CEMENTLESS TOTAL HIP ARTHROPLASTY FOR HEMOPHILIC ARTHROPATHY: MNIMUM FIVE-YEAR FOLLOW-UP

Abstract

Introduction: The aim of this study is to analyze the mid-term result of cementless total hip arthroplasty(THA) performed in hemophilic arthropathy of the hip.

Materials and Methods: Of the 22 hips (19 patients) that underwent cementless THA under the diagnosis of hemophilic arthropathy from Aug. 1995 to June. 2002, 20 hips (17 patients) that can be followed more than five years were enrolled. The average age was 35.1 years. All of the patients had type A hemophilia. There was no patient who had antibody for factors or positive test for HIV. The mean follow-up period was 99.6 (61–147) months. As a clinical assessment, we evaluated Harris hip score, hip range of motion, amount of transfusion and factor replacement, perioperative bleeding and the problems associated with the use of coagulation factors and the bleeding itself after the surgery. As a radiological assessment, we evaluated the stability and fixation of the components, various bone responses around the implants and complications such as loosening and osteolysis.

Results: The average Harris hip score improved from 62.4 before surgery to 93.6 at the final follow-up. The hip range of motions in all plane significantly increased after the operation. During and after the surgery, an average of 3.2 units of packed RBC was transfused and an average of 46000 units of coagulation factors was injected. All patient obtained significant pain relief and improvement walking ability after the operation. The episode of re-bleeding was observed in four cases. In one of them, severe osteolysis around the pelvis and femoral stem was noted due to a huge pseudotumor. Radiographically, all components except one cup showed stable fixation at the final follow-up. The osteolysis was noted in three cups and three stems each. As a re-operation, one morsellized bone graft for osteolysis and one cup revision for a loosened cup were performed at 134 and 40 months after the index operation. One case of pseudotumor is waiting for the surgery.

Conclusion: Unlike the worrisome results of cemented THA, meticulously performed cementless THA for the moderate or severe hemophilic arthropathy is safe and greatly effective in reducing the pain, increasing the range of hip motion and improving the walking ability. However, special attention should be paid to the possible complications associated with re-bleeding such as pseudotumor around the hip. To obtain best result multidisciplinary team approach is mandatory.