Abstract
Introduction
Due to complex anatomical considerations, results of cementless-stem total hip arthroplasty (THA) in hip fusion remain controversial compared with conventional THA. We therefore aimed to analyse 3D anatomy of the fused hip based on pre-operative computed tomography (CT) scans, functional outcomes based on the Harris Hip Score (HHS) and the Hip Disability and Osteoarthritis Outcome Score (HOOS), modifications of hip anatomy based on post-operative standardised radiography, and determine complication rate and long-term survival based on Kaplan–Meier analysis.
Methods
We retrospectively studied 23 hips that underwent conversion of a fused hip to THA using a 3D CT scan-based custom titanium (Ti alloy hypoxyapetite (HA)-coated stem. The mean follow-up was 15 (9–22) years. Femur anteversion ranged from −29° to 80°.
Results
HHS improved from 59 to 89 points and average range of motion (ROM) was 88° for flexion. Back pain decreased in 62%, and knee pain decreased in 42%. The mean post-operative leg-length discrepancy was 7.8 mm. No intra-operative complications occurred. One aseptic stem loosening for mechanical failure was observed. The Kaplan–Meier survivorship considering revision for any reasons as the end point was 95.6% [95% confidence interval (CI) 92.4–98.8] at 15 years.
Conclusion
Custom cementless stems may be an interesting solution to address the particular anatomical features of hip fusion at the time of THA, with an excellent survival rate at 15 years.
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References
Jain S, Giannoudis PV (2013) Arthrodesis of the hip and conversion to total hip arthroplasty: a systematic review. J Arthroplast 28:1596–1602. https://doi.org/10.1016/j.arth.2013.01.025
Joshi AB, Markovic L, Hardinge K, Murphy JCM (2002) Conversion of a fused hip to total hip arthroplasty. J Bone Joint Surg Am 84-A:1335–1341
Lustig S, Vaz G, Guyen O, Tayot O, Chavane H, Bejui-Hugues J et al (2007) Total hip arthroplasty after hip arthrodesis performed for septic arthritis. Rev Chir Orthop Reparatrice Appar Mot 93:828–835
Kilgus DJ, Amstutz HC, Wolgin MA, Dorey FJ (1990) Joint replacement for ankylosed hips. J Bone Joint Surg Am 72:45–54
Fernandez-Fairen M, Murcia-Mazón A, Torres A, Querales V, Murcia A (2011) Is total hip arthroplasty after hip arthrodesis as good as primary arthroplasty? Clin Orthop Relat Res 469:1971–1983. https://doi.org/10.1007/s11999-010-1704-y
Richards CJ, Duncan CP (2011) Conversion of hip arthrodesis to total hip arthroplasty: survivorship and clinical outcome. J Arthroplast 26:409–413. https://doi.org/10.1016/j.arth.2010.02.005
Kreder HJ, Williams JI, Jaglal S, Axcell T, Stephen (1999) A population study in the province of Ontario of the complications after conversion of hip or knee arthrodesis to total joint replacement. Can J Surg 42:433–439
Strathy GM, Fitzgerald RH (1988) Total hip arthroplasty in the ankylosed hip. A ten-year follow-up. J Bone Joint Surg Am 70:963–966
Schuh A, Zeiler G, Werber S (2005) Results and experiences of conversion of hip arthrodesis. Orthopade 34:218, 220–4. https://doi.org/10.1007/s00132-004-0723-3
Morsi E (2007) Total hip arthroplasty for fused hips; planning and techniques. J Arthroplast 22:871–875. https://doi.org/10.1016/j.arth.2006.09.003
Reikerås O, Bjerkreim I, Gundersson R (1995) Total hip arthroplasty for arthrodesed hips. 5- to 13-year results. J Arthroplast 10:529–531
Hamadouche M, Kerboull L, Meunier A, Courpied JP, Kerboull M (2001) Total hip arthroplasty for the treatment of ankylosed hips : a five to twenty-one-year follow-up study. J Bone Joint Surg Am 83-A:992–998
Flecher X, Pearce O, Parratte S, Aubaniac J-M, Argenson J-N (2010) Custom cementless stem improves hip function in young patients at 15-year followup. Clin Orthop Relat Res 468:747–755. https://doi.org/10.1007/s11999-009-1045-x
Flecher X, Parratte S, Aubaniac J-M, Argenson J-N (2007) Three-dimensional custom-designed cementless femoral stem for osteoarthritis secondary to congenital dislocation of the hip. J Bone Joint Surg (Br) 89:1586–1591. https://doi.org/10.1302/0301-620X.89B12.19252
Flecher X, Parratte S, Aubaniac JM, Argenson JN (2007) Cementless total hip arthroplasty using custom stem and reinforcement ring in hip osteoarthritis following developmental dysplasia. Hip Int 17(Suppl 5):S120–S127
Amstutz HC, Sakai DN (1975) Total joint replacement for ankylosed hips. Indications, technique, and preliminary results. J Bone Joint Surg Am 57:619–625
Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51:737–755
Nilsdotter AK, Lohmander LS, Klässbo M, Roos EM (2003) Hip disability and osteoarthritis outcome score (HOOS)--validity and responsiveness in total hip replacement. BMC Musculoskelet Disord 4:10. https://doi.org/10.1186/1471-2474-4-10
Postel M, Courpied JP (1986) Replacement of a failed total hip prosthesis. Rev Rhum Mal Osteoartic 53:133–135
Gruen TA, McNeice GM, Amstutz HC (1979) “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 141:17–27
Engh CA, Massin P, Suthers KE (1990) Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res 257:107–28.
