CLINICAL RESULTS OF UNCEMENTED TOTAL HIP ARTHROPLASTY FOR ULTIMATE HIP DISEASE COMBINED WITH PROXIMAL FEMORAL DEFORMITY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YOUZhenjun ,  SUNJunying , ZHAGuochun , WANGTao , DONGShengjie , JIANGTao

Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215006, P. R. China;

Corresponding author：

SUNJunying, Email: sunjunying@hotmail.com

Keywords：

Total hip arthroplasty; Proximal femur deformity; Hip disease

DOI：

10.7507/1002-1892.20150057

Video：

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Objective To evaluate the clinical results of uncemented total hip arthroplasty (THA) for ultimate hip disease combined with proximal femoral deformity. Methods Between February 2005 and June 2013, 48 cases (51 hips) of ultimate hip disease combined with proximal femoral deformity were treated with uncemented THA and osteotomy. There were 14 males (16 hips) and 34 females (35 hips), with an average age of 52 years (range, 19-83 years). Unilateral hip was involved in 45 cases, and bilateral hips in 3 cases. There were 36 cases (39 hips) of developmental dysplasia of hip, 3 cases (3 hips) of traumatic arthritis, 1 case (1 hip) of previous intertrochanteric valgus osteotomy, 4 cases (4 hips) of internal fixation failure, 3 cases (3 hips) of tuberculosis, and 1 case (1 hip) of suppurative infection. Preoperative Trendelenburg sign was positive in all hips. The discrepancy of limbs was observed in 19 patients. According to Berry classification system, deformity located at the greater trochanter in 4 hips, at the femoral neck in 39 hips, at the femur metaphysis in 7 hips, and at femoral shaft in 1 hip. The Harris score was 34.28±3.28 before operation. Results Healing of incision by first intention was obtained in all patients. Deep venous thrombosis occurred in 1 patient, and no complications of infection, neurovascular injury, or prosthetic dislocation were found. Forty-seven patients (50 hips) were followed up 3.8 years on average (range, 1-9 years). At last follow-up, the Harris hip score was 92.87±4.57, showing significant difference when compared to preoperative score (t=-213.19, P=0.00). Postoperative Trendelenburg sign was positive in 6 hips. Normal gait was shown in 39 cases, and slight limp in 8 cases. X-ray film results showed complete correction of deformity and bony fusion at the osteotomy sites at 3 to 6 months (mean, 4.4 months) after operation. At last follow-up, all the femoral and acetabulum components showed radiographic evidence of bone ingrowth. Osteolysis was observed in Gruen zones 1 and 7 around the femoral prosthesis of 2 cases. There was no case of prosthesis loosening. Conclusion The biological fixation of the femoral stem prosthesis combined with corrective osteotomy can attain satisfactory result for ultimate hip disease combined with proximal femoral deformity in THA.

Citation： YOUZhenjun, SUNJunying, ZHAGuochun, WANGTao, DONGShengjie, JIANGTao. CLINICAL RESULTS OF UNCEMENTED TOTAL HIP ARTHROPLASTY FOR ULTIMATE HIP DISEASE COMBINED WITH PROXIMAL FEMORAL DEFORMITY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(3): 265-269. doi: 10.7507/1002-1892.20150057 Copy

