Skip to main content
SpringerLink
Log in

Custom Cementless THA in Patients with Skeletal Dysplasia Results in Lower Apparent Revision Rates than Other Types of Femoral Fixation

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Patients with skeletal dysplasia are prone to degenerative hip disease thus requiring THA at a younger age than the general population. This is a technically demanding procedure with high complication and revision rates. Achieving good femoral fixation can be challenging because of the abnormal features of the hip.

Questions/purposes

We therefore determined: (1) survivorship, (2) function, (3) radiographic findings, and (4) complications associated with a cementless custom-made femoral component used in THAs for patients with skeletal dysplasia and compared these parameters with those from other types of femoral fixation.

Patients and Methods

Between 1992 and 2005, 40 THAs were performed in 25 patients with skeletal dysplasia using custom-made cementless femoral components. There were 15 men and 10 women with a mean age of 37.5 years (range, 18–61 years) and a mean height of 145 cm (range, 120–173 cm). Patients were followed clinically and radiographically for a minimum of 4.3 years (mean, 10.1 years; range, 4.3–18.2 years).

Results

The survivorship rates for the femoral and acetabular components were 92% and 70%, respectively, at 220 months. Revision arthroplasty was performed in four of 40 hips (10%). In two, the acetabular component was revised for aseptic loosening, one had both components revised for aseptic loosening, and one had an isolated femoral component revision for deep infection. The mean Harris hip score improved from 41 (range, 27–57) preoperatively to 80 (range, 51–94) at final followup. There were two intraoperative proximal femoral fractures and one dislocation.

Conclusions

When compared with studies with equal followup, custom-made cementless components in THAs for patients with skeletal dysplasia apparently had lower revision and complication rates with comparable function and higher midterm survival.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ain MC, Andres BM, Somel DS, Fiskin Z, Frassica FJ. Total hip arthroplasty in skeletal dysplasias: patient selection, pre-operative planning and operative techniques. J Arthroplasty. 2004;19:1–7.

    Article  PubMed  Google Scholar 

  2. Bargar WL. Shape the implant to the patient: a rationale for the use of custom-fit cementless total hip implants. Clin Orthop Relat Res. 1989;249:73–78.

    PubMed  Google Scholar 

  3. Bobyn JD, Tanzer M, Krygier JJ, Dujovne AR, Brooks CE. Concerns with modularity in total hip arthroplasty. Clin Orthop Relat Res. 1994;298:27–36.

    PubMed  Google Scholar 

  4. Brand RA, Yoder SA, Pedersen DR. Interobserver variability in interpreting radiographic lucencies about total hip reconstructions. Clin Orthop Relat Res. 1985;192:237–239.

    PubMed  Google Scholar 

  5. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement: incidence and a method of classification. J Bone Joint Surg Am. 1973;55:1629–1632.

    PubMed  CAS  Google Scholar 

  6. Brown RR, Monsell F. Understanding the skeletal dysplasias. Curr Orthop. 2003;17:44–55.

    Article  Google Scholar 

  7. Charnley J, Feagin JA. Low-friction arthroplasty in congenital subluxation of the hip. Clin Orthop Relat Res. 1973;91:98–113.

    Article  PubMed  Google Scholar 

  8. Chiavetta JB, Parvizi J, Shaughnessy WJ, Cabanela ME. Total hip arthroplasty in patients with dwarfism. J Bone Joint Surg Am. 2004;86:298–304.

    PubMed  Google Scholar 

  9. Chmell MJ, Rispler D, Poss R. The impact of modularity in total hip arthroplasty. Clin Orthop Relat Res. 1995;319:77–84.

    PubMed  Google Scholar 

  10. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am. 1979; 61:15–23.

    PubMed  CAS  Google Scholar 

  11. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.

    PubMed  Google Scholar 

  12. De Man FH, Haverkamp D, Van der Vis HM, Besselaar PP, Marti RK. Small stem total hip arthroplasty in hypoplasia of the femur. Clin Orthop Relat Res. 2008;466:1429–1437.

    Article  PubMed  Google Scholar 

  13. DiFazio F, Shon WY, Salvati EA, Wilson PD Jr. Long-term results of total hip arthroplasty with a cemented custom-designed swan-neck femoral component for congenital dislocation or severe dysplasia: a follow-up note. J Bone Joint Surg Am. 2002;84:204–207.

    PubMed  Google Scholar 

  14. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement: the factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987;69:45–55.

    PubMed  CAS  Google Scholar 

  15. Erdemli B, Yilmaz C, Atalar H, Guzel B, Cetin I. Total hip arthroplasty in developmental high dislocation of the hip. J Arthroplasty. 2005;20:1021–1028.

    Article  PubMed  Google Scholar 

  16. Flecher X, Parratte S, Aubaniac JM, Argenson JN. Three-dimensional custom-designed cementless femoral stem for osteoarthritis secondary to congenital dislocation of the hip. J Bone Joint Surg Br. 2007;89:1586–1591.

    PubMed  CAS  Google Scholar 

  17. Gruen TA, McNeice GM, Amstutz HG. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.

    PubMed  Google Scholar 

  18. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mould arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.

