Total hip arthroplasty with femoral osteotomy and modular prosthesis for proximal femoral deformity

Abstract

Background Severe anatomical abnormalities exist in proximal femoral deformities (PFDs). Total hip arthroplasty (THA) is associated with drawbacks such as high surgical complexity, long operation time, requirement for high surgical skills, high incidences of postoperative complications, and poor efficacy. Objective This study aimed to investigate the short-term efficacy of THA with femoral osteotomy and modular prosthesis implantation for femoral fixation and reconstruction in patients with PFD. Methods A total of 15 patients (15 hips) with rotational PFD treated with THA with femoral osteotomy and modular prosthesis between August 2012 and September 2014 were included. There were 10 male (10 hips) and 5 female (5 hips) patients. Preoperative limb shortening, intraoperative osteotomy length, and postoperative limb length were recorded. The Harris hip score was adopted for assessing the clinical results. Postoperative radiography was performed to observe the prosthesis position, as well as the presence or absence of abnormalities such as osteolysis, loosening, and subsidence of the prosthesis. Results All 15 patients were followed up postoperatively, with a mean follow-up duration of 62.5 (range 20–85) months. The postoperative limb-length discrepancy (1.0 ± 0.5 cm) was significantly less than the preoperative discrepancy (3.2 ± 1.2 cm) ( t = − 2.501, P = 0.002). The Harris hip score significantly improved from a mean of 47.2 ± 9.9 points preoperatively to 89.7 ± 3.9 points during the last follow-up visit ( t = 21.31, P = 0.001). Immediate postoperative radiographs showed restoration of limb alignment after femoral osteotomy, excellent initial press-fit fixation of the S-ROM prosthesis, and good canal filling. According to Engh’s criteria, all 15 hips were graded as ingrown bones. No infection, prosthesis loosening, periprosthetic fracture, or other complications occurred. Conclusion In patients with femoral deformities treated with THA, precise osteotomy, good coaptation of the osteotomy surfaces, and correct choice of modular S-ROM prostheses for femoral reconstruction and fixation remain the key factors for surgical success.

Nonsurgical Management of Distal Femur Stem Cortical Perforation

“…Metaphysis stability is not compromised by the DFSCP. The proximal sleeve of S-ROM with porous coating helps maintain metaphysis stability and prevent stem subsidence [10]. At perforation, the distal tip of the stem is impacted into medial cortical bone, providing axial stability.…”

“…At perforation, the distal tip of the stem is impacted into medial cortical bone, providing axial stability. The cylindrical stem of S-ROM connects distal and proximal femoral segments and works like an intramedullary nail [10,11]. In addition, the distal flutes and fins in the stem can provide rotation stability [12,13].…”

Locking compression plate fixation of femoral intertrochanteric fractures in patients with preexisting proximal femoral deformity: a retrospective study

“…The choice of osteotomy and internal fixation mainly depends on the degree of anatomical abnormalities [ 3 ]. Deng et al [ 6 ] described that in patients with femoral deformities without associated fractures, THA, precise osteotomy, and correct choice of prostheses were key factors for femoral reconstruction and fixation. Kim et al [ 23 ] reported that total hip arthroplasty with trochanteric ostectomy rendered favorable results for patients with deformity of the proximal femur.…”

“…On the other hand, proximal femoral deformity in adults can be induced by a wide variety of primary diseases, including poliomyelitis sequela, proximal femoral fibrous dysplasia, malunion after fracture, internal fixation implants failure, and the residual deformities from previous osteotomy [ 3 – 5 ], which may cause unpredictable pathological and biomechanical changes of the proximal femur and femoral osteotomy. Therefore, total hip arthroplasty for femoral reconstruction and fixation are conventional treatment options used for patients without proximal femoral fractures [ 6 ].…”

Cementless Hip Implants: History and Current Status of the Issue

“…Однако в ряде случаев сложно добиться надежной первичной фиксации при использовании стандартных компонентов [109]. При деформациях бедренной кости, выраженной потере костной массы, некоторых врожденных сос тояниях, когда необходимо наряду с заменой сус тава выполнить реконструкцию проксимально-го отдела бедра, может возникнуть необходимость в раздельной подготовке метафиза и диафиза бед ра для установки ножки [110,111]. Модульные ножки предназначены для адекватного восстановления положения головки бедренной кости и достижения хорошего контакта метафизарной втулки с независимой фиксацией ножки в диафизе.…”