Abstract
Background
Total hip replacement in developmental dysplasia of the hip is a demanding procedure and usually requires dedicated devices and special surgical techniques. Nevertheless, the described techniques have shown variable outcomes. The aim of this study was to assess the 11-year outcomes of an off-the-shelf modular neck prosthesis in dysplastic patients and to evaluate the ability of the modular neck system to adequately restore femoral offset, abductor muscles lever arm and leg length.
Methods
We retrospectively evaluated 61 modular neck prostheses implanted in 47 patients between June 1995 and March 2004. The preoperative diagnosis was developmental dysplasia of the hip in all cases. The clinical outcomes were assessed using the Harris hip score and the Western Ontario and McMaster Universities score. The femoral offset, abductor muscles lever arm, height and medialization of the hip center of rotation, and differences in leg length were evaluated on postoperative radiographs. Prosthesis survival was calculated according to the Kaplan-Meier method considering any reason for revision as failure. The average follow-up was 117.2 months (range 57–162 months).
Results
The cumulative survival at 11 years was 97.5%. One prosthesis failed 5 years after surgery because of a ceramic liner fracture due to an inappropriate obstetric maneuver during labour. At the latest follow-up the mean Harris hip score was 74.7 (range 23–91). Leg length discrepancy was avoided in the majority of cases; femoral offset was almost always restored.
Conclusions
The results of this series support the use of modular neck prostheses as an effective alternative in the treatment of developmental dysplasia of the hip. The modularity was very efficient in restoring offset, leg length and maintaining stability with a good mid-long-term follow-up. Unlike other proposed surgical techniques, these good results are achievable by a standard surgical technique and with an off-the-shelf prosthesis.
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References
Noble PC, Kamaric E, Sugano N, Matsubara M, Harada Y, Ohzono K, Paravic V. Three-dimensional shape of the dysplastic femur: implications for THR. Clin Orthop Relat Res. 2003;417:27–40.
Argenson JN, Flecher X, Parratte S, Aubaniac JM. Anatomy of the dysplastic hip and consequences for total hip arthroplasty. Clin Orthop Relat Res. 2007;465:40–5.
Thillemann TM, Pedersen AB, Johnsen SP, Soballe K. Implant survival after primary total hip arthroplasty due to childhood hip disorders: results from the Danish Hip Arthroplasty Registry. Acta Orthop. 2008;79:769–76.
Biant LC, Bruce WJ, Assini JB, Walker PM, Walsh WR. Primary total hip arthroplasty in severe developmental dysplasia of the hip. Ten-year results using a cementless modular stem. J Arthroplasty. 2009;24:27–32.
Cameron HU. Modified cups. Orthop Clin North Am. 1998;29:277–95.
Sakai T, Sugano N, Ohzono K, Lee SB, Nishii T. The custom femoral component is an effective option for congenital hip dysplasia. Clin Orthop Relat Res. 2006;451:146–53.
Shinar AA, Harris WH. Bulk structural autogenous grafts and allografts for reconstruction of the acetabulum in total hip arthroplasty. Sixteen-year-average follow-up. J Bone Joint Surg Am. 1997;79:159–68.
Bernasek TL, Haidukewych GJ, Gustke KA, Hill O, Levering M. Total hip arthroplasty requiring subtrochanteric osteotomy for developmental hip dysplasia: 5- to 14-year results. J Arthroplasty. 2007;22:145–50.
Erdemli B, Yilmaz C, Atalar H, Guzel B, Cetin I. Total hip arthroplasty in developmental high dislocation of the hip. J Arthroplasty. 2005;20:1021–8.
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.
Park MS, Kim KH, Jeong WC. Transverse subtrochanteric shortening osteotomy in primary total hip arthroplasty for patients with severe hip developmental dysplasia. J Arthroplasty. 2007;22:1031–6.
