Satisfying Results of Primary Hip Arthroplasty in Patients With Hip Dysplasia at a Mean Followup of 20 Years

• Published in: Clinical orthopaedics and related research 2016-11, Vol.474 (11), p.2462-2468
• Main Authors: Colo, Ena, Rijnen, Wim H. C., Gardeniers, Jean W. M., van Kampen, Albert, Schreurs, B. Willem
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - instrumentation; Biomechanical Phenomena; Bone Transplantation - adverse effects; Clinical Research; Conservative Orthopedics; Female; Follow-Up Studies; Hip; Hip Dislocation, Congenital - complications; Hip Dislocation, Congenital - diagnostic imaging; Hip Dislocation, Congenital - physiopathology; Hip Dislocation, Congenital - surgery; Hip Joint - abnormalities; Hip Joint - diagnostic imaging; Hip Joint - physiopathology; Hip Joint - surgery; Hip Prosthesis; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Osteoarthritis, Hip - diagnostic imaging; Osteoarthritis, Hip - etiology; Osteoarthritis, Hip - physiopathology; Osteoarthritis, Hip - surgery; Prosthesis Failure; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; Sports Medicine; Surgery; Surgical Orthopedics; Time Factors; Treatment Outcome
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-016-4998-6

Background Developmental dysplasia of the hip (DDH) is a common cause of secondary osteoarthritis (OA) in younger patients, and when end-stage OA develops, a THA can provide a solution. Different options have been developed to reconstruct these defects, one of which is impaction bone grafting combined with a cemented cup. To determine the true value of a specific technique, it is important to evaluate patients at a long-term followup. As there are no long-term studies, to our knowledge, on THA in patients with DDH using impaction bone grafting with a cemented cup, we present the results of this technique at a mean of 15 years in patients with previous DDH. Questions/purposes We wished to determine (1) the long-term probability of cup revision at a minimum followup of 15 years for cemented acetabular impaction bone grafting in patients with DDH; (2) the radiographic appearance of the bone graft and radiographic signs of implant loosening; and (3) the complications and pre- and postoperative Harris hip scores with cemented THA combined with impaction bone grafting in patients with previous DDH. Methods Between January 1984 and December 1995 we performed 28 acetabular impaction bone grafting procedures for secondary OA believed to be caused by DDH in 22 patients; four patients died before 15 years, leaving 24 hips in 18 patients for retrospective analysis at a minimum of 15 years (mean, 20 years; range, 16–29 years). The diagnosis of DDH was made according to preoperative radiographs and intraoperative findings. All grades of dysplasia were included; five patients had Crowe Group I, eight had Group II, nine had Group III, and two had Group IV DDH. No patients were lost to followup. In all cases the acetabular defects were combined cavitary and segmental. Owing to the high number of deaths, we performed a competing-risk analysis to determine the probability of cup revision surgery. Results The competing-risk analysis showed cumulative incidences at 15 and 20 years, with endpoint revision for any reason of 7% (95% CI, 0%–17%), whereas this was 4% (95% CI, 0%–11%) with endpoint revision of the cup for aseptic loosening. Three revision surgeries were performed. Two cup revisions were performed for aseptic loosening at 12 and 26 years. Another cup revision was performed owing to sciatic nerve problems at 2 years. A stable radiographic appearance of the graft was seen in 19 of the 25 unrevised hips. Four hips showed acetabular radiolucent lines and two showed aceta