1.	Berry DJ. Total hip arthroplasty in patients with proximal femoral deformity. Clin Orthop Relat Res, 1999, (369):262-272.
2.	Papagelopoulos PJ, Trousdale RT, Lewallen DG. Total hip arthroplasty with femoral osteotomy for proximal femoral deformity. Clin Orthop Relat Res, 1996, (332):151-162.
3.	孙俊英. 人工髋关节翻修手术学. 北京:人民军医出版社, 2012:49-57.
4.	Johnston RC, Fitzgerald RH Jr, Harris WH, et al. Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results. J Bone Joint Surg (Am), 1990, 72(2):161-168.
5.	Engh CA, Glassman AH, Griffin WL, et al. Results of cementless revision for failed cemented total hip arthroplasty. Clin Orthop Relat Res, 1988, (235):91-110.
6.	Masonis JL, Patel JV, Miu A, et al. Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia:5-year follow-up. J Arthroplasty, 2003, 18(3 Suppl 1):68-73.
7.	D'Antonio J, McCarthy JC, Bargar WL, et al. Classification of femoral abnormalities in total hip arthroplasty. Clin Orthop Relat Res, 1993, (296):133-139.
8.	Paprosky WG, Greidanus NV, Antoniou J. Minimum 10-year-results of extensively porous-coated stems in revision hip arthroplasty. Clin Orthop Relat Res, 1999, (369):230-242.
9.	Mardones R, Gonzalez C, Cabanela ME, et al. Extended femoral osteotomy for revision of hip arthroplasty:results and complications. J Arthroplasty, 2005, 20(1):79-83.
10.	Miner TM, Momberger NG, Chong D, et al. The extended trochanteric osteotomy in revision hip arthroplasty:a critical review of 166 cases at mean 3-year, 9-month follow-up. J Arthroplasty, 2001, 16(8 Suppl 1):188-194.
11.	Biant LC, Bruce WJ, Assini JB, et al. Primary total hip arthroplasty in severe developmental dysplasia of the hip. Ten-year results using a cementless modular stem. J Arthroplasty, 2009, 24(1):27-32.
12.	Li X, Sun J, Lin X, et al. Cementless total hip arthroplasty with a double chevron subtrochanteric shortening osteotomy in patients with Crowe type-IV hip dysplasia. Acta Orthop Belg, 2013, 79(3):287-292.
13.	Sun JY, Wei L. Subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty for Crowe type IV adult dislocation of the hip. Orthop Surg, 2009, 1(3):207-211.
14.	Sonohata M, Tajima T, Kitajima M, et al. Total hip arthroplasty combined with double-chevron subtrochanteric osteotomy. J Orthop Sci, 2012,17(4):382-389.
15.	Togrul E, Ozkan C, Kalaci A, et al. A new technique of subtrochanteric shortening in total hip replacement for Crowe type 3 to 4 dysplasia of the hip. J Arthroplasty, 2010, 25(3):465-470.
16.	Sener N, Tözün IR, Aşik M. Femoral shortening and cementless arthroplasty in high congenital dislocation of the hip. J Arthroplasty, 2002,17(1):41-48.
17.	李锋, 田华, 张克, 等. 人工全髋关节置换中合并股骨近端畸形的股骨侧重建. 中国修复重建外科杂志, 2011, 25(10):1188-1191.
18.	Suzuki K, Kawachi S, Matsubara M, et al. Cementless total hip replacement after previous intertrochanteric valgus osteotomy for advanced osteoarthritis. J Bone Joint Surg (Br), 2007, 89(9):1155-1157.
19.	Breusch SJ, Lukoschek M, Thomsen M, et al. Ten-year results of uncemented hip stems for failed intertrochanteric osteotomy. Arch Orthop Trauma Surg, 2005, 125(5):304-309.
20.	Mortazavi SM, Restrepo C, Kim PJ, et al. Cementless femoral reconstruction in patients with proximal femoral deformity. J Arthroplasty, 2011, 26(3):354-359.
21.	Paavilainen T, Hoikka V, Paavolainen P. Cementless total hip arthroplasty for congenitally dislocated or dysplasfic hips. Technique for replacement with a straight femoral component. Clin Orthop Relat Res, 1993, (297):71-81.
22.	何荣新, 王祥华, 严世贵, 等. 转子下截骨短缩全髋关节置换治疗髋关节发育不良. 中华骨科杂志, 2007, 27(3):183-187.

