Abstract
There are several pathological conditions in children, such as Legg-Calvé-Perthes disease, slipped capital femoral epiphysis, and femoral head avascular necrosis, which can progress to disabling hip joint destruction. These children undergo surgeries, such as hip arthrodesis, in an attempt to postpone hip replacement so that it can be done at an older age. Unfortunately, hip arthrodesis significantly limits their ability to actively engage in activities that require full hip mobility. For these children, active participation in games and sports activities remains an important factor for their physical development and mental health. On the contrary, hip arthroplasty can ensure a pain-free, unrestricted range of hip movement, but are doubts as to its viability over time, especially in young people who exhibit intense activity. We report successful hip replacement in two children, fourteen years of age and younger, with femoral head collapse and disabling joint degeneration due to avascular necrosis of the femoral head, whom the hip replacement was considered the only surgical treatment ensuring a painless hip joint. For the clinical assessment of these two hips, we used the online Harris hip score, preoperatively and postoperatively. No intraoperative or early postoperative complications occurred. Follow-up was conducted at six weeks, six months, and then at an annual clinical and radiological evaluation. At the final seven-year follow-up, these two children had greatly improved their function hip score considerably. Hip arthroplasty can ensure a pain-free, unrestricted range of hip movement in young children when their hip joint is severely affected.
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References
Spencer JD, Brookes M. Avascular necrosis and the blood supply of the femoral head. Clin Orthop Relat Res. 1988;235:127–40.
Shah KN, Racine J, Jones LC, Aaron RK. Pathophysiology and risk factors for osteonecrosis. Curr Rev Musculoskelet Med. 2015;8(3):201–9.
James J, Steijn-Myagkaya GL. Death of osteocytes. Electron microscopy after in vitro ischemia. J Bone Joint Surg (Br). 1986;68(4):620–4.
Roaten J, Spence DD. Complications related to the treatment of slipped capital femoral epiphysis. Orthop Clin North Am. 2016;47(2):405–13.
Loder RT. What is the cause of avascular necrosis in unstable slipped capital femoral epiphysis and what can be done to lower the rate? J Pediatr Orthop. 2013;33(Suppl 1):S88–91.
Maillefert JF, Tavernier C, Toubeau M, Brunotte F. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1996;78(3):473–4.
Pajaczkowski JA. The stubborn hip: idiopathic avascular necrosis of the hip. J Manipulative Physiol Ther. 2003;26(2):A2–5.
Marker DR, Seyler TM, Ulrich SD, Srivastava S, Mont MA. Do modern techniques improve core decompression outcomes for hip osteonecrosis? Clin Orthop Relat Res. 2008;466:1093–103.
Mont MA, Ragland PS, Etienne G. Core decompression of the femoral head for osteonecrosis using percutaneous multiple small-diameter drilling. Clin Orthop Relat Res. 2004;429:131–8.
Hernigou P, Manicom O, Poignard A, Nogier A, Filippini P, De Abreu L. Core decompression with marrow stem cells. Oper Tech Orthop. 2004;14:68–74.
Al OA. Multiple drilling compared with standard core decompression for avascular necrosis of the femoral head in sickle cell disease patients. Arch Orthop Trauma Surg. 2013;133:609–13.
Song WS, Yoo JJ, Kim YM, Kim HJ. Results of multiple drilling compared with those of conventional methods of core decompression. Clin Orthop Relat Res. 2007;454:139–46.
Soohoo NF, Vyas S, Manunga J, Sharifi H, Kominski G, Lieberman JR. Cost-effectiveness analysis of core decompression. J Arthroplasty. 2006;21:670–81.
Issa K, Pivec R, Kapadia BH, Banerjee S, Mont MA. Osteonecrosis of the femoral head: the total hip replacement solution. Bone Joint J. 2013;95-B:46–50.
Kawasaki M, Hasegawa Y, Sakano S, Masui T, Ishiguro N. Total hip arthroplasty after failed transtrochanteric rotational osteotomy for avascular necrosis of the femoral head. J Arthroplasty. 2005;20:574–9.
Adili A, Trousdale RT. Femoral head resurfacing for the treatment of osteonecrosis in the young patient. Clin Orthop Relat Res. 2003;417:93–101.
