Outcomes after THA in Patients with High Hip Dislocation after Childhood Sepsis

Abstract

To ascertain whether THA in patients with high dislocation after childhood sepsis would relieve pain and improve function, we assessed the rate of postoperative infection, improvement in Harris hip and WOMAC scores, and improvement in range of motion after the THA in 62 patients (62 hips) with high dislocation (Crowe Type 4) after childhood sepsis. The revision rate and the incidence of complications also were assessed. The mean age of the patients was 47.5 years. The minimum followup was 13 years (mean, 15.2 years; range, 13-17 years). One patient had persistent infection. The mean preoperative Harris hip score of 55 points improved to 89 points at the final followup, and the mean preoperative WOMAC score of 65 points improved to 42 points. The mean combined preoperative arc of range of motion of 197°improved to 275°. Four cups (6%) and three stems (5%) were revised. Complications developed in nine hips (15%), but the rate of infection was low. Improved surgical technique and design of components provided favorable results for total hip replacement performed for complications of childhood sepsis in these young and active patients.

Femoral Shortening in Total Hip Arthroplasty for High Developmental Dysplasia of the Hip

“…Intraoperative fracture during insertion of the femoral component has been reported to range from 5% to 22% [2,8,9,18,20], and nonunion has been reported to vary between 8% and 29% [13,14,30]. We identified no perioperative fractures and speculate the prophylactic use of cerclage wiring minimized that risk.…”

“…Survivorship analysis predicted an overall 15-year survival rate of 76% (86% for the cup and 82% for the stem). Kim et al [18] followed 62 hips with high dislocation after childhood sepsis for 13 to 17 years. The Harris hips score was on average 89, and the 15-year survival rates of the uncemented acetabular and femoral components were 94% and 95%, respectively.…”

“…A traditional method has been to perform osteotomy at the proximal part of the femur with distal advancement of the greater trochanter [9,13]. However, to preserve the proximal femoral anatomy, and to avoid the problems associated with reattachment and healing of the greater trochanter, subtrochanteric [2,18,20,27], diaphyseal [23], or distal [19] shortening osteotomy of the femur have been described. Disadvantages of osteotomy are the risk of fracture or nonunion.…”

“…Disadvantages of osteotomy are the risk of fracture or nonunion. Furthermore, recurrent dislocations may occur, and overall the rate of complications has been reported to range from approximately 15% to 40% [2,9,18,20,23,27].…”

Oblique femoral shortening osteotomy in total hip arthroplasty for high dislocation in patients with hip dysplasia

“…The incidence of complications is higher than in standard cases, with intra-operative fracture rates from 5 to 22 % [2,9,33,34] and non-union rates from 8 to 29 % [2,35,36]. In our series, one case of non-union was recorded that was asymptomatic and required no further surgery.…”