Intermediate-term results after uncemented total hip arthroplasty for the treatment of developmental dysplasia of the hip
Mehmet Nurullah Ermiş1, Bülent Dilaveroğlu1, Özgün Erçeltik1, Ümit Tuhanioğlu1, Eyüp Selahattin Karakaş1, Mehmet Oğuz Durakbaşa2
1Department of 2nd Orthopedics and Traumatology, Baltalimanı Metin Sabancı Training and Research Hospital, İstanbul, Turkey
2Department of 2nd Orthopaedics and Traumatology, Haydarpaşa Numune Education and Research Hospital, İstanbul, Turkey
Keywords: Developmental hip dysplasia; femoral head autograft; total hip arthroplasty.
Objectives: We aim to evaluate the restoration of the hip and limb length in patients with osteoarthritis secondary to developmental dysplasia of the hip (DDH) using total hip arthroplasty (THA).
Patients and methods: Between February 1996 and September 2001, 65 hips in 55 patients (2 males, 53 females; mean age 48.6 years; range 37 to 60 years) with advanced osteoarthritis secondary to DDH underwent uncemented THA. According to the Hartofilakidis classification, 20, 27, and 18 hips were evaluated types I (dysplasia), II (subluxation), and III (dislocation), respectively. All of the acetabular cups were reconstructed in the original anatomic location. Structural autografts were used in seven hips to supplement the acetabular coverage. We evaluated all patients clinically and radiographically.
Results: All of the patients were followed up for 7-12 years. Preoperatively, the Harris score averaged 52.5, 48.41, and 45.28 in types I to III, respectively. At the final follow-up, the Harris score averaged 89.65, 87.44, and 83.28, respectively. The difference between the pre- and postoperative scores was significant (p=0.0001). Preoperatively, 26 patients (47.27%) had slight limps (length difference 3 cm). At their final follow-up, four (7.27%) had severe limps. The limps of all of the patients improved significantly (McNemar’s test p=0.0001). We observed aseptic loosening and subsidence in six hips. In seven hips, we used a femoral head autograft for the superior acetabular defect. We performed femoral shortening osteotomies only for two (3.07%) type III hips.
Conclusion: In addition to the standard procedure, structural bone autografting, medialization of the cup, and placing the acetabular component in the true acetabulum are important factors for successful intermediate-term results.