J Korean Orthop Assoc.  2008 Jun;43(3):308-315. 10.4055/jkoa.2008.43.3.308.

Contemporary Alumina-on-Alumina THA in Patients with Sequelae of the Hip Joint Infection

• Lee HJ
• Yoo JJ
• Koo KH
• Yoon KS
• Kim YM
• Kim HJ

• KMID: 2186446
• DOI: http://doi.org/10.4055/jkoa.2008.43.3.308

Abstract

PURPOSE: THA in patients with dysplastic hips secondary to infection of the hip joint is a technically challenging procedure because of long-standing anatomic abnormalities of the bone and soft tissues. Low friction, low wear, alumina-on-alumina bearing surfaces are an attractive alternative to conventional metal-on-polyethylene articulation, and may offer a promising option for young, active patients. Here, we evaluated the results of a modern alumina-on-alumina THA performed in patients with sequelae of the hip joint infection, with a 5-year minimum follow-up.
MATERIALS AND METHODS
We retrospectively analyzed 48 primary cementless alumina-on-alumina THAs that had been performed in patients who had sequelae of the hip joint infection between November 1997 and December 2000. The average age of the patients at the time of the index arthroplasty was 36.7 years (range, 18-63 years) and41 patients were younger than 50 years old. They were followed-up for more than 5 years (average, 82 months range, 60-103 months).
RESULTS
All hips had no recurrence of a hip joint infection. The mean Harris hip score improved from 61.6 points preoperatively to 92.2 points at the latest follow-up. All of the implants had radiographic evidence of bone ingrowth and no radiological loosening. During the follow-up period, nocup or stem was revised. Periprosthetic osteolysis was suspected in one hip. Leg length discrepancy was corrected from 26.2 mm preoperatively to 9.5 mm postoperatively. Postoperatively, the hip center migrated 11.7 mm medially and 5.2 mm inferiorly. Nonunion of the osteotomized greater trochanter occurred in two hips, but no postoperative infection or ceramic failure was observed.
CONCLUSION
The 5-year minimum follow-up clinical results of modern alumina-on-alumina THA in patients with sequelae of the hip joint infection were encouraging. Our results show that alumina-on-alumina articulation offers a reliable alternative solution for young patients with technically difficult arthroplasties.

Keyword

Septic hip sequelae; Alumina-alumina bearing; Ceramic; Total hip arthroplasty; Cementless; Young; Wear; Osteolysis

MeSH Terms

Aldosterone
Arthroplasty
Ceramics
Femur
Follow-Up Studies
Friction
Hip
Hip Joint
Humans
Leg
Osteolysis
Recurrence
Retrospective Studies
Tacrine
Ursidae
Aldosterone
Ceramics
Tacrine

Figure

• 

  Fig. 1 A 44-year-old man underwent total hip arthroplasty using alumina-on-alumina bearing surfaces. (A) A preoperative radiograph shows type 1 deformity in left hip. There is complete resorption of the femoral head and neck with a high-riding greater trochanter, a dysplastic acetabulum, and a small femoral canal. (B) Postoperative radiograph obtained at 2 weeks after surgery. (C) Radiograph taken 5 years and 2 months after surgery. There is no evidence of periprosthetic osteolysis or implant loosening, but the non-union of the greater trochanter is shown.

• 

  Fig. 2 A 46-year-old man underwent total hip arthroplasty using alumina-on-alumina bearing surfaces. (A) Preoperative radiograph shows the type 2 deformity in the left hip. There is partial resorption of the femoral head and a dysplastic acetabulum, but the width of femoral canal is relatively normal. (B) Postoperative radiograph obtained at 2 weeks after surgery. (C) Radiograph taken 5 years and 9 months after surgery. No evidence of periprosthetic osteolysis or implant loosening was observed.

• 

  Fig. 3 A 20-year-old woman underwent alumina-on-alumina total hip arthroplasty. (A) Preoperative radiograph shows the type 3 deformity in left hip. There is complete destruction of the hip joint, but the shape and size of the acetabulum and femoral canal are relatively normal. (B) Postoperative radiograph obtained at 2 weeks after surgery. (C) Radiograph taken 7 years and 3 months after surgery. There is no evidence of periprosthetic osteolysis or implant loosening.

Reference

1. 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.

