Abstract
BackgroundDevelopmental dysplasia of the hip (DDH) is a common cause of secondary osteoarthritis (OA) in younger patients, and when end-stage OA develops, a THA can provide a solution. Different options have been developed to reconstruct these defects, one of which is impaction bone grafting combined with a cemented cup. To determine the true value of a specific technique, it is important to evaluate patients at a long-term followup. As there are no long-term studies, to our knowledge, on THA in patients with DDH using impaction bone grafting with a cemented cup, we present the results of this technique at a mean of 15 years in patients with previous DDH.Questions/purposesWe wished to determine (1) the long-term probability of cup revision at a minimum followup of 15 years for cemented acetabular impaction bone grafting in patients with DDH; (2) the radiographic appearance of the bone graft and radiographic signs of implant loosening; and (3) the complications and pre- and postoperative Harris hip scores with cemented THA combined with impaction bone grafting in patients with previous DDH.MethodsBetween January 1984 and December 1995 we performed 28 acetabular impaction bone grafting procedures for secondary OA believed to be caused by DDH in 22 patients; four patients died before 15 years, leaving 24 hips in 18 patients for retrospective analysis at a minimum of 15 years (mean, 20 years; range, 16–29 years). The diagnosis of DDH was made according to preoperative radiographs and intraoperative findings. All grades of dysplasia were included; five patients had Crowe Group I, eight had Group II, nine had Group III, and two had Group IV DDH. No patients were lost to followup. In all cases the acetabular defects were combined cavitary and segmental. Owing to the high number of deaths, we performed a competing-risk analysis to determine the probability of cup revision surgery.ResultsThe competing-risk analysis showed cumulative incidences at 15 and 20 years, with endpoint revision for any reason of 7% (95% CI, 0%–17%), whereas this was 4% (95% CI, 0%–11%) with endpoint revision of the cup for aseptic loosening. Three revision surgeries were performed. Two cup revisions were performed for aseptic loosening at 12 and 26 years. Another cup revision was performed owing to sciatic nerve problems at 2 years. A stable radiographic appearance of the graft was seen in 19 of the 25 unrevised hips. Four hips showed acetabular radiolucent lines and two showed acetabular osteolysis. None of the unrevised cups showed migration or radiographic failure. Postoperative complications included a pulmonary embolus and a superficial wound infection. The Harris hip score improved from 37 (range, 9–72) preoperatively to 83 (range, 42–99) at latest followup.ConclusionsCemented primary THA with the use of impaction bone grafting shows satisfying long-term results in patients with previous DDH. For future research it is important to evaluate this technique in a larger cohort with a long-term followup. Other techniques also should be evaluated at long-term followup to be able to compare different techniques in this important and specific patient group.Level of EvidenceLevel IV, therapeutic study.
Highlights
Developmental dysplasia of the hip (DDH) is a common cause of secondary osteoarthritis (OA) in younger patients, and when end-stage OA develops, THA is a good surgical option [17]
Other techniques should be evaluated at long-term followup to be able to compare different techniques in this important and specific patient group
With revision THA, using the same technique, Schreurs et al [28] reported an 87% survival rate for the cup at 20 years with an endpoint of aseptic loosening. We thought this technique might be an option in primary THA in patients with DDH to repair acetabular defects and possibly provide a durable solution in these difficult primary THAs
Summary
Developmental dysplasia of the hip (DDH) is a common cause of secondary osteoarthritis (OA) in younger patients, and when end-stage OA develops, THA is a good surgical option [17]. With revision THA, using the same technique, Schreurs et al [28] reported an 87% survival rate for the cup at 20 years with an endpoint of aseptic loosening We thought this technique might be an option in primary THA in patients with DDH to repair acetabular defects and possibly provide a durable solution in these difficult primary THAs. To the best of our knowledge, there are no studies that report the long-term outcomes of this technique in primary THA for patients with DDH. As there are no long-term studies, to our knowledge, on THA in patients with DDH using impaction bone grafting with a cemented cup, we present the results of this technique at a mean of 15 years in patients with previous DDH. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained
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