To the Editor:
We read with interest the article, “Total Hip Arthroplasty
with Cement and without Acetabular Bone Graft for Severe Hip Dysplasia”
(2005: 87; 280-5), by Klapach et al., in which the authors reported the
results of total hip arthroplasty for fifty-six patients with severe hip
dysplasia. The authors had placed the acetabular component at the anatomic
hip center, the superolateral defect was filled with cement, and no bone-
graft was used to supplement the acetabular wall. Minimum follow-up of
twenty years after surgery was presented.
While the study was well-conceived and executed. We believe, however, that
there were serious shortcomings in the review of the literature presented
in the article. In Table IV the authors compared the results of their
surgical technique with other published techniques for arthroplasty in
patients with developmental dysplasia. We were surprised to find out, that
previously published, excellent European studies by Hartofilakidis et al.
(1,2,3) and Paavilainen (4,5) were neglected in the Discussion.
In their classical article published in the Journal of Bone and Joint
Surgery in 1996, Hartofilakidis et al. presented a classification of
acetabular deficiencies, and results of total hip arthroplasty combined
with acetabuloplasty in sixty-six patients with developmental dysplasia of
the hip (DDH) (1). In 1998, Hartofilakidis et al. published results of the
same technique in sixty-seven patients with high congenital dislocation of
the hip (2). Recently they published long-term results of 229 total hip
arthroplasties in 168 patients with DDH in the Journal of Bone and Joint
Surgery (3).
Paavilainen et al. reported short-term results of 100 cementless
total hip replacements in 52 severely dysplastic and 48 totally dislocated
hips (4). In 1993, Paavilainen et al. reported the results of sixty-seven
dislocated or severely dysplastic treated with cementless total hip
arthroplasty (5). The authors used distal advancement of the greater
trochanter and anatomic replacement of the acetabular component at the
anatomic site with good results. For patients with previous low-seated
Schanz osteotomy, the authors recommended a segmental angular correction
and shortening osteotomy fixed with a modular fluited stem.
We feel, that results of these excellent studies should be presented
and discussed, whenever results of total hip arthroplasty for DDH are
presented in peer-reviewed orthopedic journals.
Yours sincerely,
Antti Eskelinen, MD, Consultant Orthopedic Surgeon
Ville Remes, MD, PhD, Consultant Orthopedic Surgeon
Department of Orthopedics and Traumatology
Helsinki University Central Hospital
P.O. Box 266, 00029 HUS
Helsinki, Finland
References
1. Hartofilakidis G, Stamos K, Karachalios T, Ioannidis TT,
Zacharakis N. Congenital hip disease in adults. Classification of
acetabular deficiencies and operative treatment with acetabuloplasty
combined with total hip arthroplasty. J Bone Joint Surg Am. 1996;78:683-
92.
2. Hartofilakidis G, Stamos K, Karachalios T. Treatment of high
dislocation of the hip in adults with total hip arthroplasty. Operative
technique and longterm clinical results. J Bone Joint Surg Am. 1998;80:510
-7.
3. Hartofilakidis G, Karachalios T. Total hip arthroplasty for
congenital hip disease. J Bone Joint Surg Am. 2004;86:242-50.
4. Paavilainen T, Hoikka V, Solonen KA. Cementless total replacement
for severely dysplastic or dislocated hips J Bone Joint Surg Br.
1990;72:205-11.
5. Paavilainen T, Hoikka V, Paavolainen P. Cementless total hip
arthroplasty for congenitally dislocated or dysplastic hips. Technique for
replacement with a straight femoral component. Clin Orthop. 1993;297:71-
81.
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