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

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

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

5. Crowther JD, Lachiewicz PF. Survival and polyethylene wear of porous-coated acetabular components in patients less than fifty years old: results at nine to fourteen years. J Bone Joint Surg Am. 2002. 84:729–735.

6. Delee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976. 121:20–32.

7. Devitt A, O'Sullivan T, Quinlan W. 16-to 25-year follow-up study of cemented arthroplasty of the hip in patients aged 50 years or younger. J Arthroplasty. 1997. 12:479–489.

8. Dorr LD, Takei GK, Conaty JP. Total hip arthroplasties in patients less than forty-five years old. J Bone Joint Surg Am. 1983. 65:474–479.

9. Garvin KL, Bowen MK, Salvati EA, Ranawat CS. Long-term results of total hip arthroplasty in congenital dislocation and displasia of the hip. A follow-up note. J Bone Joint Surg Am. 1991. 73:1348–1354.

10. Gates HS 3rd, Poletti SC, Callaghan JJ, Mccollum DE. Radiographic measurements in protrusio acetabuli. J Arthroplasty. 1989. 4:347–351.

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

12. Halley DK, Wroblewski BM. Long-term results of low-friction arthroplasty in patients 30 years of age or younger. Clin Orthop Relat Res. 1986. 211:43–50.

13. Harris WH. The problem is osteolysis. Clin Orthop Relat Res. 1995. 311:46–53.

14. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. J Bone Joint Surg Am. 1969. 51:737–755.

15. Hunt DD, Larson CB. Treatment of the residua of hip infections by mold arthroplasty. An end-result study of thrity-three hips. J Bone Joint Surg Am. 1966. 48:111–125.

16. Joshi RP, Eftekhar NS, McMahon DJ, Nercessian OA. Osteolysis after Charnley primary low-friction arthroplasty. A comparison of two matched paired groups. J Bone Joint Surg Br. 1998. 80:585–590.

17. Jupiter JB, Karchmer AW, Lowell JD, Hariis WH. Total hip arthroplasty in the treatment of adult hip with current or quiescent sepsis. J Bone Joint Surg Am. 1981. 63:194–200.

18. Kim YH. Total arthroplasty of the hip after childhood sepsis. J Bone Joint Surg Br. 1991. 73:783–786.

19. Kim YH, Han DY, Park BM. Total hip arthroplasty for tuberculous coxarthrosis. J Bone Joint Surg Am. 1987. 69:718–727.

20. Kim YH, Kim JS, Cho SH. Primary total hip arthroplasty with cementless porous-coated anatomic total hip prosthesis: 10- to 12-year results of prospective and consecutive series. J Arthroplasty. 1999. 14:538–548.

21. Kim YH, Oh SH, Kim JS. Total hip arthroplasty in adult patients who had childhood infection of the hip. J Bone Joint Surg Am. 2003. 85:198–204.

22. Maloney WJ, Jasty M, Harris WH, Galante JO, Callaghan JJ. Endosteal erosion in association with stable uncemented femoral components. J Bone Joint Surg Am. 1990. 72:1025–1034.

23. McAuley JP, Szuszczewicz ES, Young A, Engh CA Sr. Total hip arthroplasty in patients 50 years and younger. Clin Orthop Relat Res. 2004. 418:119–125.

24. Russotti GM, Harris WH. Proximal placement of the acetabular component in total hip arthroplasty. A long-term follow-up study. J Bone Joint Surg Am. 1991. 73:587–592.

25. Skinner HB. Ceramic bearing surfaces. Clin Orthop Relat Res. 1999. 369:83–91.

26. Smith E, Harris WH. Increasing prevalence of femoral lysis in cementless total hip arthroplasty. J Arthroplasty. 1995. 10:407–412.

27. Yoo JJ, Kim HJ, Kim YM. Damage of an alumina-on-alumina bearing surface from a difficult reduction of a total hip arthroplasty. A report of three cases. J Bone Joint Surg Am. 2004. 86:376–378.

28. Yoo JJ, Kim HJ, Kim YM, et al. Sequelae of hip joint infection treated with a modern alumina-on-alumina THA. Key Eng Mater. 2007. 330-332:1247–1250.

29. Yoo JJ, Kim YM, Yoon KS, Koo KH, Song WS, Kim HJ. Alumina-on-alumina total hip arthroplasty. A five-year minimum follow-up study. J Bone Joint Surg Am. 2005. 87:530–535.