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Abstract
Purpose
THA in patients with dysplastic hips secondary to infection of the hip joint is a technically challenging procedure because of long-standing anatomic abnormalities of the bone and soft tissues. Low friction, low wear, alumina-on-alumina bearing surfaces are an attractive alternative to conventional metal-on-polyethylene articulation, and may offer a promising option for young, active patients. Here, we evaluated the results of a modern alumina-on-alumina THA performed in patients with sequelae of the hip joint infection, with a 5-year minimum follow-up.
Materials and Methods
We retrospectively analyzed 48 primary cementless alumina-on-alumina THAs that had been performed in patients who had sequelae of the hip joint infection between November 1997 and December 2000. The average age of the patients at the time of the index arthroplasty was 36.7 years (range, 18-63 years) and41 patients were younger than 50 years old. They were followed-up for more than 5 years (average, 82 months range, 60-103 months).
Results
All hips had no recurrence of a hip joint infection. The mean Harris hip score improved from 61.6 points preoperatively to 92.2 points at the latest follow-up. All of the implants had radiographic evidence of bone ingrowth and no radiological loosening. During the follow-up period, nocup or stem was revised. Periprosthetic osteolysis was suspected in one hip. Leg length discrepancy was corrected from 26.2 mm preoperatively to 9.5 mm postoperatively. Postoperatively, the hip center migrated 11.7 mm medially and 5.2 mm inferiorly. Nonunion of the osteotomized greater trochanter occurred in two hips, but no postoperative infection or ceramic failure was observed.
Conclusion
The 5-year minimum follow-up clinical results of modern alumina-on-alumina THA in patients with sequelae of the hip joint infection were encouraging. Our results show that alumina-on-alumina articulation offers a reliable alternative solution for young patients with technically difficult arthroplasties.
Figures and Tables
Fig. 1
A 44-year-old man underwent total hip arthroplasty using alumina-on-alumina bearing surfaces. (A) A preoperative radiograph shows type 1 deformity in left hip. There is complete resorption of the femoral head and neck with a high-riding greater trochanter, a dysplastic acetabulum, and a small femoral canal. (B) Postoperative radiograph obtained at 2 weeks after surgery. (C) Radiograph taken 5 years and 2 months after surgery. There is no evidence of periprosthetic osteolysis or implant loosening, but the non-union of the greater trochanter is shown.
Fig. 2
A 46-year-old man underwent total hip arthroplasty using alumina-on-alumina bearing surfaces. (A) Preoperative radiograph shows the type 2 deformity in the left hip. There is partial resorption of the femoral head and a dysplastic acetabulum, but the width of femoral canal is relatively normal. (B) Postoperative radiograph obtained at 2 weeks after surgery. (C) Radiograph taken 5 years and 9 months after surgery. No evidence of periprosthetic osteolysis or implant loosening was observed.
Fig. 3
A 20-year-old woman underwent alumina-on-alumina total hip arthroplasty. (A) Preoperative radiograph shows the type 3 deformity in left hip. There is complete destruction of the hip joint, but the shape and size of the acetabulum and femoral canal are relatively normal. (B) Postoperative radiograph obtained at 2 weeks after surgery. (C) Radiograph taken 7 years and 3 months after surgery. There is no evidence of periprosthetic osteolysis or implant loosening.
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