1. Berry DJ. Total hip arthroplasty in patients with proximal femoral deformity. Clin Orthop Relat Res, 1999, (369):262-272.
2. Papagelopoulos PJ, Trousdale RT, Lewallen DG. Total hip arthroplasty with femoral osteotomy for proximal femoral deformity. Clin Orthop Relat Res, 1996, (332):151-162.
3. 孙俊英. 人工髋关节翻修手术学. 北京:人民军医出版社, 2012:49-57.
4. Johnston RC, Fitzgerald RH Jr, Harris WH, et al. Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results. J Bone Joint Surg (Am), 1990, 72(2):161-168.
5. Engh CA, Glassman AH, Griffin WL, et al. Results of cementless revision for failed cemented total hip arthroplasty. Clin Orthop Relat Res, 1988, (235):91-110.
6. Masonis JL, Patel JV, Miu A, et al. Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia:5-year follow-up. J Arthroplasty, 2003, 18(3 Suppl 1):68-73.
7. D'Antonio J, McCarthy JC, Bargar WL, et al. Classification of femoral abnormalities in total hip arthroplasty. Clin Orthop Relat Res, 1993, (296):133-139.
8. Paprosky WG, Greidanus NV, Antoniou J. Minimum 10-year-results of extensively porous-coated stems in revision hip arthroplasty. Clin Orthop Relat Res, 1999, (369):230-242.
9. Mardones R, Gonzalez C, Cabanela ME, et al. Extended femoral osteotomy for revision of hip arthroplasty:results and complications. J Arthroplasty, 2005, 20(1):79-83.
10. Miner TM, Momberger NG, Chong D, et al. The extended trochanteric osteotomy in revision hip arthroplasty:a critical review of 166 cases at mean 3-year, 9-month follow-up. J Arthroplasty, 2001, 16(8 Suppl 1):188-194.
11. Biant LC, Bruce WJ, Assini JB, et al. Primary total hip arthroplasty in severe developmental dysplasia of the hip. Ten-year results using a cementless modular stem. J Arthroplasty, 2009, 24(1):27-32.
12. Li X, Sun J, Lin X, et al. Cementless total hip arthroplasty with a double chevron subtrochanteric shortening osteotomy in patients with Crowe type-IV hip dysplasia. Acta Orthop Belg, 2013, 79(3):287-292.
13. Sun JY, Wei L. Subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty for Crowe type IV adult dislocation of the hip. Orthop Surg, 2009, 1(3):207-211.
14. Sonohata M, Tajima T, Kitajima M, et al. Total hip arthroplasty combined with double-chevron subtrochanteric osteotomy. J Orthop Sci, 2012,17(4):382-389.
15. Togrul E, Ozkan C, Kalaci A, et al. A new technique of subtrochanteric shortening in total hip replacement for Crowe type 3 to 4 dysplasia of the hip. J Arthroplasty, 2010, 25(3):465-470.
16. Sener N, Tözün IR, Aşik M. Femoral shortening and cementless arthroplasty in high congenital dislocation of the hip. J Arthroplasty, 2002,17(1):41-48.
17. 李锋, 田华, 张克, 等. 人工全髋关节置换中合并股骨近端畸形的股骨侧重建. 中国修复重建外科杂志, 2011, 25(10):1188-1191.
18. Suzuki K, Kawachi S, Matsubara M, et al. Cementless total hip replacement after previous intertrochanteric valgus osteotomy for advanced osteoarthritis. J Bone Joint Surg (Br), 2007, 89(9):1155-1157.
19. Breusch SJ, Lukoschek M, Thomsen M, et al. Ten-year results of uncemented hip stems for failed intertrochanteric osteotomy. Arch Orthop Trauma Surg, 2005, 125(5):304-309.
20. Mortazavi SM, Restrepo C, Kim PJ, et al. Cementless femoral reconstruction in patients with proximal femoral deformity. J Arthroplasty, 2011, 26(3):354-359.
21. Paavilainen T, Hoikka V, Paavolainen P. Cementless total hip arthroplasty for congenitally dislocated or dysplasfic hips. Technique for replacement with a straight femoral component. Clin Orthop Relat Res, 1993, (297):71-81.
22. 何荣新, 王祥华, 严世贵, 等. 转子下截骨短缩全髋关节置换治疗髋关节发育不良. 中华骨科杂志, 2007, 27(3):183-187.

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Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL RESULTS OF UNCEMENTED TOTAL HIP ARTHROPLASTY FOR ULTIMATE HIP DISEASE COMBINED WITH PROXIMAL FEMORAL DEFORMITY

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