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Halperin SJ, Dhodapkar MM, Radford Z, Frumberg DB, Rubin LE, Grauer JN. Patients With Down Syndrome and Total Hip and Total Knee Arthroplasty: Outcome Measures Show Increased Risk of Perioperative Complications. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202312000-00008. [PMID: 38054749 PMCID: PMC10697628 DOI: 10.5435/jaaosglobal-d-23-00108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/27/2023] [Accepted: 10/28/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Patients with Down syndrome (DS) are being considered for total joint arthroplasty. There is limited literature regarding outcomes of patients with DS after total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS Data were abstracted from the 2010 to 2021 Q1 PearlDiver M151 database. THA and TKA osteoarthritis adult patients with and without DS were identified. Patients were matched 1:10. Ninety-day postoperative events and 2-year revision rates were compared. RESULTS For THA, 154 patients with DS were matched with 1,532 patients without DS. For TKA, 150 patients with DS were matched with 1,495 patients without DS. On multivariable logistic regression, THA and TKA patients with DS were at markedly greater odds of postoperative events including any adverse event, sepsis, minor adverse event, urinary tract infection (UTI), acute kidney injury (AKI), and pneumonia. For both THA and TKA, 2-year revision rates were not increased for those with DS. DISCUSSION This study represents the largest cohorts for matched patients with DS undergoing THA or TKA through 90 days postoperatively. For both procedures, DS patients were found to have greater risk of several adverse events, but not 2-year revisions. These findings may help guide perioperative risk assessment, patient/family counseling, and care pathways.
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Affiliation(s)
- Scott J Halperin
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
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Hernandez NM, Cunningham DJ, Millikan PD, Penrose CT, Seyler TM. Is primary total hip arthroplasty in patients with Down's syndrome associated with increased complications at 2 years follow-up? Arch Orthop Trauma Surg 2022; 142:2927-2934. [PMID: 34542651 DOI: 10.1007/s00402-021-04132-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Previous reports on primary total hip arthroplasty (THA) in patients with Down's syndrome (DS) are often small and/or lack a comparison cohort, and thus it is challenging to draw meaningful conclusions about this group. The purpose of this study was to report on the post-operative complications in patients with DS undergoing primary THA, compared to a non-DS cohort. METHODS In this retrospective study, we evaluated patients from 2010 to 2018 using a national database. We assessed surgical complications: closed reduction for dislocation, revision, resection, periprosthetic fracture, and infection in patients with a diagnosis of DS undergoing primary THA and compared them to a THA group of patients without DS. Patients undergoing THA for hip fractures were excluded. Complications were evaluated at 90 days and 2 years. Multivariable logistic regression analysis was used to adjust for age, sex, body mass index, and Charlson comorbidity index. RESULTS At 90 days patients with DS had an increased risk of revision (OR 3.1, CI 1.14-8.41), but no significant risk of resection (OR 5.24, CI 0.73-37.8), closed reduction (OR 2.03, CI 0.28-14.59), infection (OR 1.48, CI 0.6-3.62), or periprosthetic fracture (OR 1.97, CI 0.27-14.14). At 2 years patients with DS had an increased risk of periprosthetic fracture (OR 5.88, CI 1.84-18.78), but no significant increased risk of revision (OR 1.82, CI 0.66-5.01), resection (OR 2.37, CI 0.33-17.17), or infection (OR 0.65, CI 0.2-2.07). CONCLUSIONS Primary THA in patients with DS is associated with increased 90-day revision, and periprosthetic fracture at 2 years.
