The Journal of Bone and Joint Surgery (American). 2005;87:280-285.
doi:10.2106/JBJS.D.02130
© 2005 The Journal of Bone and Joint Surgery, Inc.
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 Adult Hip Reconstruction Test 12: Spring 2005
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Total Hip Arthroplasty with Cement and without Acetabular Bone Graft for Severe Hip Dysplasia

A Concise Follow-Up, At a Minimum of Twenty Years, of a Previous Report*

A.S. Klapach, MD1, J.J. Callaghan, MD1, K.A. Miller, MD1, D.D. Goetz, MD2, P.M. Sullivan, MD2, D.R. Pedersen, PhD1 and R.C. Johnston, MD1

1 Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, 01073 JPP, 200 Hawkins Drive, Iowa City, IA 52242. E-mail address for J.J. Callaghan: john-callaghan{at}uiowa.edu
2 Des Moines Orthopedic Surgeons, 6001 Westown Parkway, West Des Moines, IA 50266

Investigation performed at the Iowa Methodist Medical Center, Des Moines, Iowa, and the Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa

McQueary FG, Johnston RC. Coxarthrosis after congenital dysplasia. Treatment by total hip arthroplasty without acetabular bone-grafting. J Bone Joint Surg Am. 1988;70:1140-4.

MacKenzie JR, Kelley SS, Johnston RC. Total hip replacement for coxarthrosis secondary to congenital dysplasia and dislocation of the hip. Long-term results. J Bone Joint Surg Am. 1996;78:55-61.

In support of their research or preparation of this manuscript, one or more of the authors received the Veterans Administration Merit Award; National Institutes of Health Grants AR 43314, AR 46601, and AR 047653; and funding from DePuy. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (DePuy). Also, a commercial entity (DePuy) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

* Original Publications

We previously evaluated a cohort of fifty-three patients with severe hip dysplasia (Crowe Type-II, III, or IV subluxation) who underwent a total of sixty-six Charnley total hip arthroplasties. The acetabular component was placed at the anatomic hip center, the superolateral defect was filled with cement, and no bone-grafting was used to supplement the acetabular wall. All but one patient, who was lost to follow-up, were followed until death or for a minimum of twenty years. Radiographic and functional follow-up data were collected prospectively. This retrospective review included twenty-four patients (thirty-four hips) who were alive at a minimum of twenty years following the surgery.

Fourteen (22%) of the sixty-five hips underwent revision of a component, with eleven of the revisions performed because of aseptic loosening. Eight of those eleven hips underwent revision because of acetabular loosening alone; two, because of femoral loosening alone; and one, because of loosening of both components. The combined prevalence of revision because of aseptic loosening of the acetabular component and radiographic evidence of failure of the acetabular component was 28% (eighteen hips). With the numbers available, the need for acetabular revision was not associated with the percentage of cement coverage (p = 0.362) or the Crowe classification (p = 0.159). At a minimum of twenty years postoperatively, the survivorship of the acetabular component was 86% ± 8% with revision because of aseptic loosening as the end point and 82% ± 10% with revision because of aseptic loosening or radiographic evidence of loosening as the end point. The results that we evaluated at a minimum of twenty years after use of this technique can be compared with the results of other techniques in studies with similar long-term follow-up periods.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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Coxarthrosis after congenital dysplasia. Treatment by total hip arthroplasty without acetabular bone-grafting
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B. J. Hampton and W. H. Harris
Primary Cementless Acetabular Components in Hips with Severe Developmental Dysplasia or Total Dislocation. A Concise Follow-up, at an Average of Sixteen Years, of a Previous Report
J. Bone Joint Surg. Am., July 1, 2006; 88(7): 1549 - 1552.
[Abstract] [Full Text] [PDF]

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TOTAL HIP ARTHROPLASTY WITH CEMENT AND WITHOUT ACETABULAR BONE GRAFT FOR SEVERE HIP DYSPLASIA.
Antti P. Eskelinen, M.D., et al.
JBJS Online, 29 Mar 2005 [Full text]
Editor Note
Robert Poss MD
JBJS Online, 29 Mar 2005 [Full text]