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Results of Total Hip Arthroplasty Differ in Subtypes of High Dislocation

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

Abstract

Background

In a previous study, we described two subtypes of high dislocation of the hip depending on the presence (C1) or absence (C2) of a false acetabulum, yet we have already presented the concise followup of total hip arthroplasty (THA) in these patients as a group at a minimum of 15 years.

Questions/purposes

In this retrospective study, we investigated differences in the results of THA in the C1 and C2 subtypes of high dislocation such as (1) survivorship of the reconstructions; (2) Merle d’Aubigné-Postel clinical scores; (3) leg lengthening and femoral shortening; and (4) site of reattachment and union rate of the greater trochanter.

Methods

We included 49 hips of the C1 subtype and 30 hips of the C2 subtype operated on from 1976 to 1994. We evaluated survivorship (using reoperation for any reason as the end point) and performed chart and radiographic reviews.

Results

The 15-year survival was 84% (± 10% [95% CI]) for the C1 subtype and 60% (± 17% [95% CI]) for the C2 subtype (p = 0.001). Cox regression analysis, after adjustment for confounding factors, showed also statistically significantly worse survivorship in the C2 subtype (p = 0.021) and, after adjustment for possible predictive factors, found a statistically significant relationship of high dislocation subtype (p = 0.018) and trochanteric union (p = 0.005) with survival of THAs. Pain, function, and mobility scores improved from preoperative to last followup in C1 and C2 groups but they did not differ between C1 and C2 hips. C2 hips were lengthened more (p < 0.001) despite greater amounts of femoral shortening (p = 0.006). Site of reattachment and the risk of greater trochanter nonunion were not different between the groups.

Conclusions

We found important differences in fundamental parameters after THA in the high-dislocation subtypes, including the risk of revision, which was higher in patients whose hips did not have a false acetabulum. These findings indicate that while reporting THA results in patients with high dislocation, mixing results of the two subtypes may lead to statistical bias.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Antonios Galanos MSc, for his contribution to the statistical analysis and Professor S. M. Vratsanos for his kind suggestions regarding the writing style throughout the course of this work.

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Authors and Affiliations

  1. Orthopaedic Department, National and Kapodistrian University of Athens, KAT Hospital, 21 Fotiou Patriarchou Street, 11471, Athens, Greece

    George Hartofilakidis MD

  2. First Orthopaedic Department, University of Athens Medical School, Athens, Greece

    George C. Babis MD, DSC

  3. Third Orthopaedic Department, University of Athens, KAT Hospital, Athens, Greece

    Kalliopi Lampropoulou-Adamidou MD, MSc & John Vlamis MD, DSC

Authors
  1. George Hartofilakidis MD
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  2. George C. Babis MD, DSC
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  3. Kalliopi Lampropoulou-Adamidou MD, MSc
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  4. John Vlamis MD, DSC
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Corresponding author

Correspondence to George Hartofilakidis MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or 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.

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Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

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.

This work was performed at the National and Kapodistrian University of Athens, KAT Hospital, Athens, Greece.

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Hartofilakidis, G., Babis, G.C., Lampropoulou-Adamidou, K. et al. Results of Total Hip Arthroplasty Differ in Subtypes of High Dislocation. Clin Orthop Relat Res 471, 2972–2979 (2013). https://doi.org/10.1007/s11999-013-2983-x

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  • DOI: https://doi.org/10.1007/s11999-013-2983-x

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