Total Joint Arthroplasty in Patients With Achondroplasia: Comparison of 90-Day Adverse Events and 5-Year Implant Survival

Abstract

Background Achondroplasia is the most common skeletal dysplasia, and total joint arthroplasty of the hip and/or knee in this patient population may present unique challenges. Methods All patients undergoing primary total hip or total knee arthroplasty (THA or TKA) for osteoarthritis in the 2010-2019 PearlDiver Mariner administrative database with least 90 days of postoperative follow-up were identified. Those with achondroplasia were matched 1:10 to patients without achondroplasia based on age, sex, and medical comorbidities. Ninety-day adverse events were assessed and compared using multivariate logistic regression. Five-year implant survival was determined and compared with Kaplan-Meier implant survival curves. Significance was set at P < .05. Results For THA, 150 patients with achondroplasia were matched to 1484 patients without and had significantly higher 90 days odds of surgical site infection (odds ratio [OR] = 3.49, P = .005) and readmission (OR = 2.35, P = .016). For TKA, 285 patients with achondroplasia were matched to 2828 without and had higher odds of aggregated any adverse event (OR = 1.52, P = .006) and transfusion (OR = 2.31, P < .001). Rates of the other studied adverse events were not significant for either set of the analyses. At 5 years, implant survival for those with and without achondroplasia was not different for those undergoing THA ( P = .321) or TKA ( P = .910). Conclusions The present study represents the largest cohort of patients with achondroplasia undergoing total joint arthroplasty to date. Although several short-term adverse events had greater odds for those with achondroplasia, 5-year survival was not different for those with or without achondroplasia after THA or TKA, supporting confidence in longer term implant success.

Total hip arthroplasty in patients with common pediatric hip orthopedic pathology

“…Statistically significant results were found in the analysis of radiographic values for head size, preoperative, and postoperative offset, all of which were higher in the control group. Moore et al 40 examined postoperative complications within 90 days in patients with achondroplasia. They found no significant difference in the overall complication rate of 90 days after the surgery for individual complications, but did find a statistically significant difference in the rate of postoperative surgical site infections and readmission within the first 90 days after the surgery.…”

“…One case series, one case report, and one case-control retrospective study were found; [39][40][41] the search time frame was 8 years (2015-2023). A total of 320 THAs were performed in patients with achondroplasia, comprising 234 females and 67 males with a median age of 59.8 years at the time of THA.…”

Primary Staged Bilateral Total Hip Arthroplasty in a Patient With Short Stature and Hartofilakidis Type I Developmental Dysplasia of the Hip

“…In a review of 150 cases of THA in achondroplasia, with varying prostheses and surgical approaches, in comparison to an unaffected matched cohort, a univariate analysis revealed a significant increase in surgical site infection and readmission (3.49 and 2.53 odds ratio respectively in the multivariate analysis) in the immediate postoperative period. However, 95% remained unrevised at 5 years [ 19 ].…”

Total Hip Arthroplasty with Extra-small Femoral Stems in Extremely Hypoplastic Femurs: A Case-Series Study

“…These challenges are particularly pronounced in patients with preexisting anatomical deformities of the hip, such as sequelae of previous infection, genetic musculoskeletal disorders, or juvenile inflammatory arthritis. 23 24) To achieve adequate insertion and fixation of the femoral stem in hypoplastic femurs, surgeons have to select the smallest available premade stem. Moreover, additional osteotomy or trochanteric osteotomy is required, which is surgically demanding and leads to the risk of other complications.…”