Skip to main content
SpringerLink
Log in

Cementless total hip arthroplasty for patients previously treated with femoral osteotomy for hip dysplasia: the incidence of periprosthetic fracture

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Femur deformities can make stem fixation difficult in total hip arthroplasty (THA). We report the clinical results of cementless THA using a press-fit stem in patients who had previously undergone femoral osteotomy for hip dysplasia.

Methods

The subjects included 66 hips in 64 patients, with the mean follow-up period of 7.3 years. THA was performed at a mean period of 17.1 years after intertrochanteric femoral osteotomy. Valgus osteotomy was performed in 42 hips, and varus osteotomy in 24. Clinical results were evaluated by using the Merle d’Aubigne-Postel score. Implant survival was determined with revision as the end point, and any related complications were investigated.

Results

The Merle d’Aubigne-Postel score improved from 9.4 to 16.1 at the final follow-up, without any implant loosening. However, periprosthetic femoral fractures were observed in four hips (6.0 %), one intra-operatively and three within three weeks after THA. Among these cases, three hips previously had varus osteotomy (12.5 %) and one hip had valgus osteotomy (2.3 %). Two hips were revised with full porous stems and circumferential wiring. The five and ten year cumulative survivorship rates were 97 % (range, 88.8–99.3 %) and 97 % (88.8–99.3 %), respectively.

Conclusions

Although the use of a press-fit cementless stem yielded acceptable results in most of the patients, perioperative femoral fracture was a major complication especially in the patients previously treated with intertrochanteric varus osteotomy. Careful planning and implant selection could be emphasized for these cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Santore RF, Turgeon TR, Phillips WF, Kantor SR (2006) Pelvic and femoral osteotomy in the treatment of hip disease in the young adult. Instr Course Lect 55:131–144

    PubMed  Google Scholar 

  2. Fujii M, Nakashima Y, Noguchi Y, Yamamoto T, Mawatari T, Motomura G, Iwamoto Y (2011) Effect of intra-articular lesions on the outcome of periacetabular osteotomy in patients with symptomatic hip dysplasia. J Bone Joint Surg (Br) 93(11):1449–1456

    Article  CAS  Google Scholar 

  3. Ikemura S, Yamamoto T, Jingushi S, Nakashima Y, Mawatari T, Iwamoto Y (2007) Leg-length discrepancy after transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg (Br) 89(6):725–729

    Article  CAS  Google Scholar 

  4. Jingushi S, Sugioka Y, Noguchi Y, Miura H, Iwamoto Y (2002) Transtrochanteric valgus osteotomy for the treatment of osteoarthritis of the hip secondary to acetabular dysplasia. J Bone Joint Surg (Br) 84(4):535–539

    Article  CAS  Google Scholar 

  5. Ferguson GM, Cabanela ME, Ilstrup DM (1994) Total hip arthroplasty after failed intertrochanteric osteotomy. J Bone Joint Surg (Br) 76(2):252–257

    CAS  Google Scholar 

  6. Suzuki K, Kawachi S, Matsubara M, Morita S, Jinno T, Shinomiya K (2007) Cementless total hip replacement after previous intertrochanteric valgus osteotomy for advanced osteoarthritis. J Bone Joint Surg (Br) 89(9):1155–1157

    Article  CAS  Google Scholar 

  7. Shinar AA, Harris WH (1998) Cemented total hip arthroplasty following previous femoral osteotomy: an average 16-year follow-up study. Arthroplasty 13(3):243–253

    Article  CAS  Google Scholar 

  8. Boos N, Krushell R, Ganz R, Muller M (1997) Total hip arthroplasty after previous proximal femoral osteotomy. J Bone Joint Surg (Br) 79(2):247–253

    Article  CAS  Google Scholar 

  9. Haverkamp D, de Jong PT, Marti RK (2006) Intertrochanteric osteotomies do not impair long-term outcome of subsequent cemented total hip arthroplasties. Clin Orthop Relat Res 444:154–160

    Article  CAS  PubMed  Google Scholar 

  10. Breusch SJ, Lukoschek M, Thomsen M, Mau H, Ewerbeck V, Aldinger PR (2005) Ten-year results of uncemented hip stems for failed intertrochanteric osteotomy. Arch Orthop Trauma Surg 125(5):304–309

    Article  PubMed  Google Scholar 

  11. Parsch D, Jung AW, Thomsen M, Ewerbeck V, Aldinger PR (2008) Good survival of uncemented tapered stems for failed intertrochanteric osteotomy: a mean 16 year follow-up study in 45 patients. Arch Orthop Trauma Surg 128(10):1081–1085

    Article  PubMed  Google Scholar 

  12. Nakashima Y, Sato T, Yamamoto T, Motomura G, Ohishi M, Hamai S, Akiyama M, Hirata M, Hara D, Iwamoto Y (2013) Results at a minimum of 10 years of follow-up for AMS and PerFix HA-coated cementless total hiparthroplasty: impact of cross-linked polyethylene on implant longevity. J Orthop Sci 18(6):962–968

    Article  CAS  PubMed  Google Scholar 

  13. Nakashima Y, Hirata M, Akiyama M, Itokawa T, Yamamoto T, Motomura G, Ohishi M, Hamai S, Iwamoto Y (2014) Combined anteversion technique reduced the dislocation in cementless total hip arthroplasty. Int Orthop 38(1):27–32

    Article  PubMed  Google Scholar 

  14. Charnley J (1972) The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg (Br) 54(1):61–76

    CAS  Google Scholar 

  15. Engh CA, Massin P, Suthers KE (1990) Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res 257:107–128

    PubMed  Google Scholar 

  16. Brady OH, Garbuz DS, Masri BA, Duncan CP (2000) The reliability and validity of the Vancouver classification of femoral fractures after hip replacement. J Arthroplasty 15(1):59–62

    Article  CAS  PubMed  Google Scholar 

  17. Schwarzkopf R, Oni JK, Marwin SE (2013) Total hip arthroplasty periprosthetic femoral fractures. Bull Hosp Jt Dis 71(1):68–78

    Google Scholar 

  18. Lindahl H (2007) Epidemiology of periprosthetic femur fracture around a total hip artroplasty. Injury 38:651–654

    Article  PubMed  Google Scholar 

  19. Capello WN, D’Antonio JA, Naughton M (2014) Periprosthetic fractures around a cementless hydroxyapatite-coated implant: a new fracture pattern is described. Clin Orthop Relat Res 472(2):604–610

    Article  PubMed  Google Scholar 

  20. Mallory TH, Kraus TJ, Vaughn BK (1989) Intraoperative femoral fractures associated with cementless total hip arthroplasty. Orthopedics 12(2):231–239

    CAS  PubMed  Google Scholar 

  21. Van Houwelingen AP, Duncan CP (2011) The pseudo A(LT) periprosthetic fracture: it’s really a B2. Orthopedics 34(9):e479–e481

    PubMed  Google Scholar 

  22. Thien TM, Chatziagorou G, Garellick G, Furnes O, Havelin LI, Mäkelä K, Overgaard S, Pedersen A, Eskelinen A, Pulkkinen P, Kärrholm J (2014) Periprosthetic femoral fracture within two years after total hip replacement: analysis of 437,629 operations in the nordic arthroplasty register association database. J Bone Joint Surg Am 96(19), e167. doi:10.2106/JBJS.M.00643

    Article  PubMed  Google Scholar 

  23. Iwase T, Hasegawa Y, Iwasada S, Kitamura S, Iwata H (1999) Total hip arthroplasty after failed intertrochanteric valgus osteotomy for advanced osteoarthrosis. Clin Orthop Relat Res 364:175–181

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (No. 24592268).

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Faculty of Medical Sciences, Graduate School of Medicine, Kyushu University, 3-1-1 Maidashi Higashiku, Fukuoka, 812-8582, Japan

    Masanobu Ohishi, Yasuharu Nakashima, Takuaki Yamamoto, Goro Motomura, Jun-ichi Fukushi, Satoshi Hamai, Yusuke Kohno & Yukihide Iwamoto

Authors
  1. Masanobu Ohishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasuharu Nakashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takuaki Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Goro Motomura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jun-ichi Fukushi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Satoshi Hamai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yusuke Kohno
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yukihide Iwamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yasuharu Nakashima.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ohishi, M., Nakashima, Y., Yamamoto, T. et al. Cementless total hip arthroplasty for patients previously treated with femoral osteotomy for hip dysplasia: the incidence of periprosthetic fracture. International Orthopaedics (SICOT) 40, 1601–1606 (2016). https://doi.org/10.1007/s00264-015-2992-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-015-2992-3

Keywords

Search

Navigation