Brooker AF, Bowerman JW, Robinson RA, Riley LH (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 55:1629–1632
Bland JM, Altman DG (1998) Survival probabilities (the Kaplan-Meier method). BMJ 317:1572
Hardinge K, Murphy JC, Frenyo S (1986) Conversion of hip fusion to Charnley low-friction arthroplasty. Clin Orthop Relat Res 211:173–9.
Rajaratnam SS, Sexton SA, Waters TS, Walter WL, Zicat BA, Walter WK (2009) Long term results of cementless total hip replacement for reversal of hip ankylosis. Hip Int 19:120–127
Peterson ED, Nemanich JP, Altenburg A, Cabanela ME (2009) Hip arthroplasty after previous arthrodesis. Clin Orthop Relat Res 467:2880–2885. https://doi.org/10.1007/s11999-009-1027-z
Kim Y-H, Oh S-H, Kim J-S, Lee S-H (2003) Total hip arthroplasty for the treatment of osseous ankylosed hips. Clin Orthop Relat Res 414:136-48 doi:https://doi.org/10.1097/01.blo.0000081935.75404.7f
Rittmeister M, Starker M, Zichner L (2000) Hip and knee replacement after longstanding hip arthrodesis. Clin Orthop Relat Res:136–145
Sirikonda SP, Beardmore SP, Hodgkinson JP (2008) Role of hip arthrodesis in current practice: long term results following conversion to total hip arthroplasty. Hip Int 18:263–271
Schäfer D, Dick W, Morscher E (2000) Total hip arthroplasty after arthrodesis of the hip joint. Arch Orthop Trauma Surg 120:176–178
Villanueva M, Sobrón FB, Parra J, Rojo JM, Chana F, Vaquero J (2013) Conversion of arthrodesis to Total hip arthroplasty: clinical outcome, complications, and prognostic factors of 21 consecutive cases. HSS J 9:138–144. https://doi.org/10.1007/s11420-013-9330-3
Jauregui JJ, Kim JK, Shield WP 3rd, Harb M, Illical EM, Adib F, Maheshwari AV (2017) Hip fusion takedown to a total hip arthroplasty-is it worth it? A systematic review. Int Orthop 41:1535–1542. https://doi.org/10.1007/s00264-017-3436-z
Besser MI (1982) A muscle transfer to replace absent abductors in the conversion of a fused hip to a total hip arthroplasty. Clin Orthop Relat Res 162:173–4
Sochart DH, Porter ML (1997) Long-term results of total hip replacement in young patients who had ankylosing spondylitis. Eighteen to thirty-year results with survivorship analysis. J Bone Joint Surg Am 79:1181–1189
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Jean-Noel Argenson is educational consultant for Symbios.
All of the other authors have nothing to disclose regarding the present manuscript.
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Flecher, X., Ollivier, M., Maman, P. et al. Long-term results of custom cementless-stem total hip arthroplasty performed in hip fusion. International Orthopaedics (SICOT) 42, 1259–1264 (2018). https://doi.org/10.1007/s00264-018-3762-9
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DOI: https://doi.org/10.1007/s00264-018-3762-9