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Affiliation(s)
- Nicholas M Hernandez
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Daniel J Cunningham
- Department of Orthopaedic Surgery, Duke University, 200 Trent Drive, Durham, NC, 27710, USA
| | | | - Colin T Penrose
- Department of Orthopaedic Surgery, Duke University, 200 Trent Drive, Durham, NC, 27710, USA
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University, 200 Trent Drive, Durham, NC, 27710, USA
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Ahlström G, Axmon A, Sandberg M, Flygare Wallén E. Health care utilisation among older people with Down syndrome compared to specific medical guidelines for health surveillance: a Swedish national register study. BMC Health Serv Res 2020; 20:949. [PMID: 33059705 PMCID: PMC7559468 DOI: 10.1186/s12913-020-05800-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Specific medical guidelines for health surveillance exist for people with Down syndrome (DS) since 25 years but knowledge of adherence to the guidelines is lacking. The guidelines were developed to avoid unnecessary suffering from preventable conditions. The aims of the study were to investigate 1) planned health care visits in relation to the co-morbidities described in specific medical guidelines as a measure of adherence, 2) unplanned health care visits as a measure of potentially unmet health care needs and 3) gender differences in health care utilisation among older people with DS. Methods This register-based study includes people with DS (n = 472) from a Swedish national cohort of people with intellectual disability (n = 7936), aged 55 years or more, and with at least one support according to the disability law, in 2012. Data on inpatient and outpatient specialist health care utilisation were collected from the National Patient Register for 2002–2012. Results A total of 3854 inpatient and outpatient specialist health care visits were recorded during the 11 years, of which 54.6% (n = 2103) were planned, 44.0% (n = 1695) unplanned and 1.4% (n = 56) lacked information. More than half of the visits, 67.0% (n = 2582) were outpatient health care thus inpatient 33% (n = 1272). Most planned visits (29.4%, n = 618) were to an ophthalmology clinic, and most unplanned visits to an internal medicine clinic (36.6%, n = 621). The most common cause for planned visits was cataract, found at least once for 32.8% in this cohort, followed by arthrosis (8.9%), epilepsy (8.9%) and dementia (6.6%). Pneumonia, pain, fractures and epilepsy each accounted for at least one unplanned visit for approximately one-fourth of the population (27.1, 26.9, 26.3 and 19.7% respectively). Men and women had similar numbers of unplanned visits. However, women were more likely to have visits for epilepsy or fractures, and men more likely for pneumonia. Conclusions Increased awareness of existing specific medical guidelines for people with DS is vital for preventive measures. The relatively few planned health care visits according to the medical guidelines together with a high number of unplanned visits caused by conditions which potentially can be prevented suggest a need of improved adherence to medical guidelines.
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Affiliation(s)
- G Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00, Huddinge, Sweden.
| | - A Axmon
- EPI@LUND (Epidemiology, Population studies, and Infrastructures at Lund University), Lund University, 221 00, Stockholm, Sweden
| | - M Sandberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00, Huddinge, Sweden
| | - E Flygare Wallén
- Department of Neurobiology, Care Sciences and Society (NVS), H1 Division of Family Medicine and Primary Care, Karolinska Institutet (KI), Alfred Nobels allé 10, 141 83, Huddinge, Sweden.,Academic Primary Health Care Center, Solnavägen 1e, 113 65, Stockholm, Sweden
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Dilogo IH, Fiolin J, Pangestu JJ, Muhyi A. Management of recurrent hip dislocation in Down Syndrome using modified Ganz periacetabular osteotomy: Follow up after 5 years. Ann Med Surg (Lond) 2020; 54:97-100. [PMID: 32419945 PMCID: PMC7218225 DOI: 10.1016/j.amsu.2020.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/02/2022] Open
Abstract
Recurrent hip dislocation in a Down Syndrome patient with dysplastic hip is a very rare and challenging case to treat even for an expert orthopaedic hip surgeon. Least compliant patient and family, lowly educated with low socioeconomic status, young age and several anatomical variations forces limited option as a treatment. Several literatures mentioned Despite requiring only minimal implant, this technically demanding surgery requires a thorough understanding of the hip anatomy. This is the first case worldwide reporting 5 year follow up of dysplastic hip with DS treated successfully with periacetabular osteotomy (PAO) technique. An eighteen years old female with DS had multiple posterior hip dislocation episodes since 3 years prior our hospital admission. A modified Ganz PAO was performed under image intensifier guide. Patient was able to talk and hip was never dislocated again within 5 years follow up. Ganz periacetabular osteotomy, although a technically demanding surgery, is a preferable treatment in recurrent hip dislocation for Down Syndrome patient with good to excellent clinical and radiological outcome.
