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Abstract
BackgroundDevelopmental hip dysplasia (DDH) may lead to severe acetabular and femoral abnormalities that can render total hip arthroplasty (THA) challenging, especially in DDH patients with a small physique. Most conventional cemented or cementless femoral components are often difficult to implant in the narrow femoral canal and require slight version correction during surgery. The aim of this study was to present the mid-term results of THA in the treatment of DDH patients with a small physique using a cementless Wagner cone prosthesis (Zimmer®, US).MethodsBetween January 2006 and March 2010, we retrospectively reviewed 50 patients who were treated at our center. A total of 50 patients (52 hips; 45 women, five men; mean age 32.5 years; range 27 to 38 years) who underwent THA were observed. The mean femoral medullary canal dimension at the isthmus was 7.6 mm (range 6.0 to 8.7). According to the Crowe classification, 19 hips presented dysplasia of grade I, while 33 presented dysplasia of grade II. All patients were treated with THA using a cementless Wagner cone prosthesis. Clinical and radiologic evaluations were performed on all patients.ResultsThe mean duration of follow-up was 7.7 years (range 5.4 to 10.5). The Harris hip score (HHS) improved from 63 ± 9 (range 55 to 70) pre-operatively to 92 ± 8 (range 88 to 100) at the last follow-up. The HHS at the most recent follow-up was excellent in 66% of patients (34 hips), good in 26% (14 hips), fair in 6% (3 hips), and poor in 2% (1 hip). Radiographic evaluation demonstrated excellent osteointegration of the implants. Stem subsidence was present in three stems, and the range of stem subsidence was 2 mm in two stems (3.9%) and 3 mm in one stem (1.9%). Femoral osteolysis was observed in nine hips (18%) in the proximal zones, and no distal osteolysis was noted. Heterotopic ossification was observed in three hips (5.8%); of these, two were classified as Brooker’s grade 1, and one was classified as Brooker’s grade 2 at the most recent follow-up. None of the implants were revised.ConclusionsBased on the tapered shape and free setting of anteversion, the Wagner cone femoral stem facilitates its implantation in dysplastic hips. Therefore, this series of short stems with a smaller diameter can ensure safe implantation in narrow medullary canals, especially in young DDH patients with a small physique.Trial registrationRegistration Number: ChiCTR-ORC-17011181.Reg Date: 2017-04-19 00:44:59Retrospective registration
Highlights
Developmental hip dysplasia (DDH) may lead to severe acetabular and femoral abnormalities that can render total hip arthroplasty (THA) challenging, especially in DDH patients with a small physique
Developmental hip dysplasia (DDH) consists of abnormal development of the hip joint that is characterized by anatomical alterations involving both the acetabulum and the femur [1, 2]
A series of short stems are available in 12 diameters from 6.4 to 15.4 mm to appropriately fit the intramedullary canal in DDH patients with a small physique [14]
Summary
Developmental hip dysplasia (DDH) may lead to severe acetabular and femoral abnormalities that can render total hip arthroplasty (THA) challenging, especially in DDH patients with a small physique. In some Asian DDH patients with a small physique, the femur usually presents with a short skeleton and an excessive narrow canal [6]. Total hip arthroplasty (THA) is technically difficult in such small-proportioned patients because most conventional cemented or cementless femoral components are often difficult to implant in the narrow femoral canal and require slight version correction of the femoral stem [6,7,8,9]. The Wagner cone prosthesis hip stem was designed for uncemented fixation in challenging bone conditions at the proximal femur, such as proximal femoral deformities, especially in DDH patients [1]. A series of short stems are available in 12 diameters from 6.4 to 15.4 mm to appropriately fit the intramedullary canal in DDH patients with a small physique [14]
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