We describe the clinical and radiological results
of cementless primary total hip replacement (THR) in 25 patients
(18 women and seven men; 30 THRs) with severe developmental dysplasia
of the hip (DDH). Their mean age at surgery was 47 years (23 to
89). In all, 21 hips had Crowe type III dysplasia and nine had Crowe
type IV. Cementless acetabular components with standard polyethylene
liners were introduced as close to the level of the true acetabulum
as possible. The modular cementless S-ROM femoral component was
used with a low resection of the femoral neck. A total of 21 patients (25 THRs) were available for review at
a mean follow-up of 18.7 years (15.8 to 21.8). The mean modified
Harris hip score improved from 46 points pre-operatively to 90 at
final follow up (p <
0.001). A total of 15 patients (17 THRs; 57%) underwent revision of the
acetabular component at a mean of 14.6 years (7 to 20.8), all for
osteolysis. Two patients (two THRs) had symptomatic loosening. No
patient underwent femoral revision. Survival with revision of either
component for any indication was 81% at 15 years (95% CI 60.1 to
92.3), with 21 patients at risk. This technique may reduce the need for femoral osteotomy in severe
DDH, while providing a good long-term functional result. Cite this article:
We report on 397 consecutive revision total hip
replacements in 371 patients with a mean clinical and radiological follow-up
of 12.9 years (10 to 17.7). The mean age at surgery was 69 years
(37 to 93). A total of 28 patients (8%) underwent further revision,
including 16 (4%) femoral components. In all 223 patients (56%,
233 hips) died without further revision and 20 patients (5%, 20
hips) were lost to follow-up. Of the remaining patients, 209 (221
hips) were available for clinical assessment and 194 (205 hips)
for radiological review at mean follow-up of 12.9 years (10 to 17.7). The mean Harris Hip Score improved from 58.7 (11 to 92) points
to 80.7 (21 to 100) (p <
0.001) and the mean Merle d’Aubigné and
Postel hip scores at final follow-up were 4.9 (2 to 6), 4.5 (2 to
6) and 4.3 (2 to 6), respectively for pain, mobility and function.
Radiographs showed no lucencies around 186 (90.7%) femoral stems
with stable bony ingrowth seen in 199 stems (97%). The survival
of the S-ROM femoral stem at 15 years with revision for any reason as
the endpoint was 90.5% (95% confidence interval (CI) 85.7 to 93.8)
and with revision for aseptic loosening as the endpoint 99.3% (95%
CI 97.2 to 99.8). We have shown excellent long-term survivorship and good clinical
outcome of a cementless hydroxyapatite proximally-coated modular
femoral stem in revision hip surgery. Cite this article:
