Clinical outcome in total hip arthroplasty for septic sequelae in childhood

Management of postinfective pathological hip dislocation with absent capital femoral epiphysis in young children: a long-term follow-up study

LEVEL OF EVIDENCE

Level IV - therapeutic study.

Total hip arthroplasty for sequelae of childhood hip disorders: Current review of management to achieve hip centre restoration

Adults requiring total hip arthroplasty (THA) for childhood disorder sequelae present with shortening, limp, pain, and altered gait. THA, which can be particularly challenging due to altered anatomy, requires careful planning, assessment, and computed tomography evaluation. Preoperative templating is essential to establish the appropriate acetabular and femoral size. Information regarding neck length and offset is needed to ensure the proper options are available at THA. Hip centre restoration must be planned preoperatively and achieved intraoperatively with appropriate exposure, identification, and stable fixation with optimum-size components. Identifying the actual acetabular floor is essential as changes include altered anatomy, distortion of the margins and version changes. Proximal femur changes include anatomical variation, decreased canal diameter, cortical thickness, changes in anteversion, and metaphyseal and diaphyseal mismatch. Preoperative assessment should consist of limb assessment for variations due to prior surgical procedures. Evaluation of the shortening pattern with the relationship of the lesser trochanter to the teardrop would help identify and plan for subtrochanteric shortening osteotomy, especially in high-riding hips. The surgical approach must ensure adequate exposure and soft tissue release to achieve restoration of the anatomical hip centre. The femoral components may require modularity to enable restoration of anteversion and optimum fixation.

Outcome and complication rate of total hip arthroplasty in patients younger than twenty years: which bearing surface should be used?

PURPOSE

Total hip arthroplasty (THA) in younger patients remains controversial due to concerns regarding long-term implant survival and potential complications. This study aimed to evaluate long-term clinical outcomes, complications, differences in complication and revision rates by bearing surfaces, and Kaplan-Meier survival curves for THA in patients under 20 years old.

METHODS

A retrospective review was conducted for 65 patients (78 hips) who underwent THA between 1991 and 2018. Their mean age was 18.9 years. Their clinical outcomes were assessed using the Harris Hip Score (HHS). Radiological outcomes were evaluated based on the presence of loosening, osteolysis, and heterotopic ossification. Complications such as dislocation, periprosthetic fractures, and infections were assessed. The mean follow-up period was 13.2 years (range, 5.0-31.2 years).

RESULTS

The mean HHS improved from 44.6 to 90.1. There were two cases of dislocation. However, no periprosthetic fracture, deep infection, or ceramic component fracture was noted. There were 19 revisions of implants. Eighteen of 19 hips were operated with hard-on-soft bearings in the index surgery (p < 0.01). The 23-year survivorship was 97.8% for THA using ceramic-on-ceramic bearings, while the 31-year survivorship was 36.7% using hard-on-soft bearings.

CONCLUSION

THA in patients under 20 years old yielded promising clinical and radiological outcomes, although polyethylene-bearing-related concerns persisted. Previously operated patients with hard-on-soft bearing should be meticulously examined during the follow-up. As ceramic-on-ceramic bearing showed excellent survivorship in this particular cohort, we recommend the use of this articulation as the bearing of choice.