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Affiliation(s)
- Ismail Hadisoebroto Dilogo
- Department of Orthopaedics and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jl. Diponegoro No. 71, Jakarta Pusat, Indonesia
| | - Jessica Fiolin
- Department of Orthopaedics and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jl. Diponegoro No. 71, Jakarta Pusat, Indonesia
| | - Juniarto Jaya Pangestu
- Department of Orthopaedics and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jl. Diponegoro No. 71, Jakarta Pusat, Indonesia
| | - Amri Muhyi
- Department of Orthopaedics and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jl. Diponegoro No. 71, Jakarta Pusat, Indonesia
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Capone G, Stephens M, Santoro S, Chicoine B, Bulova P, Peterson M, Jasien J, Smith AJ. Co-occurring medical conditions in adults with Down syndrome: A systematic review toward the development of health care guidelines. Part II. Am J Med Genet A 2020; 182:1832-1845. [PMID: 32338447 DOI: 10.1002/ajmg.a.61604] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 12/12/2022]
Abstract
Adults with Down syndrome (DS) represent a unique population who are in need of clinical guidelines to address their medical care. Many of these conditions are of public health importance with the potential to develop screening recommendations to improve clinical care for this population. Our workgroup previously identified and prioritized co-occurring medical conditions in adults with DS. In this study, we again performed detailed literature searches on an additional six medical conditions of clinical importance. A series of key questions (KQ) were formulated a priori to guide the literature search strategy. Our KQs focused on disease prevalence, severity, risk-factors, methodologies for screening/evaluation, impact on morbidity, and potential costs/benefits. The available evidence was extracted, evaluated and graded on quality. The number of participants and the design of clinical studies varied by condition and were often inadequate for answering most of the KQ. Based upon our review, we provide a summary of the findings on hip dysplasia, menopause, acquired cardiac valve disease, type 2 diabetes mellitus, hematologic disorders, and dysphagia. Minimal evidence demonstrates significant gaps in our clinical knowledge that compromises clinical decision-making and management of these medically complex individuals. The creation of evidence-based clinical guidance for this population will not be possible until these gaps are addressed.
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Affiliation(s)
- George Capone
- Down Syndrome Clinic and Research Center, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Mary Stephens
- Adult Down Syndrome Clinic, Christiana Care Health System, Wilmington, Delaware, USA
| | | | - Brian Chicoine
- Lutheran General Hospital, Advocate Adult Down Syndrome Center, Park Ridge, Illinois, USA
| | - Peter Bulova
- Adult Down Syndrome Clinic, Montefiore Hospital, Pittsburgh, Pennsylvania, USA
| | - Moya Peterson
- Adults with Down Syndrome Specialty Clinic, University of Kansas Medical Center, Kansas City, Missouri, USA
| | - Joan Jasien
- Department of Pediatrics and Child Neurology, Lenox Baker Children's Hospital, Durham, North Carolina, USA
| | - Anna Jo Smith
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Total hip arthroplasty in patients with Trisomy 21: Systematic review and exploratory patient level analysis. Surgeon 2019; 17:52-57. [DOI: 10.1016/j.surge.2018.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/20/2018] [Accepted: 04/29/2018] [Indexed: 01/08/2023]
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Abstract
The incidence of hip instability in children with Down syndrome is 1% to 7%. The natural history is often progressive, with the typical onset of hypermobility of the hip evolving to habitual dislocation, persistent subluxation, and fixed dislocation, and eventually leading to the loss of independent mobility. Treatment focuses on stabilizing the hip joint and depends on the patient's age and the severity of the disease. Typically, surgical intervention is recommended for the treatment of patients with habitual dislocation, subluxation, and complete dislocation of the hip. When indicated, surgical management must take into account associated anatomic abnormalities of the femur and acetabulum. Hip instability in Down syndrome may persist despite surgical intervention and remains a difficult condition to manage.
