Angular proximal femoral deformities increase the technical complexity of primary total hip arthroplasties (THAs). The goals were to determine the long-term implant survivorship, risk factors, complications, and clinical outcomes of contemporary primary THAs in this difficult cohort.

Our institutional total joint registry was used to identify 119 primary THAs performed in 109 patients with an angular proximal femoral deformity between 1997 and 2017. The deformity was related to previous femoral osteotomy in 85%, and developmental or metabolic disorders in 15%. 53% had a predominantly varus angular deformity. The mean age was 44 years, mean BMI was 29 kg/m², and 59% were female. An uncemented metaphyseal fixation stem was used in 30%, an uncemented diaphyseal fixation stem in 28%, an uncemented modular body stem with metaphyseal fixation sleeve in 24%, and a cemented stem in 18%. Simultaneous corrective femoral osteotomy was performed in 18%. Kaplan-Meier survivorships and Harris hip scores were reported. Mean follow-up was 8 years.

The 10-year survivorships free of femoral loosening, aseptic femoral revision, any revision, and any reoperation were 95%, 93%, 90% and 88%, respectively. Revisions occurred in 13 hips for: aseptic femoral component loosening (3), stem fracture (2), dislocation (2), aseptic acetabular loosening (2), polyethylene liner exchange (2), and infection (2). Preoperative varus angular deformities were associated with a higher risk of any revision (HR 10, p=0.03), and simultaneous osteotomies with a higher risk of any reoperation (HR 3.6, p=0.02). Mean Harris hip scores improved from 52 preoperatively to 82 at 10 years (p<0.001).

In the largest series to date of primary THAs in patients with angular proximal femoral deformities, we found a good 10-year survivorship free from any revision. Varus angular deformities, particularly those treated with a simultaneous osteotomy due to the magnitude or location of the deformity, had a higher reoperation rate.

Keywords: Proximal femoral deformity; dysplasia; femoral osteotomy; survivorship; revision

Level of evidence: Level III, comparative retrospective cohort

Aims

As has been shown in larger animal models, knee immobilization can lead to arthrofibrotic phenotypes. Our study included 168 C57BL/6J female mice, with 24 serving as controls, and 144 undergoing a knee procedure to induce a contracture without osteoarthritis (OA).

Introduction

The constitutional knee anatomy in the coronal plane includes the distal femoral joint line obliquity (DFJLO) which in most patients is in slight valgus positioning. Despite this native anatomy, the mechanical positioning of the femoral component during primary total knee arthroplasty (TKA) often ignores the native DFJLO opting to place the femur in a set degree of valgus that varies upon the practitioner's practice and experience. Unfortunately, this technique is likely to generate high rate of distal lateral femoral overstuffing. This anatomical mismatch might be a cause of anterior knee pain and therefore partly explain the adverse functional outcomes of mechanically aligned (MA) TKA. Our study aims at assessing the relationship between constitutional knee anatomy and clinical outcomes of MA TKA. We hypothesized that a negative relationship would be found between the constitutional frontal knee deformity, the distal femoral joint line obliquity, and functional outcomes of MA TKA with a special emphasize on patellofemoral (PF) specific outcomes.