    PubMed  CAS  Google Scholar 

  19. Helenius I, Remes V, Tallroth K, Peltonen J, Poussa M, Paavilainen T. Total hip arthroplasty in diastrophic dysplasia. J Bone Joint Surg Am. 2003;85:441–447.

    PubMed  Google Scholar 

  20. Hoppenfeld S, de Boer P, Buckley R. Approaches to the hip. Surgical Exposures in Orthopaedics: The Anatomic Approach. Ed 3. Philadelphia, PA: Lippincott Williams & Wilkins; 2003:365–453.

  21. Hua J, Walker PS. Closeness of fit of uncemented stems improves the strain distribution in the femur. J Orthop Res. 1995;13:339–346.

    Article  PubMed  CAS  Google Scholar 

  22. Hua J, Walker PS, Muirhead-Alwood W, Bentley G, McCullough CJ. The rationale for CAD-CAM uncemented custom-hips: an interim assessment. Hip Int. 1995;5:52–62.

    Google Scholar 

  23. Huo MH, Salvati EA, Lieberman JR, Burstein AH, Wilson PD Jr. Custom-designed femoral prostheses in total hip arthroplasty done with cement for severe dysplasia of the hip. J Bone Joint Surg Am. 1993;75:1497–1504.

    PubMed  CAS  Google Scholar 

  24. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481.

    Article  Google Scholar 

  25. Lim SJ, Park YS, Moon YW, Jung SM, Ha HC, Seo JG. Modular cementless total hip arthroplasty for multiple epiphyseal dysplasia. J Arthroplasty. 2009;24:77–82.

    Article  PubMed  Google Scholar 

  26. Manaster BJ. From the RSNA refresher courses. Total hip arthroplasty: radiographic evaluation. Radiographics. 1996;16:645–660.

    PubMed  CAS  Google Scholar 

  27. Mulroy WF, Estok DM, Harris WH. Total hip arthroplasty with use of so-called second-generation cementing techniques: a fifteen-year average follow-up study. J Bone Joint Surg Am. 1995;77:1845–1852.

    PubMed  CAS  Google Scholar 

  28. Onodera S, Majima T, Ito H, Matsuno T, Kishimoto T, Minami A. Cementless total hip arthroplasty using the modular S-ROM prosthesis combined with corrective proximal femoral osteotomy. J Arthroplasty. 2006;21:664–669.

    Article  PubMed  Google Scholar 

  29. Peltonen JI, Hoikka V, Poussa M, Paavilainen T, Kaitila I. Cementless hip arthroplasty in diastrophic dysplasia. J Arthroplasty. 1992;7(suppl):369–376.

    Article  PubMed  Google Scholar 

  30. Ranawat CS, Dorr LD, Inglis AE. Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. J Bone Joint Surg Am. 1980;62:1059–1065.

    PubMed  CAS  Google Scholar 

  31. Sekundiak TD. Total hip arthroplasty in patients with dwarfism. Orthopedics. 2005;28(9 suppl):s1075–1078.

    PubMed  Google Scholar 

  32. Sheridan BD, Gargan MF, Monsell FP (2009) The hip in osteochondrodysplasias: general rules for diagnosis and treatment. Hip Int 19(suppl 6):S26–34.

    PubMed  Google Scholar 

  33. Umarji SI, Lee MB, Gargan MF, Portinaro NM, Learmonth ID. Total hip arthroplasty in skeletal dysplasia. Hip Int. 2003;13:177–183.

    Google Scholar 

  34. Wirtz DC, Birnbaum K, Siebert CH, Heller KD. Bilateral total hip replacement in pseudoachondroplasia. Acta Orthop Belg. 2000;66:405–408.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We acknowledge Professor P. S. Walker from the Biomedical Engineering Department of University College London for his pioneering work on developing CAD-CAM custom-made orthopaedic implants. We also acknowledge the contribution of Professor G. Bentley, Stanmore Implants Worldwide Ltd, and Professor G. W. Blunn and Dr J. Hua from the Institute of Orthopaedics & Musculoskeletal Science, University College London.

Author information

Authors and Affiliations

  1. Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK

    Mathew D. Sewell BSc (Hons), MRCS (Eng), Sammy A. Hanna MRCS (Eng), Sarah K. Muirhead-Allwood BSc, FRCS, Stephen R. Cannon MA, MCh (Orth), FRCS & Timothy W. R. Briggs MD (Res), MCh (Orth), FRCS

Authors
  1. Mathew D. Sewell BSc (Hons), MRCS (Eng)
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sammy A. Hanna MRCS (Eng)
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sarah K. Muirhead-Allwood BSc, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephen R. Cannon MA, MCh (Orth), FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Timothy W. R. Briggs MD (Res), MCh (Orth), FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mathew D. Sewell BSc (Hons), MRCS (Eng).

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

About this article

Cite this article

Sewell, M.D., Hanna, S.A., Muirhead-Allwood, S.K. et al. Custom Cementless THA in Patients with Skeletal Dysplasia Results in Lower Apparent Revision Rates than Other Types of Femoral Fixation. Clin Orthop Relat Res 469, 1406–1412 (2011). https://doi.org/10.1007/s11999-010-1656-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-010-1656-2

Keywords

Search

Navigation