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Maranho DA, Williams KA, Millis MB, Kim YJ, Novais EN. Mid-Term Results of Periacetabular Osteotomy for the Treatment of Hip Dysplasia Associated with Down Syndrome: Minimum Follow-up of Five Years. J Bone Joint Surg Am 2018; 100:428-434. [PMID: 29509620 DOI: 10.2106/jbjs.17.00957] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of hip dysplasia in patients with Down syndrome is challenging. We investigated the clinical, functional, and radiographic outcomes of periacetabular osteotomy (PAO) as well as factors associated with its failure at a minimum of 5 years of follow-up. METHODS Between 1992 and 2011, 19 patients with Down syndrome (26 hips) underwent PAO at a mean age of 16.2 ± 4.7 years. Hip pain and function were assessed with use of the modified Harris hip score (HHS) and the Gross Motor Function Classification System (GMFCS). The criteria for PAO failure were progression of osteoarthritis with a recommendation for total hip arthroplasty or hip arthrodesis, or an HHS of <60 points. Preoperative and most recent radiographs were assessed for measurement of the lateral and anterior center-edge angles, Tönnis angle, extrusion index, and anterior and posterior wall indices, and for evaluation of the Tönnis grade of osteoarthritis. RESULTS At an average follow-up of 13.1 ± 5.2 years (range, 5.4 to 24 years), 13 (62%) of 21 hips with an HHS demonstrated good or excellent HHS results (median, 91 points; interquartile range, 65 to 96 points). Ninety-five percent of the patients were independent in ambulation. All radiographic parameters significantly improved after PAO. Eight (31%) of the 26 hips were considered to have failed the procedure. Tönnis grade-2 osteoarthritis (4 hips compared with 1 hip; p = 0.008; odds ratio [OR] = 17.00) and older patient age at the time of the procedure (19.6 ± 6.7 compared with 14.7 ± 2.4 years; p = 0.017; OR = 1.36 per year) were demonstrated to be factors associated with PAO failure in an analysis of hips that failed compared with those without failure at the time of latest follow-up. CONCLUSIONS PAO improves radiographic deformity and helps to preserve independent ambulation in patients with hip dysplasia and Down syndrome. Although nearly 70% of the hips were preserved at an average of 13 years postoperatively, 1 in 3 hips met the criteria for failure, which was associated with older age at the time of the procedure and a moderate osteoarthritis grade (Tönnis grade 2). LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniel A Maranho
- Department of Orthopedic Surgery (D.A.M., M.B.M., Y.-J.K., and E.N.N.) and Clinical Research Center (K.A.W.), Boston Children's Hospital, Boston, Massachusetts.,Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Kathryn A Williams
- Department of Orthopedic Surgery (D.A.M., M.B.M., Y.-J.K., and E.N.N.) and Clinical Research Center (K.A.W.), Boston Children's Hospital, Boston, Massachusetts
| | - Michael B Millis
- Department of Orthopedic Surgery (D.A.M., M.B.M., Y.-J.K., and E.N.N.) and Clinical Research Center (K.A.W.), Boston Children's Hospital, Boston, Massachusetts
| | - Young-Jo Kim
- Department of Orthopedic Surgery (D.A.M., M.B.M., Y.-J.K., and E.N.N.) and Clinical Research Center (K.A.W.), Boston Children's Hospital, Boston, Massachusetts
| | - Eduardo N Novais
- Department of Orthopedic Surgery (D.A.M., M.B.M., Y.-J.K., and E.N.N.) and Clinical Research Center (K.A.W.), Boston Children's Hospital, Boston, Massachusetts
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Boylan MR, Kapadia BH, Issa K, Perfetti DC, Maheshwari AV, Mont MA. Down Syndrome Increases the Risk of Short-Term Complications After Total Hip Arthroplasty. J Arthroplasty 2016; 31:368-72. [PMID: 26482683 DOI: 10.1016/j.arth.2015.09.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/02/2015] [Accepted: 09/15/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Down syndrome is the most common chromosomal abnormality and is associated with degenerative hip disease. Because of the recent increase in life expectancy for patients with this syndrome, orthopaedic surgeons are likely to see an increasing number of these patients who are candidates for total hip arthroplasty (THA). METHODS Using Nationwide Inpatient Sample (NIS) data from 1998 to 2010, we compared the short-term adverse outcomes of THA among 241 patients with Down syndrome and a matched 723-patient cohort. Specifically, we assessed: (1) incidence of THA; (2) perioperative medical and surgical complications during the primary hospitalization; (3) length of stay; and (4) hospital charges. RESULTS The annual mean number of patients with Down syndrome undergoing THA was 19. Compared to matched controls, Down syndrome patients had an increased risk of perioperative (OR, 4.33; P<.001), medical (OR, 4.59; P<.001) and surgical (OR, 3.51; P<.001) complications during the primary hospitalization. Down syndrome patients had significantly higher incidence rates of pneumonia (P=.001), urinary tract infection (P<.001), and wound hemorrhage (P=.027). The mean lengths of stay for Down syndrome patients were 26% longer (P<.001), but there were no differences in hospital charges (P=.599). CONCLUSION During the initial evaluation and pre-operative consultation for a patient with Down syndrome who is a candidate for THA, orthopaedic surgeons should educate the patient, family and their clinical decision makers about the increased risk of medical complications (pneumonia and urinary tract infections), surgical complications (wound hemorrhage), and lengths of stay compared to the general population.
