Total Hip Arthroplasties for Hartofilakidis Type C1 and C2 High Hip Dislocations Demonstrate Similar Survivorship and Clinical Function at Minimum 10-year Follow-up With Cementless Implants

Abstract

BackgroundThis study aimed to determine the differences in survivorship, clinical function, and complications among patients who have Hartofilakidis Type C1 or C2 developmental dysplasia of the hips and underwent total hip arthroplasty (THA) with cementless implants. MethodsThis retrospective study identified 84 Hartofilakidis Type C hips that underwent THA between 2002 and 2011 with a minimum 10-year follow-up (mean, 13 years, range, 10 to 19 years). Survivorship, latest Harris Hip Scores and satisfaction levels, radiographic outcomes (eg, implant stability, rate and length of subtrochanteric shortening transverse osteotomy, leg-length discrepancy, cup position, and orientation), as well as complications (eg, dislocation, periprosthetic fracture, periprosthetic joint infection) were compared to analyze the differences between Hartofilakidis C1 and C2 hips. ResultsBetween C1 and C2 hips, no difference existed in the 15-year cumulative Kaplan-Meier survivorship, with the endpoint defined as any reoperation (93.1 versus 90.8%), aseptic loosening combined with periprosthetic joint infection (93.1 versus 96.2%), or aseptic loosening (94.8 versus 96.2%), latest Harris Hip Score (87.1 versus 86.1%), vertical (6.1 versus 6.0 mm) and horizontal (11.5 versus 10.3 mm) distance to the anatomic center of rotation, postoperative leg length discrepancy (11.2 versus 15.5 mm), dislocation (5.2 versus 11.5%), stem aseptic loosening (6.9 versus 7.7%), periprosthetic fracture (3.4 versus 7.7%), and intraoperative femoral fracture (32.8 versus 23.1%). However, Type C2 hips demonstrated more severe preoperative leg length discrepancy (66.9 versus 42.5 mm) and required a higher percentage of subtrochanteric shortening transverse osteotomies (84.6 versus 36.2%) that were longer (33.7 versus 26.47 mm) than the Type C1 hips. ConclusionWith cementless cups positioned near the anatomic acetabular center and cementless stems combined with subtrochanteric shortening transverse osteotomies, THAs for the Hartofilakidis Type C1 and C2 hips demonstrated similar survivorship, clinical function, and complications.