Rackwitz L, Eden L, Reppenhagen S, Reichert JC, Jakob F, Walles H, et al. Stem cell- and growth factor-based regenerative therapies for avascular necrosis of the femoral head. Stem Cell Res Ther. 2012;3:7.
Yan Z, Hang D, Guo C, Chen Z. Fate of mesenchymal stem cells transplanted to osteonecrosis of femoral head. J Orthop Res. 2009;27:442–6.
Gangji V, Toungouz M, Hauzeur JP. Stem cell therapy for osteonecrosis of the femoral head. Expert Opin Biol Ther. 2005;5:437–42.
Hernigou P, Poignard A, Manicom O, Mathieu G, Rouard H. The use of percutaneous autologous bone marrow transplantation in nonunion and avascular necrosis of bone. J Bone Joint Surg Br. 2005;87:896–902.
Keizer SB, Kock NB, Dijkstra PD, Taminiau AH, Nelissen RG. Treatment of avascular necrosis of the hip by a non-vascularised cortical graft. J Bone Joint Surg Br. 2006;88:460–6.
Plakseychuk AY, Kim SY, Park BC, Varitimidis SE, Rubash HE, Sotereanos DG. Vascularized compared with nonvascularized fibular grafting for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg Am. 2003;85–B:589–96.
Matsusaki H, Noguchi M, Kawakami T, Tani T. Use of vascularized pedicle iliac bone graft combined with transtrochanteric rotational osteotomy in the treatment of avascular necrosis of the femoral head. Arch Orthop Trauma Surg. 2005;125:95–101.
Lee CK, Rehmatullah N. Muscle-pedicle bone graft and cancellous bone graft for the “silent hip” of idiopathic ischemic necrosis of the femoral head in adults. Clin Orthop Relat Res. 1981;158:185–94.
Baksi DP. Treatment of osteonecrosis of the femoral head by drilling and muscle-pedicle bone grafting. J Bone Joint Surg Br. 1991;73:241–5.
Hasegawa Y, Sakano S, Iwase T, Iwasada S, Torii S, Iwata H. Pedicle bone grafting versus transtrochanteric rotational osteotomy for avascular necrosis of the femoral head. J Bone Joint Surg Br. 2003;85:191–8.
Ito H, Tanino H, Yamanaka Y, Nakamura T, Takahashi D, Minami A, et al. Long term results of conventional varus half-wedge proximal femoral osteotomy for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg Br. 2012;94:308–14.
Sugioka Y, Katsuki I, Hotokebuchi T. Transtrochanteric rotational osteotomy of the femoral head for the treatment of osteonecrosis Followup statistics. Clin Orthop Relat Res. 1982;169:115–26.
Sugioka Y. Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip: a new osteotomy operation. Clin Orthop Relat Res. 1978;130:191–201.
Zhao G, Yamamoto T, Ikemura S, Motomura G, Mawatari T, Nakashima Y, et al. Radiological outcome analysis of transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head at a mean follow-up of 12.4 years. J Bone Joint Surg Br. 2010;92:781–6.
Sakano S, Hasegawa Y, Torii Y, Kawasaki M, Ishiguro N. Curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Br. 2002;84:817–24.
Beaulé PE, Matta JM, Mast JW. Hip arthrodesis: current indications and techniques. J Am Acad Orthop Surg. 2002;10(4):249–58.
Sirikonda SP, Beardmore SP, Hodgkinson JP. Role of hip arthrodesis in current practice: long term results following conversion to total hip arthroplasty. Hip Int. 2008;18(4):263–71.
Sedrakyan A, Romero L, Graves S, Davidson D, de Steiger R, Lewis P, et al. Survivorship of hip and knee implants in pediatric and young adult populations: analysis of registry and published data. J Bone Joint Surg. 2014;96(Supplement_1):73–8.
Lachiewicz PF, McCaskill B, Inglis A, Ranawat CS, Rosenstein BD. Total hip arthroplasty in juvenile rheumatoid arthritis. Two to eleven-year results. J Bone Joint Surg [Am]. 1986;68–B:502–8.
Wangen H, Lereim P, Holm I, Gunderson R, Reikeras O. Hip arthroplasty in patients younger than 30 years: excellent ten to 16-year follow-up results with an HA-coated stem. Int Orthop. 2008;32:203–8.
