We describe the results of 81 consecutive revision
total hip replacements with impaction grafting in 79 patients using
a collared polished chrome–cobalt stem, customised in length according
to the extent of distal bone loss. Our hypothesis was that the features
of this stem would reduce the rate of femoral fracture and subsidence
of the stem. The mean follow-up was 12 years (8 to 15). No intra-operative
fracture or significant subsidence occurred. Only one patient suffered
a post-operative diaphyseal fracture, which was associated with
a fall. All but one femur showed incorporation of the graft. No
revision for aseptic loosening was recorded. The rate of survival of the femoral component at 12 years, using
further femoral revision as the endpoint, was 100% (95% confidence
interval (CI) 95.9 to 100), and at nine years using re-operation
for any reason as the endpoint, was 94.6% (95% CI 92.0 to 97.2). These results suggest that a customised cemented polished stem
individually adapted to the extent of bone loss and with a collar
may reduce subsidence and the rate of fracture while maintaining
the durability of the fixation.
Conventional uncemented femoral implants provide
dependable long-term fixation in patients with a wide range of functional
requirements. Yet challenges associated with proximal–distal femoral
dimensional mismatch, preservation of bone stock, and minimally
invasive approaches have led to exploration into alternative implant designs.
Short stem designs focusing on a stable metaphyseal fit have emerged
to address these issues in total hip replacement (THR). Uncemented
metaphyseal-engaging short stem implants are stable and are associated
with proximal bone remodeling closer to the metaphysis when compared
with conventional stems and they also have comparable clinical performances.
Short stem metaphyseal-engaging implants can meet the goals of a
successful THR, including tolerating a high level of patient function,
as well as durable fixation. Cite this article:
Down’s syndrome is associated with a number of
musculoskeletal abnormalities, some of which predispose patients
to early symptomatic arthritis of the hip. The purpose of the present
study was to review the general and hip-specific factors potentially
compromising total hip replacement (THR) in patients with Down’s
syndrome, as well as to summarise both the surgical techniques that
may anticipate the potential adverse impact of these factors and
the clinical results reported to date. A search of the literature
was performed, and the findings further informed by the authors’
clinical experience, as well as that of the hip replacement in Down
Syndrome study group. The general factors identified include a high
incidence of ligamentous laxity, as well as associated muscle hypotonia
and gait abnormalities. Hip-specific factors include: a high incidence
of hip dysplasia, as well as a number of other acetabular, femoral
and combined femoroacetabular anatomical variations. Four studies
encompassing 42 hips, which reported the clinical outcomes of THR
in patients with Down’s syndrome, were identified. All patients
were successfully treated with standard acetabular and femoral components.
The use of supplementary acetabular screw fixation to enhance component
stability was frequently reported. The use of constrained liners
to treat intra-operative instability occurred in eight hips. Survival
rates of between 81% and 100% at a mean follow-up of 105 months
(6 to 292) are encouraging. Overall, while THR in patients with
Down’s syndrome does present some unique challenges, the overall
clinical results are good, providing these patients with reliable
pain relief and good function. Cite this article:
