The Journal of Bone and Joint Surgery (American). 2006;88:80-91.
doi:10.2106/JBJS.E.00037
© 2006 The Journal of Bone and Joint Surgery, Inc.
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 Adult Hip Reconstruction Test 19: Spring 2006 (publication date May 15, 200...
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Cementless Total Hip Arthroplasty in Patients with High Congenital Hip Dislocation

Antti Eskelinen, MD1, Ilkka Helenius, MD, PhD2, Ville Remes, MD, PhD2, Pekka Ylinen, MD2, Kaj Tallroth, MD, PhD2 and Timo Paavilainen, MD, PhD2

1 Koivuviita 12 B 6, Espoo FIN-02130, Finland. E-mail address: antti.eskelinen{at}fimnet.fi
2 ORTON Orthopedic Hospital, Invalid Foundation, Tenholantie 10, Helsinki FIN-00280, Finland

Investigation performed at ORTON Orthopedic Hospital, Invalid Foundation, Helsinki, Finland

In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from Orion Research Foundation, Research Foundation of Orthopaedics and Traumatology, Pär Slätis Joint Surgery Research Foundation, and Duodecim Research Foundation. None of the authors received 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.

Background: The optimal surgical treatment for patients with high congenital dislocation of the hip remains controversial. The purpose of our study was to evaluate the mid-term to long-term results of cementless total hip arthroplasty in such patients.

Methods: The study included sixty-eight total hip replacements performed between 1989 and 1994 in fifty-six consecutive patients with high congenital hip dislocation at our hospital. The cup was placed at the level of the true acetabulum, and a shortening osteotomy of the proximal part of the femur and distal advancement of the greater trochanter were performed in 90% of the hips. At the time of final follow-up, at a mean of 12.3 years postoperatively, fifty-two patients (sixty-four hips) were evaluated by us with a physical examination, determination of Harris hip scores, and radiographs.

Results: The mean Harris hip score increased from 54 points preoperatively to 84 points at the time of final follow-up (p < 0.001). There was a negative Trendelenburg sign in fifty-nine (92%) of the sixty-four hips. There were thirteen perioperative complications (19%): three peroneal nerve palsies, one femoral nerve palsy, one superior gluteal nerve palsy, four nondisplaced fractures of the proximal part of the femur, one malpositioned stem perforating the posteromedial cortex of the femur, one superficial wound infection, and two early dislocations. With revision because of aseptic loosening as the end point, the ten-year survival rate for press-fit, porous-coated acetabular components was 94.9% (95% confidence interval, 89.3% to 100%). Eight of nine threaded acetabular components were revised, and the ninth was radiographically loose at the time of the last follow-up examination. The rate of survival for the CDH femoral components, with revision because of aseptic loosening as the end point, was 98.4% (95% confidence interval, 96.8% to 100%) at ten years.

Conclusions: Total hip arthroplasty, with placement of the cup at the level of the true acetabulum, distal advancement of the greater trochanter, and femoral shortening osteotomy, can be recommended for patients with high congenital hip dislocation. Complications such as wear, osteolysis, and cup revision were secondary to the suboptimal design of the acetabular components used in this series.

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


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Total Hip Arthroplasty For High Dislocation Of The Hip: The Femoral Side
Omur Caglar, M.D., et al.
JBJS Online, 16 Nov 2006 [Full text]