Sedrakyan A, Romero L, Graves S, et al. Survivorship of hip and knee implants in pediatric and young adult populations: analysis of registry and published data. J Bone Joint Surg [Am]. 2014;96:73–8.
Makarewich CA, Anderson MB, Gililand JM, Pelt CE, Peters CL. Ten-year survivorship of primary total hip arthroplasty in patients 30 years of age and younger. Bone Joint. 2018;100–B(7):867–74.
Metcalfe D, Peterson N, Wilkinson JM, Perry DC. Temporal trends and survivorship of total hip arthroplasty in very young patients: a study using the National Joint Registry data set. Bone Joint J. 2018;100–B(10):1320–9.
Merola M, Affatato S. Materials for hip prostheses: a review of wear and loading considerations. Materials. 2019;12(3):495.
Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370:1508–19.
Sabah SA, Henckel J, Cook E, Whittaker R, Hothi H, Pappas Y, … Hart AJ. Validation of primary metal-on-metal hip arthroplasties on the National Joint Registry for England, Wales, and Northern Ireland using data from the London Implant Retrieval Centre. Bone Joint J. 2015;97-B(1):10–18.
Smith AJ, Dieppe P, Porter M, Blom AW. National Joint Registry of England and Wales. Risk of cancer in first seven years after metal-on-metal hip replacement compared with other bearings and general population: linkage study between the National Joint Registry of England and Wales and hospital episode statistics. BMJ. 2012;344:e2383.
Finkbone PR, Severson EP, Cabanela ME, Trousdale RT. Ceramic-on-ceramic total hip arthroplasty in patients younger than 20 years. J Arthroplasty. 2012;27:213–9.
Kim YH, Choi Y, Kim JS. Cementless total hip arthroplasty with ceramic-on-ceramic bearing in patients younger than 45 years with femoral-head osteonecrosis. Int Orthop. 2009;34(8):1123–7.
Byun JW, Yoon TR, Park KS, Seon JK. Third-generation ceramic-on-ceramic total hip arthroplasty in patients younger than 30 years with osteonecrosis of femoral head. J Arthroplasty. 2012;27(7):1337–43.
Zivic F, Affatato S, Trajanovic M, Schnabelrauch M, Grujovic N. Biomaterials in clinical practice: advances in clinical research and medical devices. Berlin: Springer; 2018.
Affatato S, Jaber SA, Taddei P. Ceramics for hip joint replacement. In: Zivic F, ed. Biomaterials in Clinical Practice. Berlin: Springer; 2017.
Lee J-M. The Current Concepts of Total Hip Arthroplasty. Hip Pelvis. 2016;28:191–200.
Wroblewski BM, Purbach B, Siney PD, Fleming PA. Charnley low-friction arthroplasty in teenage patients: the ultimate challenge. J Bone Joint Surg [Br]. 2010;92–B:486–8.
Tsukanaka M, Halvorsen V, Nordsletten L, et al. Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old. Acta Orthop. 2016;87:479–84.
Singsen BH, Isaacson AS, Bernstein BH, et al. Total hip replacement in children with arthritis. Arthr Rheum. 1978;21:401–6.
Dudkiewicz I, Salai M, Chechik A, Ganel A. Total hip arthroplasty after childhood septic hip in patients younger than 25 years of age. J Ped Orthop. 2000;20:585–7.
Finkbone PR, Severson EP, Cabanela ME, Trousdale RT. Ceramic-on-ceramic total hip arthroplasty in patients younger than 20 years. J Arthroplasty. 2012;27:213–9.
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Corresponding author. Surname: Megremis. First Name: Panos
Contribution: surgical technique, study design, performed measurements, manuscript preparation, photo editing
Co-author. Surname: Megremis. First Name: Orestis
Contribution: study design, manuscript preparation, photo editing
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Megremis, P., Megremis, O. Hip Replacement in Children with Femoral Head Collapse and Hip Joint Degeneration—Two Case Reports. SN Compr. Clin. Med. 4, 86 (2022). https://doi.org/10.1007/s42399-022-01166-5
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DOI: https://doi.org/10.1007/s42399-022-01166-5