ObjectiveTo evaluate the clinical results of uncemented total hip arthroplasty (THA) for ultimate hip disease combined with proximal femoral deformity. MethodsBetween 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. ResultsHealing 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. ConclusionThe 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.
ObjectiveTo analyze the mid-and long-term effectiveness of the 3rd-generation ceramic-on-ceramic (CoC) total hip arthroplasty (THA) in the younger patients. MethodsA retrospective analysis was made on the clinical data of 68 younger patients (73 hips) who accepted the 3rd-generation CoC THA between March 2001 and May 2009. Of 68 cases, 39 was male and 29 was female with the average age of 38.6 years (range, 18-50 years); there were 15 cases (15 hips) of osteonecrosis of the femoral head, 9 cases (9 hips) congenital dysplasia of the hip, 5 cases (8 hips) of ankylosing spondylitis, 10 cases (10 hips) of osteoarthritis of the hip joint, 12 cases (12 hips) of traumatic hip arthritis, 12 cases (12 hips) of femoral neck fracture, 4 cases (6 hips) of rheumatoid hip arthritis, and 1 case (1 hip) of tumor of the femoral neck. The Harris score and University of California Los Angeles (UCLA) score were used to evaluate the hip joint function and activity level respectively. The visual analogue scale (VAS) was used to assess postoperative thigh pain. Radiological signs of osteolysis, loosening, and alumina ceramic related complications were evaluated continuously. And the KaplanMeier survival analysis was used to assess the prosthesis survival. ResultsThe average duration of follow-up was 9.7 years (range, 6-14 years). Sandwich ceramic liners fracture was observed in 3 cases (3 hips), and revision was performed; 1 case had "squeaking" hip because of physical activity. At last follow-up, Harris score and UCLA score were significantly improved when compared with preoperative scores (P<0.05). Bony healing was obtained in all patients, without osteolysis, loosening, and thigh pain. The VAS score was 0. The 5-year and 10-year cumulative survival rates for ceramic fracture revision were 98.6% and 95.9%, and the 5-year and 10-year cumulative survival rates for osteolysis and loosening revision both were 100%. ConclusionThe 3rd-generation CoC prosthesis offer an excellent option for younger patients in THA and the mid-and long-term effectiveness are satisfactory.