J Korean Orthop Assoc.  2007 Dec;42(6):718-723. 10.4055/jkoa.2007.42.6.718.

Cementless Total Hip Arthroplasty using Cone Prosthesis for Childhood Septic Hip Sequelae

• Yoon TR
• Song EK
• Park SJ
• Cho SG
• Yim JH

• KMID: 1947776
• DOI: http://doi.org/10.4055/jkoa.2007.42.6.718

Abstract

PURPOSE: To evaluate the clinical and radiographic results of cementless total hip arthroplasty using cone prosthesis for childhood septic hip sequelae.
MATERIALS AND METHODS
Thirty-seven patients of childhood septic hip sequelae that were treated with total hip arthroplasty using cone prosthesis, were evaluated after at least 2 years of follow-up. The average age at the time of the operation was 44 years. The cause of hip infection was pyogenic in 34 cases and tuberculous in 3. The average duration of follow-up was 51 months.
RESULTS
The average Harris hip score improved from 45 points preoperatively to 90 points postoperatively. The mean leg length discrepancy decreased from 3.1 cm preoperatively to 0.7cm postoperatively. There was one case of stem subsidence over 5 mm, which didn't progress further. One patient underwent revision for migration of acetabular cup at postoperative 53 months. Postoperative infection occurred in 2 patients at postoperative 6 and 9 months respectively, which were treated by prosthesis removal. Radiolucent line over 2 mm was observed between the bone and stem in 1 case, without any evidence of loosening.
CONCLUSION
Cementless total hip arthroplasty using cone prosthesis for childhood septic hip sequelae resulted in excellent clinical and radiographic outcome.

Keyword

Hip; Infection sequelae; Cone prosthesis; Total hip arthroplasty

MeSH Terms

Acetabulum
Arthroplasty, Replacement, Hip*
Follow-Up Studies
Hip*
Humans
Leg
Prostheses and Implants*

Figure

• 

  Fig. 1 (A) Preoperative radiograph of 53 year old woman shows complete disruption of joint space with a high-riding greater trochanter, a dysplastic acetabulum, and a small femoral canal. (B) Anteroposterior radiograph immediately after a cementless total hip arthroplasty using Cone prosthesis is showed. (C) Anteroposterior radiograph at 8 years and 4 months postoperatively shows no evidence of radiolucent line or subsidence.

Reference

1. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973. 55:1629–1632.

2. Callaghan JJ, Salvati EA, Pellicci PM, Wilson PD Jr, Ranawat CS. Results of revision for mechanical failure after cemented total hip replacement, 1979 to 1982. A two to five-year follow-up. J Bone Joint Surg Am. 1985. 67:1074–1085.

3. Chandler HP, Reineck FT, Wixson RL, McCarthy JC. Total hip replacement in patients younger than thirty years old. A five-year follow up study. J Bone Joint Surg Am. 1981. 63:1426–1434.

4. Charnley J. Low friction arthroplasty of the hip. 1979. New York: Springer-Verlag.

5. Charnley J, Feagin JA. Low friction arthroplasty in congenital subluxation of the hip. Clin Orthop Relat Res. 1973. 91:98–113.

6. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am. 1979. 61:15–23.

7. Davlin LB, Amstutz H, Tooke S, Dorney F, Nasser S. Treatment of osteoarthrosis secondary to congenital dislocation of the hip. Primary cemented surface replacement compared with conventional total hip replacement. J Bone Joint Surg Am. 1990. 72:1032–1042.

8. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in hip arthroplasty. Clin Orthop Relat Res. 1976. 121:20–32.

9. Dickob M, Martini T. The cementless PM hip arthroplasty. Four-to-seven-year results. J Bone Joint Surg Br. 1996. 78:195–199.

10. Dunn HK, Hess WE. Total hip reconstruction in chronically dislocated hips. J Bone Joint Surg Am. 1976. 58:838–845.

11. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Othop Relat Res. 1990. 257:107–128.

12. Garvin KL, Bowen MK, Salvati EA, Ranawat CS. Long term results of total hip arthroplasty in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am. 1991. 73:1348–1354.

13. Gruen TA, McNeice GM, Amstutz HC. "Mode of failure" of cemented stem type femoral components. A radiographic analysis of loosening. Clin Othop Relat Res. 1979. 141:17–27.

14. Hardinge K, Cleary J, Charnley J. Low-friction arthroplasty for healed septic and tuberculous arthritis. J Bone Joint Surg Am. 1979. 61:144–147.

15. Harley JM, Wilkinson JA. Hip replacement for adults with unreduced congenital dislocation. J Bone Joint Surg Br. 1987. 69:752–755.

16. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end result study using a new method of result evaluation. J Bone Joint Surg Am. 1969. 51:737–755.

17. Hwang DS, Yune SH, Rhee KJ, Kim SB. Cementless total hip arthroplasty using conical femoral stem in pediatric hip sequelae patients - short-tem report with at least 2 years follow up. J Korean Hip Soc. 1998. 10:190–196.

18. Jasty M, Harris WH. Total hip reconstruction using femoral head allograft in patients with acetabular bone loss. Orthop Clin North Am. 1987. 18:291–299.

19. Jupiter JB, Karchmer AW, Lowell JD, Harris WH. Total hip arthroplasty. An end-result study of thirty-three hips. J Bone Joint Surg Am. 1966. 48:111–125.

20. Lee JM, Kim JM. Total hip arthroplasty using cone prosthesis in severely underdevelped and deformed femur. J Korean Hip Soc. 2001. 13:367–374.

21. Linde F, Jensen J, Pilgaard S. Charnley arthroplasty in osteoarthritis secondary to congenital dislocation or subluxation of the hip. Clin Orthop Relat Res. 1988. 227:164–171.

22. McQueary FG, Johnston RC. Coxarthrosis after congenital dysplasia. Treatment by total hip arthroplasty without acetabular bone grafting. J Bone Joint Surg Am. 1988. 70:1140–1144.

23. Mendes DG. Total hip arthroplasty in congenital dislocated hips. Clin Orthop Relat Res. 1981. 161:163–179.

24. Nagano H, Inoue H, Usui M, Mitani S, Satoh T. Long-term results of Charnley low-friction arthroplasty for coxarthrosis with congenital hip dysplasia. 15 year follow-up study. Bull Hosp Jt Dis. 1997. 56:197–203.

25. Schenk RK, Wehrli U. Reaction of the bone to a cement-free SL femur revision prosthesis. Histologic findings in an autopsy specimen 5 1/2 months after surgery. Orthopade. 1989. 18:454–462.

26. Wagner H, Wagner M. Morsher E, editor. Conical stem fixation for cementless hip prostheses for primary implantations and revision. Endoprosthesis. 1995. Berlin Heidelberg New York: Springer;258–267.

27. Woolson ST, Harris WH. Complex total hip replacement for dysplastic or hypoplastic hips using miniature or microminiature components. J Bone Joint Surg Am. 1983. 65:1099–1108.