RAPIDLY DESTRUCTIVE DEGENERATION OF THE HIP JOINT: RADIOCLINICAL ASPECTS AND LONG-TERM RESULTS OF TOTAL HIP ARTHROPLASTIES

Abstract

Purpose: Rapidly destructive degeneration of the hip joint is a condition whose relations with habitual degenerative hip disease are poorly understood. This uncommon condition is observed in 5 to 10% of patients with degenerative hips and almost always requires arthroplasty; The objectives of this retrospective study were to determine the distinctive radiological and clinical features of this condition and assess long-term outcome after total hip arthroplasty in these patients.

Material and methods: The study concerned 100 total hip arthroplasties performed between 1984 and 1088 in 67 men and 11 men, mean age 71 years with rapidly destructive degeneration of the hip joint. All arthroplasties were implanted via the transtrochanteric approach with cemented Charnley-Kerboul implants. Mean follow-up was seven years ten months.

Results: There were seven complications: two nonunions of the trochanter, three extensive periprosthetic ossifications, one recurrent case of dislocation, and one late infection by blood stream dissemination. At last follow-up, 95 hips exhibited excellent or very good function (Poste-Merle-d’Aubigné classification). Fixation was stable for 94 ace-tabular implants and 97 femoral implants. Six acetabular implants and three femoral implants had loosened. These femoral loosenings were always associated with acetabular loosening. Four hips required revision surgery: one for non-union of the trochanter, one for septic loosening, and two for asepctic loosening.

Discussion: This study confirmed the radiological definition and the clinical features of this condition and demonstrated the reliability of the pathology examination of the femoral head and the articular capsule. Among the different hypotheses put forward to explain this condition, we cannot retain the presence of joint over-use, or use of anti-inflammatory drugs, nor infirm a micro-crystalline or vascular origin. Nevertheless, the vascular phenomena observed in the femoral head are comparable to those observed in joint lesions subsequent to ischaemia. Total hip arthroplasty causes considerable blood loss, estimated at 2706 ml (haematocrit 35%), apparently much higher than during arthroplasties using an identical technique for patients with the usual form of degenerative hip disease. Excepting this fact, complications, clinical outcome and arthroplasty longevity were not different than those generally observed.