CUSTOM-MADE NON-CEMENTED FEMORAL STEM FOR SEQUELAR DEVELOPMENTAL DYSPLASIA OF THE HIP: STUDY AT TWO TO TWELVE YEARS FOLLOW-UP

X. Flecher; E. Ryembault; J.M. Aubaniac

doi:10.1302/0301-620X.86BSUPP_I.0860040

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CUSTOM-MADE NON-CEMENTED FEMORAL STEM FOR SEQUELAR DEVELOPMENTAL DYSPLASIA OF THE HIP: STUDY AT TWO TO TWELVE YEARS FOLLOW-UP

X. Flecher
E. Ryembault
J.M. Aubaniac

CUSTOM-MADE NON-CEMENTED FEMORAL STEM FOR SEQUELAR DEVELOPMENTAL DYSPLASIA OF THE HIP: STUDY AT TWO TO TWELVE YEARS FOLLOW-UP

Flecher X, Ryembault E, Aubaniac J. CUSTOM-MADE NON-CEMENTED FEMORAL STEM FOR SEQUELAR DEVELOPMENTAL DYSPLASIA OF THE HIP: STUDY AT TWO TO TWELVE YEARS FOLLOW-UP. Orthop Procs. 2004;86-B(SUPP_I):40-40. doi:10.1302/0301-620X.86BSUPP_I.0860040

Flecher, X., et al. “CUSTOM-MADE NON-CEMENTED FEMORAL STEM FOR SEQUELAR DEVELOPMENTAL DYSPLASIA OF THE HIP: STUDY AT TWO TO TWELVE YEARS FOLLOW-UP.” Orthopaedic Proceedings, vol. 86-B, no. SUPP_I, 2004, pp. 40-40., https://doi.org/10.1302/0301-620X.86BSUPP_I.0860040

Flecher, X., Ryembault, E., & Aubaniac, J. (2004). CUSTOM-MADE NON-CEMENTED FEMORAL STEM FOR SEQUELAR DEVELOPMENTAL DYSPLASIA OF THE HIP: STUDY AT TWO TO TWELVE YEARS FOLLOW-UP. Orthopaedic Proceedings, 86-B(SUPP_I), 40-40. https://doi.org/10.1302/0301-620X.86BSUPP_I.0860040

Flecher, X., Ryembault, E. and Aubaniac, J. (2004) “CUSTOM-MADE NON-CEMENTED FEMORAL STEM FOR SEQUELAR DEVELOPMENTAL DYSPLASIA OF THE HIP: STUDY AT TWO TO TWELVE YEARS FOLLOW-UP.” Orthopaedic Proceedings, 86-B(SUPP_I), pp. 40-40. Available at: https://doi.org/10.1302/0301-620X.86BSUPP_I.0860040

Flecher, X., E. Ryembault, and J.M. Aubaniac. “CUSTOM-MADE NON-CEMENTED FEMORAL STEM FOR SEQUELAR DEVELOPMENTAL DYSPLASIA OF THE HIP: STUDY AT TWO TO TWELVE YEARS FOLLOW-UP.” Orthopaedic Proceedings 86-B, no. SUPP_I (2004): 40-40. https://doi.org/10.1302/0301-620X.86BSUPP_I.0860040

Flecher X, Ryembault E, Aubaniac J. CUSTOM-MADE NON-CEMENTED FEMORAL STEM FOR SEQUELAR DEVELOPMENTAL DYSPLASIA OF THE HIP: STUDY AT TWO TO TWELVE YEARS FOLLOW-UP. Orthop Procs. 2004 Jan 1;86-B(SUPP_I):40-40. https://doi.org/10.1302/0301-620X.86BSUPP_I.0860040

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Abstract

Purpose: Hip prosthesis for sequelar developmental dysplasia of the hip is a therapeutic challenge because of the anatomic deformity and the young age of the patients. The purpose of this work was to report results obtained using a non-cemented femoral stem with an intramedullar design and a prosthetic neck custom-made to match individual anatomy observed on preoperative computerised tomographic.

Material and methods: This study included 257 hips with a mean follow-up of 5.6 years. Mean age at implantation was 55 years (range 17–78). The computed tomography study assessed: dislocation according to Crowe, leg length discrepancy, and acetabular anteversion and diameter. The cup was not cemented and was inserted with an anchor hook in the obturator foramen for implantation in the paleoacetabulum. The medullary canal was prepared using a blunt reamer shaped like the definitive prosthesis. The prosthetic neck was designed individually to match the lever arm and anteverion.

Results: There were 174 cases of dysplasia and 83 dislocations (39% grade 1, 30% grade 2, 14% grade 3 and 17% grade 4). Mean lengthening was 39 mm. The mean ante-verion was 28±16° and the mean anteroposterior diameter of the acetabulum was 51 mm. The Harris clinical score improved from 58 points preoperatively to 93 points at last follow-up. The follow-up x-rays showed osteointegration in 88% of the cases with osteolysis in 5% and one stem impaction. The prosthesis had to be changed for six hips: two for infection, one for dislocation and two for nonfixation. The 11-year survival rate was 97%.

Discussion and conclusion: This study illustrates the anatomic sequelae observed in patients with developmental dysplasia of the hip and demonstrates a surgical solution for these problems. There is no correlation between dislocation and the degree of anteversion so it is difficult to assess the difficulty of inserting a non-cemented stem without preoperative computed tomography. The good 11-year survival is encouraging for this young and active population.

The abstracts were prepared by Docteur Jean Barthas. Correspondence should be addressed to him at Secrétariat de la Société S.O.F.C.O.T., 56 rue Boissonade, 75014 Paris.