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Total Hip Arthroplasty in Patients with Dwarfism

¹ Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for M.E. Cabanela: cabanela.miguel{at}mayo.edu
² Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107

Investigation performed at the Department of Orthopedics, Mayo Clinic, Rochester, Minnesota

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Methods: Between 1971 and 1997, sixty-two total hip arthroplasties were performed at our institution in thirty-seven patients with severe osteoarthritis secondary to osteochondrodysplasia. There were seventeen female patients and twenty male patients. Their average height was 142 cm, and their average age at the time of the index arthroplasty was thirty-seven years. The patients were followed clinically with use of the Harris hip score for a mean of 12.8 years, and they were followed radiographically for a mean of 11.5 years.

Results: The mean Harris hip score improved significantly (p < 0.0001), from 57 points preoperatively to 87 points at the time of the latest follow-up. Of the sixty hips available for follow-up, eighteen (30%) had required revision arthroplasty: fourteen required it because of aseptic loosening of one or both components; two, because of deep infection; one, because of periprosthetic fracture; and one, because of extensive osteolysis. There were two additional periprosthetic femoral fractures, which were treated with open reduction and internal fixation with retention of the components. The majority of patients had other functionally limiting conditions, such as spinal deformities, in addition to the degenerative arthritis.

Conclusions: There was a high prevalence of complications, periprosthetic fractures, and mechanical failure in these patients with osteochondrodysplasia who underwent total hip arthroplasty. Young age, severe deformity, and multiple joint involvement may in part explain these findings. Nonetheless, total hip arthroplasty proved to be reliable for alleviating pain and improving function in patients with advanced symptomatic arthritis of the hip secondary to osteochondrodysplasia.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

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