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Durable Fixation Achieved With Medialized, High Hip Center Cementless THAs for Crowe II and III Dysplasia

Clinical Orthopaedics and Related Research® volume 472, pages 630–636 (2014)Cite this article

Abstract

Background

A high hip center total hip arthroplasty (THA) for dysplasia allows more complete socket coverage by native bone at the expense of abnormal hip biomechanics. Despite poor results with cemented components, intermediate-term results with cementless cups at a high hip center have been promising, but there are few reports at long-term followup without bone graft.

Questions/purposes

The purpose of this study was to examine (1) survivorship; 2) radiographic results; and 3) hip scores at a minimum of 10 years for patients treated with high hip center cementless THA for Crowe II and III dysplasia without bone graft.

Methods

We reviewed charts and radiographs of 32 patients with Crowe II or III dysplasia who were treated with high hip center cementless THA; at a mean followup of 12 years (range, 10–21 years), 23 patients (27 hips) were available for review. We sought to medialize cups to the inner table to achieve bony coverage of > 75%. At final followup, the WOMAC and Harris hip scores were recorded. Radiographic analysis including computerized wear evaluation was performed. Radiographic parameters were compared with a control group of 23 patients with Crowe I dysplasia who had cementless cups placed at an anatomic hip center; among the high hip center reconstructions, we also compared wear between those in the superolateral and superomedial quadrants.

Results

Kaplan-Meier survivorship for all-cause revisions was 97% (95% confidence interval, 79%–99%) in the high hip center group; this was no different from the anatomic hip center group. There were no revisions for acetabular loosening. Wear rates did not differ significantly between the high hip center and the control group, but lateralized high hip centers were associated with higher (p = 0.002) wear. Hip scores were excellent in both groups.

Conclusions

In Crowe II and III dysplasia, a high hip center cementless cup obviates the need for bone graft and provides durable fixation beyond 10 years. Medialization of these reconstructions seems important to decrease wear.

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 Huong T. Do MA, for her assistance with the statistical analysis and Matin Lendhey BS, and Dhanasekara Raja MD, for assisting us with the data collection. Danyal H. Nawabi thanks the British Hip Society Charnley Latta Fund for supporting his fellowship training.

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Affiliations

  1. Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Danyal H. Nawabi MD, Denis Nam MD, Amar S. Ranawat MD & Chitranjan S. Ranawat MD

  2. Ranawat Orthopaedic Center, Research Division, Hospital for Special Surgery, New York, NY, USA

    Morteza Meftah MD

Authors
  1. Danyal H. Nawabi MD
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  2. Morteza Meftah MD
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  3. Denis Nam MD
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  4. Amar S. Ranawat MD
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  5. Chitranjan S. Ranawat MD
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Corresponding author

Correspondence to Danyal H. Nawabi MD.

Additional information

One of the authors certifies that he (ASR) or she, or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from DePuy (Warsaw, IN, USA), less than USD 100,000 from Conformis (Bedford, MA, USA), less than USD 10,000 from Convatec (Skillman, NJ, USA), and less than USD 100,000 from MAKO (Fort Lauderdale, FL, USA) and has ownership interest in Conformis. One of the authors certifies that he (CSR) or she, or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 1,000,000 from DePuy and less than USD 1,000,000 from Stryker (Mahwah, NJ, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

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 prior to 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.

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Nawabi, D.H., Meftah, M., Nam, D. et al. Durable Fixation Achieved With Medialized, High Hip Center Cementless THAs for Crowe II and III Dysplasia. Clin Orthop Relat Res 472, 630–636 (2014). https://doi.org/10.1007/s11999-013-3187-0

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Keywords

  • Acetabular Component
  • Polyethylene Wear
  • Linear Wear Rate
  • Acetabular Loosening
  • Acetabular Bone Stock