Cementless total hip arthroplasty in patients with severely dysplastic hips and a previous Schanz osteotomy of the femur

Figures & data

Table 1. Classification of the hips according to Eftekhar (1978) and Hartofilakidis et al. (1996)

		Eftekhar classification (n ^b)
Hip disease ^a	n ^b	A	B	C	D
Congenital hip disease (n = 63)
Dysplasia	4	4
Low dislocation ^c	9		9
High dislocation	51			18	33
Tuberculosis (n = 3) ^c
Dysplasia	1	1
High dislocation	2			1	1
Coxa vara (n = 1) ^c
Dysplasia	1	1

^a Classification of dysplasia according to Hartofilakidis et al. (1996).

^b n: number of hips.

^c Hips with previous tuberculous coxarthritis or coxa vara were classified with the same methods.

Table 2. Clinical characteristics at the time of primary arthroplasty

Male/female (no. of patients)	5 / 54
Median age (range) at time of operation (yr)	50 (29–69)
Median height (range), m	1.55 (1.40–1.73)
Median weight (range), kg	63 (44–87)
No. of hips Trendelenburg +/−	52 / 16

Figure 1. A 54-year-old woman who had high congenital dislocation of both hips. At the age of 17, she had undergone a bilateral high-seated Schanz osteotomy to reduce limp. A. Preoperatively. B. 9 years after a cementless total hip arthroplasty of the left hip and 8 years after a similar procedure on the left hip. Both hips underwent femoral shortening and advancement of the greater trochanter. The leg-length discrepancy was 1 cm (the left side being shorter). There were no radiographic signs of loosening of the components and no signs of polyethylene wear.

Figure 2. Osteotomies used for various deformities of the femur. The femoral shaft is usually transected distal to the lesser trochanter, as shown by the transverse solid line in (A). A dotted line demonstrates the most distal possible level of the osteotomy. A. Proximal shortening osteotomy with distal advancement of the greater trochanter (vertical solid line) in hips with a previous proximal Schanz osteotomy. B. Segmental shortening with angular correction for hips with a previous, more distal Schanz osteotomy. Copyright for the illustrations in this figure is owned by The Journal of Bone and Joint Surgery, Inc. (published in Eskelinen et al. Cementless total hip arthroplasty in patients with high congenital hip dislocation, J Bone Joint Surg Am. 2006; 88: 80-91). Reproduced with permission.

Table 3. Prosthetic components

Implant	n	Material	Porous coating	Design	Dates	Liner
Stem
Lord Madréporique	1	Cobalt-chromium	Full	Straight, intramedullary rod	1988	–
Biomet CDH (Collared)	46	Titanium alloy	Proximal	Straight, collared	1988–1995	–
Biomet CDH (Collarless)	17	Titanium alloy	Proximal	Straight, collarless	1993–1995	–
Biomet Head-Neck	2	Titanium alloy	Proximal	Straight, tapered, box-like collar	1988–1990	–
Biomet Bi-Metric	2	Titanium alloy	Proximal	Straight, tapered	1994–1995	–
Cup
Biomet T-Tap	18	Titanium alloy	No ^a	Conical	1988–1989	HexLocTM
Biomet Universal	24	Titanium alloy	Yes	Hemispherical	1989–1994	HexLocTM
Biomet Mallory	18	Titanium alloy	Yes	Hemispherical, with fins	1989–1992	HexLocTM
Biomet Vision	8	Titanium alloy	Yes	Hemispherical	1995	RingLocTM

^a Smooth threaded

Table 4. Clinical results of intact and revised hips

Follow-up	HHS total ^a	HHS pain ^a	HHS > 80	Pain-free	Satisfied ^b
Intact hips (n = 26)
Preoperatively	50 (14)	18 (12)	0	0	–
1-year	89 (8)	42 (9)	24 (92%)	21 (81%)	–
Final	92 (8)	43 (1)	24 (96%)	22 (92%)	21 (91%)
Revised hips (n = 35)
Preoperatively	54 (19)	22 (13)	4 (11%)	0	–
1-year	85 (11)	42 (2)	24 (69%)	18 (51%)	–
Final	86 (14)	42 (6)	25 (71%)	24 (69%)	21 (66%)

^a SD in parentheses.

^b Satisfaction of patients.

Figure 3. Kaplan-Meier survival curve for the press-fit porous-coated Figure 4. Kaplan-Meier survival curve for the CDH femoral compo-acetabular components, with cup revision because of aseptic loosennents, with stem revision for any reason as the endpoint. CI: confi-ing and cup revision for any reason as the endpoints. CI: confidence dence interval. interval.

Figure 4. Kaplan-Meier survival curve for the CDH femoral components, with stem revision for any reason as the endpoint. CI: confi-dence interval.

Table 5. Complications

Complication	n	Etiology	Treatment	Outcome
Peroneal nerve palsy #1	2	Hematoma	Surgical evacuation on the 1st POD	Permanent incomplete dropfoot
Peroneal nerve palsy #2		Too much offset, ischial nerve impinging against acetabulum	Exchange of femoral head to a shorter one on the 2nd POD	Permanent incomplete dropfoot
Femoral nerve palsy #1	2	Hematoma	Surgical evacuation on the 5th POD	Spontaneous recovery in 3 months
Femoral nerve palsy #2		Hematoma	Surgical evacuation on the 1st POD	Motor paresis fully resolved in 6 months, permanent sensory deificit in thigh
Superior gluteal nerve plasy	1	Perioperative neuropraxia	Watchful waiting	Spontaneous recovery in 6 months
Obturatorius nerve palsy	1	Perioperative neuropraxia	Watchful waiting	Spontaneous recovery in 6 months
Non-displaced fracture of	5	1 identified during rasping,	3 fixed with Parham bands and	All united without reoperations
proximal femur		4 during stem insertion	2 fixed with Dall-Miles cables perioperatively
Superficial wound infection	1	Staphylococcus aureus	Peroral antibiotics	Fully resolved

POD: postoperative day.

Eskelinen A, Helenius I, Remes V, Ylinen P, Tallroth K, Paavilainen T. Cementless total hip arthroplasty in patients with high congenital hip dislocation. J Bone Joint Surg (Am) 2006; 88: 80–91

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