observed between groups (log-rank, P = .343). The survival rates with an endpoint of cup aseptic loosening in cases with a cemented cup at 7.9 and 10 years (68.1% and 60.5%, respectively) were significantly lower than those in cementless cup cases (100%) at the same checkpoints (P = .019)..

CONCLUSION

We found similar clinical outcomes between the DDH and SSH groups. However, due to poor bone quality and a lack of containment, cementless acetabular cups could not be performed in more than 50% of patients. Our experience shows that revision cementless fixation cup was possible due to reconstitution of the acetabulum in cases with failed cemented fixation.

Mid-term results of total hip arthroplasty with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip

Background

This study aimed to explore mid-term clinical results of cementless total hip arthroplasty (THA) with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip (DDH).

Methods

Thirteen patients (13 hips) with Crowe type IV DDH who underwent THA with modified trochanteric osteotomy between May 2013 and October 2015 were retrospectively analyzed. The mean follow-up duration was 5.2 years (range, 4.9–6.1 years).

Results

The mean Harris Hip Score (HHS) significantly (p < 0.05) improved from 30.7 (range, 22–38) to 87.5 (range, 83–93). The mean leg length discrepancy (LLD) was 53.4 mm (range, 42.1–68.5 mm) preoperatively. The final LLD was 5.6 mm (range, 2.4–9.1 mm; p < 0.05). The mean leg length after surgery was 47.4 mm (range, 33.6–67.2 mm) and the femur shortening distance was 43.8 mm (range, 31.2–53.4 mm). The average duration of bone union for the greater trochanter (GT) was 2.5 months (range, 1.5–3.6 months). There was no infection, GT non-union, or loosening (septic or aseptic) of the stem or cup in any case.

Conclusions

THA with modified trochanteric osteotomy with a cementless cup is an effective treatment for Crowe type IV DDH. It can rebuild complex biomechanics and biology of hip dysplasia without increasing complications.

Cementless Total Hip Arthroplasty for Adult Patients With Sequelae From Childhood Hip Infection: A Medium-Term Follow-Up Study

BACKGROUND

The aim of this study is to evaluate midterm clinical and radiographic results of total hip arthroplasties (THAs) with cementless implants for adult patients with sequelae from childhood hip infection.

METHODS

Between 2002 and 2016, 165 patients (165 hips) who had a hip infection during childhood were treated with THAs with cementless implants. The average duration of follow-up was 93.5 months (range 26-206). Clinical results were evaluated via the Harris Hip Score and radiographic results were analyzed with postoperative serial X-rays.

RESULTS

The average Harris Hip Score increased from 27 (range 8-53) before surgery to 91 (range 45-100) at the latest follow-up examination (P < .001). At the latest follow-up evaluation, 9 cementless acetabular components demonstrated partial, nonprogressive radiolucencies. No subsidence of more than 2 mm or evidence of a radiolucent line was observed around the femoral components. Intraoperative periprosthetic fractures occurred in 11 hips, including 3 acetabular fractures, 2 fractures of greater trochanter, 1 femoral shaft fracture, and 5 fractures of femoral calcar. Postoperative complications included 3 cases of periprosthetic infection, 1 episode of dislocation, 1 case of a femoral periprosthetic fracture, 5 cases of sciatic nerve injury, 1 case of femoral nerve injury, and 1 case of squeaking from a ceramic bearing surface.

CONCLUSION

Cementless THA for adult patients with sequelae from childhood hip infection presents significant technical challenges and a relatively high complication rate. With meticulous surgical planning and anticipation for the key technical challenges frequently encountered, the medium-term clinical and radiographic results of THA in this setting were good with high implant survivorship and patient satisfaction.

[Research progress of total hip arthroplasty for patients with sequelae of suppurative hip arthritis]

OBJECTIVE

To summarize the research progress of total hip arthroplasty (THA) in treatment of sequelae of suppurative hip arthritis.

METHODS

The relevant literature was systematically searched and the operation timing, treatments of acetabular and femoral sides, and prosthesis selection in THA for sequelae of suppurative hip arthritis were summarized.

RESULTS

THA is an effective way to treat the sequelae of suppurative hip arthritis. In order to avoid the recurrence of infection, THA is recommended to be performed after 10 years of resting period of hip septic infection. These patients may have acetabulum dysplasia and poor coverage of acetabulum. When performing THA, high position acetabulum, osteotomy of the medial acetabular wall, structural bone graft, Cage, tantalum augment, or three-dimensional printing prosthesis can be chosen. The femoral side may has small medullary cavity, increased femoral neck anteversion, increased femoral neck-stem angle, extend trochanter, and poor bone mass. When performing THA, the femoral osteotomy and appropriate prosthesis can be selected for treatment. The patients with sequelae of suppurative hip arthritis are mostly young, cementless THA is preferred for a better long-term survivorship.