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Affiliation(s)
- Matthew R Boylan
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York; Department of Epidemiology and Biostatistics, SUNY Downstate Medical Center, Brooklyn, New York
| | - Bhaveen H Kapadia
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York
| | - Kimona Issa
- Department of Orthopaedic Surgery, Seton Hall University School of Health and Medical Sciences at St. Joseph's Regional Medical Center, Paterson, New Jersey
| | - Dean C Perfetti
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York; Department of Epidemiology and Biostatistics, SUNY Downstate Medical Center, Brooklyn, New York
| | - Aditya V Maheshwari
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, Baltimore, Maryland
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Amanatullah DF, Rachala SR, Trousdale RT, Sierra RJ. Total hip replacement in patients with Down syndrome and degenerative osteoarthritis of the hip. Bone Joint J 2014; 96-B:1455-8. [DOI: 10.1302/0301-620x.96b11.34089] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Dysplasia of the hip, hypotonia, osteopenia, ligamentous laxity, and mental retardation increase the complexity of performing and managing patients with Down syndrome who require total hip replacement (THR). We identified 14 patients (six males, eight females, 21 hips) with Down syndrome and degenerative disease of the hip who underwent THR, with a minimum follow-up of two years from 1969 to 2009. In seven patients, bilateral THRs were performed while the rest had unilateral THRs. The mean clinical follow-up was 5.8 years (standard deviation (sd) 4.7; 2 to 17). The mean Harris hip score was 37.9 points (sd 7.8) pre-operatively and increased to 89.2 (sd 12.3) at final follow-up (p = 1x10-9). No patient suffered a post-operative dislocation. In three patients, four hips had revision THR for aseptic loosening at a mean follow-up of 7.7 years (sd 6.3; 3 to 17). This rate of revision THR was higher than expected. Our patients with Down syndrome benefitted clinically from THR at mid-term follow-up. Cite this article: Bone Joint J 2014;96-B:1455–8.
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Affiliation(s)
- D. F. Amanatullah
- Stanford University, 450
Broadway Street, Redwood City, California, 94063, USA
| | - S. R. Rachala
- University of Buffalo, 100
High Street, Buffalo, New
York 14203, USA
| | - R. T. Trousdale
- Mayo Clinic, 200
First Street SW, Rochester, Minnesota, 55905, USA
| | - R. J. Sierra
- Mayo Clinic, 200
First Street SW, Rochester, Minnesota, 55905, USA
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Zywiel MG, Mont MA, Callaghan JJ, Clohisy JC, Kosashvili Y, Backstein D, Gross AE. Surgical challenges and clinical outcomes of total hip replacement in patients with Down’s syndrome. Bone Joint J 2013; 95-B:41-5. [DOI: 10.1302/0301-620x.95b11.32901] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Down’s syndrome is associated with a number of musculoskeletal abnormalities, some of which predispose patients to early symptomatic arthritis of the hip. The purpose of the present study was to review the general and hip-specific factors potentially compromising total hip replacement (THR) in patients with Down’s syndrome, as well as to summarise both the surgical techniques that may anticipate the potential adverse impact of these factors and the clinical results reported to date. A search of the literature was performed, and the findings further informed by the authors’ clinical experience, as well as that of the hip replacement in Down Syndrome study group. The general factors identified include a high incidence of ligamentous laxity, as well as associated muscle hypotonia and gait abnormalities. Hip-specific factors include: a high incidence of hip dysplasia, as well as a number of other acetabular, femoral and combined femoroacetabular anatomical variations. Four studies encompassing 42 hips, which reported the clinical outcomes of THR in patients with Down’s syndrome, were identified. All patients were successfully treated with standard acetabular and femoral components. The use of supplementary acetabular screw fixation to enhance component stability was frequently reported. The use of constrained liners to treat intra-operative instability occurred in eight hips. Survival rates of between 81% and 100% at a mean follow-up of 105 months (6 to 292) are encouraging. Overall, while THR in patients with Down’s syndrome does present some unique challenges, the overall clinical results are good, providing these patients with reliable pain relief and good function. Cite this article: Bone Joint J 2013;95-B, Supple A:41–5.
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Affiliation(s)
- M. G. Zywiel
- University of Toronto, 149
College Street, Room 508-A, Toronto, Ontario, M5T 1P5, Canada
| | - M. A. Mont
- Center for Joint Preservation and Replacement,
Rubin Institute for Advanced Orthopedics, 2401
W Belvedere Ave, Baltimore, Maryland
21215, USA
| | - J. J. Callaghan
- Department of Orthopaedic Surgery, University
of Iowa, 200 Hawkins Drive, 01008 JPP, Iowa
City, Iowa, 52242, USA
| | - J. C. Clohisy
- Department of Orthopaedic Surgery, Washington
University School of Medicine, 660 South
Euclid Avenue, Campus Box 8233, St
Louis, Missouri, 63110, USA
| | - Y. Kosashvili
- Orthopaedic Department, Rabin Medical
Center, Tel Aviv University, 39 Zabotinsky
Street, Petach Tikva, 49414, Israel
| | - D. Backstein
- Division of Orthopaedic Surgery, Mount
Sinai Hospital, University of Toronto, 600 University
Ave, Toronto, Ontario, M5G
1X5, Canada
| | - A. E. Gross
- Division of Orthopaedic Surgery, Mount
Sinai Hospital, University of Toronto, 600 University
Ave, Toronto, Ontario, M5G
1X5, Canada
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