To our knowledge, no study has compared the long-term results of cemented and hybrid total hip arthroplasty (THA) in patients with osteoarthritis (OA) secondary to congenital hip disease (CHD). This is a demanding procedure that may require special techniques and implants. Our aim was to compare the long-term outcome of cemented low-friction arthroplasty (LFA) and hybrid THA performed by one surgeon. Between January 1989 and December 1997, 58 hips (44 patients; one man, 43 woman; mean age 56.6 years (25 to 77)) with OA secondary to CHD were treated with a cemented Charnley LFA (group A), and 55 hips (39 patients; two men, 37 women; mean age 49.1 years (27 to 70)) were treated with a hybrid THA (group B), by the senior author (GH). The clinical outcome and survivorship were compared.Aims
Patients and Methods
We evaluated the outcome of 41 consecutive Charnley
low-friction arthroplasties (LFAs) performed by a single surgeon
in 28 patients aged ≤ 35 years at operation between 23 and 36 years
previously. There were 20 women and eight men with a mean age of
32 years (23 to 35) at surgery. Two patients (three hips) were lost
to follow-up at 12 and 17 years post-operatively, respectively,
and one patient (one hip) died at 13 years post-operatively. These patients
were excluded from the final evaluation. The survival rate of the
acetabular components was 92.7% (95% confidence interval (CI) 88.7
to 96.7) at ten years, 67.1% (95% CI 59.75 to 74.45) at 20 years
and 53.2% (95% CI 45.3 to 61.1) at 25 years. For the femoral component
the survival was 95.1% (95% CI 91.8 to 98.5) at ten years, 77.1%
(95% CI 73.9 to 80.3) at 20 years and 68.2% (95% CI 60.7 to 75.8)
at 25 years. The results indicate that the Charnley LFA remains
a reasonable choice in the treatment of young patients and can serve
for comparison with newer techniques and implants. Cite this article:
We report the results at a mean of 24.3 years
(20 to 32) of 61 previously reported consecutive total hip replacements carried
out on 44 patients with severe congenital hip disease, performed
with reconstruction of the acetabulum with an impaction grafting
technique known as cotyloplasty. The mean age of the patients at
operation was 46.7 years (23 to 68) and all were women. The patients
were followed post-operatively for a mean of 24.3 years (20 to 32), using
the Merle d’Aubigné and Postel scoring system as modified by Charnley,
and with serial radiographs. At the time of the latest follow-up,
28 acetabular components had been revised because of aseptic loosening
at a mean of 15.9 years (6 to 26), and one at 40 days after surgery
because of repeated dislocations. The overall survival rate for aseptic
failure of the acetabular component at ten years was 93.1% (95%
confidence interval (CI) 86.5 to 96.7) when 53 hips were at risk,
and at 23 years was 56.1% (95% CI 49.4 to 62.8), when 22 hips remained
at risk. These long-term results are considered satisfactory for
the reconstruction of an acetabulum presenting with inadequate bone
stock and circumferential segmental defects. Cite this article:
