The Journal of Bone and Joint Surgery, Vol 75, Issue 10 1497-1504, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Custom-designed femoral prostheses in total hip arthroplasty done with cement for severe dysplasia of the hip
MH Huo, EA Salvati, JR Lieberman, AH Burstein and PD Wilson
Hospital for Special Surgery, New York City, NY 10021.
A custom-designed femoral prosthesis was implanted with cement and a
standard acetabular component was used to treat nineteen severely
dysplastic hips in fourteen consecutively managed patients. Components that
had been custom-designed with the use of plain radiography were used
because the anatomical reconstructive goals could not be achieved with
commercially available implants. These goals were to match the offset of
the femoral head and the length of the lower limb with those on the normal
side for patients who had unilateral involvement and to provide an average
(thirty to forty-millimeter) offset with equal limb lengths for patients
who had bilateral involvement. A retrospective clinical and radiographic
analysis was performed. The diagnoses included coxa vara (one hip),
congenital dislocation (twelve hips), achondroplasia (three hips), and
spondyloepiphyseal dysplasia (three hips). The mean age at the time of the
reconstruction was forty-nine years (range, twenty-two to seventy-three
years), and the mean duration of follow-up was fifty-seven months (range,
twenty-seven to 108 months). In five hips, bone-grafting of the acetabulum
was needed to obtain superolateral coverage. The clinical result was
excellent in eighteen hips and good in one. No revisions have been
performed to date. Two femoral components were possibly loose
radiographically. One was associated with a definite loosening of the
acetabular cup. In addition, one other cup was possibly loose. There was a
100 per cent rate of survival if only a revision procedure was considered
as a failure.(ABSTRACT TRUNCATED AT 250 WORDS)
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