Zadeh HG, Hua J, Walker PS, Muirhead-Allwood SK. Uncemented total hip arthroplasty with subtrochanteric derotational osteotomy for severe femoral anteversion. J Arthroplasty. 1999;14:682–8.
Sakai T, Sugano N, Ohzono K, Nishii T, Haraguchi K, Yoshikawa H. Femoral anteversion, femoral offset, and abductor lever arm after total hip arthroplasty using a modular femoral neck system. J Orthop Sci. 2002;7:62–7.
Traina F, De Fine M, Biondi F, Tassinari E, Galvani A, Toni A. The influence of the centre of rotation on implant survival using a modular stem hip prosthesis. Int Orthop. 2009;33:1513–8.
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.
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.
Engh CA, Bobyn JD. The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. Clin Orthop Relat Res. 1988;7–28.
Viceconti M, Baleani M, Squarzoni S, Toni A. Fretting wear in a modular neck hip prosthesis. J Biomed Mater Res. 1997;35:207–16.
Traina F, Baleani M, Viceconti M, Toni A. Modular neck primary prosthesis: experimental and clinical outcomes. In: Scientific Exhibit at the 71st AAOS Annual Meeting. San Francisco; 2004.
Toni A, Traina F, Stea S, Sudanese A, Visentin M, Bordini B, et al. Early diagnosis of ceramic liner fracture. Guidelines based on a twelve-year clinical experience. J Bone Joint Surg Am. 2006;88(Suppl 4):55–63.
Korovessis P, Petsinis G, Repanti M, Repantis T. Metallosis after contemporary metal-on-metal total hip arthroplasty. Five to nine-year follow-up. J Bone Joint Surg Am. 2006;88:1183–91.
Park YS, Moon YW, Lim SJ, Yang JM, Ahn G, Choi YL. Early osteolysis following second-generation metal-on-metal hip replacement. J Bone Joint Surg Am. 2005;87:1515–21.
Hannouche D, Hamadouche M, Nizard R, Bizot P, Meunier A, Sedel L. Ceramics in total hip replacement. Clin Orthop Relat Res. 2005;430:62–71.
McGrory BJ, Morrey BF, Cahalan TD, An KN, Cabanela ME. Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty. J Bone Joint Surg Br. 1995;77:865–9.
Sakalkale DP, Sharkey PF, Eng K, Hozack WJ, Rothman RH. Effect of femoral component offset on polyethylene wear in total hip arthroplasty. Clin Orthop Relat Res. 2001;125–34.
Dolhain P, Tsigaras H, Bourne RB, Rorabeck CH, Mac Donald S, Mc Calden R. The effectiveness of dual offset stems in restoring offset during total hip replacement. Acta Orthop Belg. 2002;68:490–9.
Massin P, Geais L, Astoin E, Simondi M, Lavaste F. The anatomic basis for the concept of lateralized femoral stems: a frontal plane radiographic study of the proximal femur. J Arthroplasty. 2000;15:93–101.
Traina F, De Clerico M, Biondi F, Pilla F, Tassinari E, Toni A. Sex differences in hip morphology: is stem modularity effective for total hip replacement? J Bone Joint Surg Am. 2009;91(Suppl 6):121–8.
Atwood SA, Patten EW, Bozic KJ, Pruitt LA, Ries MD. Corrosion-induced fracture of a double-modular hip prosthesis: a case report. J Bone Joint Surg Am. 2010;92:1522–5.
Wright G, Sporer S, Urban R, Jacobs J. Fracture of a modular femoral neck after total hip arthroplasty: a case report. J Bone Joint Surg Am. 2010;92:1518–21.
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All authors declare that no grants, funds or benefits of any kind were received in support of the study.
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Traina, F., De Fine, M., Tassinari, E. et al. Modular neck prostheses in DDH patients: 11-year results. J Orthop Sci 16, 14–20 (2011). https://doi.org/10.1007/s00776-010-0018-y
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DOI: https://doi.org/10.1007/s00776-010-0018-y