Reverse hybrid total hip arthroplasty in select patients

Abstract

Abstract Purpose To report the result of cemented cups and cementless stems (reverse hybrid) in 17 total hip arthroplasties (THAs). Methods From January 2003 to January 2008, 17 hips (17 patients) received reverse hybrid THAs and were included in this study. The mean patient age was 70 years (range, 52–81 years). The reasons for a reverse hybrid THA were an acetabulum too small to accommodate a metal shell, a severely osteoporotic acetabulum with thin subchondral bone, in which press-fit and screw fixation of the metal shell was deemed unstable, irradiation arthritis, and sequelae of sepsis, while the proximal femoral canal is normally shaped for a press-fit stem. Demographic data, surgical techniques, reasons for surgery, Harris hip score, and complications were reported. Results The average Harris hip score was 84.4 (range, 48–100) points at an average follow-up of 40.1 months (range, 24–73 months). One patient had a Vancouver type 2B fracture and received reoperation with open reduction. The patient had a 3-cm subsidence of the stem and thigh pain at follow-up. Another patient had an asymptomatic 1.5-cm subsidence of the stem. No loosening, migration, or progressive radiolucent lines around the cup were noted in any patient. Conclusion Reverse hybrid THA was associated with good clinical and radiographic results of the cemented cups in patients with the four selection criteria. It is noteworthy that one periprosthetic femoral fracture and one asymptomatic stem subsidence occurred. The lower average hip score with reverse hybrid THA than with ordinary THA is attributable to major comorbidities in the patients.