CONCLUSION

THA is an effective method for the sequelae of suppurative hip arthritis, but the operation is difficult and has relative high complication rate. Surgeons should have full understanding.

Total Hip Arthroplasty With Subtrochanteric Shortening Osteotomy in Patients With High Hip Dislocation Secondary to Childhood Septic Arthritis: A Matched Comparative Study With Crowe IV Developmental Dysplasia

BACKGROUND

Total hip arthroplasty (THA) with subtrochanteric shortening osteotomy (SSO) is performed to manage hips with high dislocations. We compared outcomes of THA with SSO in patients with high hip dislocation resulting from childhood septic arthritis and Crowe IV developmental dysplasia of the hip (DDH).

METHODS

We reviewed 60 THAs with SSO performed between May 1996 and December 2013. Thirty-one cases were classified as sequelae of childhood infection and 29 as DDH. Twenty-five hips were selected for each group after the propensity score was matched with preoperative demographics and leg length discrepancy (LLD). Clinical scores, complication and reoperation rates, radiographic results, and survivorships were compared. The mean duration of follow-up was 12.3 (range 5-22) years.

RESULTS

The average correction in LLD was 2.5 cm for childhood infection and 3.6 cm for DDH (P = .002). The infection group received more transfusions (mean 3.3 vs 2.0 units, P = .002), required more time for union of osteotomy site (mean 6.8 vs 5.2 months, P = .042), and reported lower Harris Hip Score (mean 85.1 vs 91.3, P = .017). Reoperations were performed in 11 (44%) previously infected hips and 3 (12%) DDHs (P = .012). Kaplan-Meier survivorship with an endpoint of revision for any reason was lower in the infection group (83.6%) than in the DDH group (100%) at 10 years (log rank, P = .040).

CONCLUSION

THA with SSO in high hip dislocation secondary to childhood septic arthritis demonstrated less favorable clinical outcomes with increased risks of complication, compared with those performed in Crowe IV DDH with similar degree of chronic dislocation.

Modular Stems: Advantages and Current Role in Primary Total Hip Arthroplasty

Using modular femoral stems in total hip arthroplasty enables surgeons to make fine adjustments to individual joints and offers intraoperative flexibility. The concept of modularity has been developed in numerous shapes, resulting in a vast range of options. Among them, the greatest achievement has been made for prostheses with modular proximal sleeves. The use of these implants has resulted in excellent mid- to long-term results in a number of cases. Although the use of tapered stems with a broaching technique is gaining popularity in straightforward primary surgeries, modular femoral implants are still associated with a number of potential challenges (e.g., developmental dysplasia of the hip, infection sequelae, and skeletal dysplasia). Based on published results, it is advisable to consider it as an option for complicated cases where the proximal femur is severely deformed.

The ratio of femoral head diameter to pelvic height in the normal hips of a Chinese population

OBJECTIVE

The aim of this study was to determine whether the ratio between the femoral head diameter and pelvic height in a Chinese population is the same as that found in Westerners.

MATERIALS AND METHODS

Standard pelvic radiography was performed on a group of 187 Chinese adult subjects consisting of 81 males and 106 females with a mean age of 40 years (21-68 years). Femoral head diameter (vertical distance from the femoral head-neck junction to the highest point of the femoral head) and pelvic height (vertical distance from the highest point of the iliac crest to the edge of the ischial tuberosities) were measured.

RESULTS

There were significant differences between males and females (p < 0.001), and between persons of high height versus low height (p = 0.011) and medium height (p = 0.039). There were no significant differences between persons of different age (p = 0.244), body mass index (p = 0.091), or between persons of low- and medium-height groups (p = 0.69). The overall mean ratio between the femoral head diameter and pelvic height was 0.215 (0.173-0.249) with a 95 % CI = 0.214-0.217. The mean ratios in males and females were 0.221 (0.194-0.249) and 0.211 (0.173-0.238), respectively.

CONCLUSION

The mean ratio in Chinese population was similar to the reported ratio in a western population (about 1:5). We suggest that Chinese surgeons may be able to use the Crowe classification to classify patients with hip dysplasia.