Long Term Outcomes and Survivorship of Bilateral Lower Limb Arthroplasties in Patients with Multiple Epiphyseal Dysplasia

Abstract

Background: Multiple epiphyseal dysplasia (MED) a rare form of skeletal dysplasia with early-onset osteoarthritis affecting the hip and knee joints. There is paucity of evidence regarding the long term outcomes of arthroplasty in this patient cohort. This is the first study to describe the outcomes of bilateral arthroplasty of the hip and knee in patients with MED. Methods: A prospective study of patients with MED who underwent bilateral staged total hip arthroplasty (THA) and bilateral simultaneous total knee arthroplasty (TKA) between July 2013 to April 2014. Preoperative and postoperative clinical and radiographic assessment including functional outcomes namely Merle d’aubigne score, Harris hip score (HHS), Knee society score (KSS) and numeric rating scale (NRS) for pain were recorded in prospective database and evaluated. Results: 3 patients (female - 1 / male - 2) with MED who underwent bilateral lower limb arthroplasty of the hip and knee were reviewed periodically with an average followup of 7.31 years. Mean preoperative Merle d'Aubigné score (6.33 ± 0.58), HHS (31.83 ± 5.31) and KSS (28.67 ± 7.97) increased following bilateral lower limb arthroplasty with mean postoperative Merle d'Aubigné score (16.33 ± 0.58), HHS (84.33 ± 5.99) and KSS (86.33 ± 7.09) (P<0.001). Mean NRS decreased from 7.33 ± 0.58 in the preoperative period to 0.67 ± 0.58 at the most recent followup (P<0.001). One patient had heterotrophic ossification following THA. There were no revisions. Conclusions: Bilateral lower limb arthroplasty of the hip and knee is a good treatment option to restore function and mobility in MED patients with advanced degenerative arthritis. Careful preoperative planning, meticulous surgical techniques, patient focussed postoperative rehabilitation with multidisciplinary team approach are vital to ensure good functional outcomes and implant survivorship.