TOTAL HIP ARTHROPLASTY AFTER FEMORAL OSTEOTOMY

Abstract

Purpose: Total hip arthroplasty after failure of femoral osteotomy raises high risk of complications. Outcome has been controversial. The purpose of this retrospective analysis was to evaluate the difficulties and results.

Material and methods: Between March 1974 and January 1995, 68 patients (82 hips), 51 women and 17 men, mean age 59±11.5 years (32–84) underwent surgery. Initial indications were mainly acetabular and/or femoral dysplasia (n=47 hips) or congenital dislocation (n=21 hips). Mean time between osteotomy and arthroplasty was 13.8±8.4 years (10 months-45 years). We used cemented titanium femoral stems (Ceraver Ostal) with an alumina (n=66) or polyethylene (n=16) cup. An alumina-alumina bearing was used in 67 hips (81%). Functional outcome was assessed with the Postel-Merle-d’Aubligné score. Radiological analysis searched for lucent lines and signs of wear. The actuarial survival was determined.

Results: One patient (1 hip) was lost to follow-up. Thirteen patients (14 hips) died of intercurrent causes. Six hips required revision for aseptic loosening (isolated cup loosening in five and bipolar loosening in one) at 8.5 years on average (4.5–12). There were 22 intraoperative complications (27%) including 18 fractures or femoral stem misalignments and four cases of damage to the acetabular fundus. Other complications included one postoperative dislocation, two sciatic nerve palsies with partial recovery, and one non-union of the greater trochanter. There were no infections. At maximum follow-up (11.8±4.7 years, ragne 5.4–20), the mean functional score was 16.5 (15–18) versus 9.9 (6–14) preoperatively (p< 0.05). There were no femoral lucent lines. A complete lucent line around the cup was observed in eleven hips including six with a massive cemented alumina cup. Considering revision for aseptic loosening as failure, cumulative survival at 12 years was 82% (95%IC 67–96%) for the cup and 98% (92–99.7%) for the femoral stem.

Discussion: These results confirm the high risk of intraoperative complications of total hip arthroplasty performed for failure of femoral osteotomy. Architectural changes expose these patients to technical problems. The survival of the implants appears to be relatively unaffected by the prior procedure but the functional results are slightly less satisfactory then for primary arthroplasties.