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Scientific Articles   |    
Total Hip Arthroplasty with Cement and without Acetabular Bone Graft for Severe Hip DysplasiaA Concise Follow-Up, At a Minimum of Twenty Years, of a Previous Report*
A.S. Klapach, MD1; J.J. Callaghan, MD1; K.A. Miller, MD1; D.D. Goetz, MD2; P.M. Sullivan, MD2; D.R. Pedersen, PhD1; R.C. Johnston, MD1
1 Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, 01073 JPP, 200 Hawkins Drive, Iowa City, IA 52242. E-mail address for J.J. Callaghan: john-callaghan@uiowa.edu
2 Des Moines Orthopedic Surgeons, 6001 Westown Parkway, West Des Moines, IA 50266
View Disclosures and Other Information
McQueary FG, Johnston RC. Coxarthrosis after congenital dysplasia. Treatment by total hip arthroplasty without acetabular bone-grafting. J Bone Joint Surg Am. 1988;70:1140-4.
MacKenzie JR, Kelley SS, Johnston RC. Total hip replacement for coxarthrosis secondary to congenital dysplasia and dislocation of the hip. Long-term results. J Bone Joint Surg Am. 1996;78:55-61.
In support of their research or preparation of this manuscript, one or more of the authors received the Veterans Administration Merit Award; National Institutes of Health Grants AR 43314, AR 46601, and AR 047653; and funding from DePuy. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (DePuy). Also, a commercial entity (DePuy) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Original Publications
Investigation performed at the Iowa Methodist Medical Center, Des Moines, Iowa, and the Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Feb 01;87(2):280-285. doi: 10.2106/JBJS.D.02130
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Abstract

We previously evaluated a cohort of fifty-three patients with severe hip dysplasia (Crowe Type-II, III, or IV subluxation) who underwent a total of sixty-six Charnley total hip arthroplasties. The acetabular component was placed at the anatomic hip center, the superolateral defect was filled with cement, and no bone-grafting was used to supplement the acetabular wall. All but one patient, who was lost to follow-up, were followed until death or for a minimum of twenty years. Radiographic and functional follow-up data were collected prospectively. This retrospective review included twenty-four patients (thirty-four hips) who were alive at a minimum of twenty years following the surgery.

Fourteen (22%) of the sixty-five hips underwent revision of a component, with eleven of the revisions performed because of aseptic loosening. Eight of those eleven hips underwent revision because of acetabular loosening alone; two, because of femoral loosening alone; and one, because of loosening of both components. The combined prevalence of revision because of aseptic loosening of the acetabular component and radiographic evidence of failure of the acetabular component was 28% (eighteen hips). With the numbers available, the need for acetabular revision was not associated with the percentage of cement coverage (p = 0.362) or the Crowe classification (p = 0.159). At a minimum of twenty years postoperatively, the survivorship of the acetabular component was 86% ± 8% with revision because of aseptic loosening as the end point and 82% ± 10% with revision because of aseptic loosening or radiographic evidence of loosening as the end point. The results that we evaluated at a minimum of twenty years after use of this technique can be compared with the results of other techniques in studies with similar long-term follow-up periods.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Robert Poss MD
    Posted on March 29, 2005
    Editor Note
    Journal of Bone and Joint Surgery

    The corresponding author of this article has been invited to respond to Dr. Eskelinen, et al but has not done so.

    Antti P. Eskelinen, M.D.
    Posted on March 03, 2005
    TOTAL HIP ARTHROPLASTY WITH CEMENT AND WITHOUT ACETABULAR BONE GRAFT FOR SEVERE HIP DYSPLASIA.
    Dept. Orthopedics & Traumatology, Helsinki University Central Hospital, Helsinki, Finland

    To the Editor:

    We read with interest the article, “Total Hip Arthroplasty with Cement and without Acetabular Bone Graft for Severe Hip Dysplasia” (2005: 87; 280-5), by Klapach et al., in which the authors reported the results of total hip arthroplasty for fifty-six patients with severe hip dysplasia. The authors had placed the acetabular component at the anatomic hip center, the superolateral defect was filled with cement, and no bone- graft was used to supplement the acetabular wall. Minimum follow-up of twenty years after surgery was presented.

    While the study was well-conceived and executed. We believe, however, that there were serious shortcomings in the review of the literature presented in the article. In Table IV the authors compared the results of their surgical technique with other published techniques for arthroplasty in patients with developmental dysplasia. We were surprised to find out, that previously published, excellent European studies by Hartofilakidis et al. (1,2,3) and Paavilainen (4,5) were neglected in the Discussion.

    In their classical article published in the Journal of Bone and Joint Surgery in 1996, Hartofilakidis et al. presented a classification of acetabular deficiencies, and results of total hip arthroplasty combined with acetabuloplasty in sixty-six patients with developmental dysplasia of the hip (DDH) (1). In 1998, Hartofilakidis et al. published results of the same technique in sixty-seven patients with high congenital dislocation of the hip (2). Recently they published long-term results of 229 total hip arthroplasties in 168 patients with DDH in the Journal of Bone and Joint Surgery (3).

    Paavilainen et al. reported short-term results of 100 cementless total hip replacements in 52 severely dysplastic and 48 totally dislocated hips (4). In 1993, Paavilainen et al. reported the results of sixty-seven dislocated or severely dysplastic treated with cementless total hip arthroplasty (5). The authors used distal advancement of the greater trochanter and anatomic replacement of the acetabular component at the anatomic site with good results. For patients with previous low-seated Schanz osteotomy, the authors recommended a segmental angular correction and shortening osteotomy fixed with a modular fluited stem.

    We feel, that results of these excellent studies should be presented and discussed, whenever results of total hip arthroplasty for DDH are presented in peer-reviewed orthopedic journals.

    Yours sincerely,

    Antti Eskelinen, MD, Consultant Orthopedic Surgeon

    Ville Remes, MD, PhD, Consultant Orthopedic Surgeon

    Department of Orthopedics and Traumatology Helsinki University Central Hospital P.O. Box 266, 00029 HUS Helsinki, Finland

    References

    1. Hartofilakidis G, Stamos K, Karachalios T, Ioannidis TT, Zacharakis N. Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg Am. 1996;78:683- 92.

    2. Hartofilakidis G, Stamos K, Karachalios T. Treatment of high dislocation of the hip in adults with total hip arthroplasty. Operative technique and longterm clinical results. J Bone Joint Surg Am. 1998;80:510 -7.

    3. Hartofilakidis G, Karachalios T. Total hip arthroplasty for congenital hip disease. J Bone Joint Surg Am. 2004;86:242-50.

    4. Paavilainen T, Hoikka V, Solonen KA. Cementless total replacement for severely dysplastic or dislocated hips J Bone Joint Surg Br. 1990;72:205-11.

    5. Paavilainen T, Hoikka V, Paavolainen P. Cementless total hip arthroplasty for congenitally dislocated or dysplastic hips. Technique for replacement with a straight femoral component. Clin Orthop. 1993;297:71- 81.

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