End-stage posttraumatic osteoarthritis treated with THA in osteogenesis imperfecta

Hip Arthroplasty in Patients with Osteogenesis Imperfecta

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Osteogenesis imperfecta (OI) is a rare congenital disorder that affects connective tissue.

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Modern medicine has mitigated the mortality that is associated with OI, allowing patients to live a near-normal life span.

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The degenerative process in OI is probably accelerated because of subclinical intra-articular fractures, joint laxity, and distorted femoral and acetabular anatomy.

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Total hip arthroplasty is seldom performed in patients with OI; it is technically difficult due to bone fragility, deformity, soft-tissue alteration, acetabular protrusion, the risk of intraoperative and postoperative fractures, and joint laxity.

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This review highlights that patients with OI need hip arthroplasty procedures at an early age and that early revision surgery can be expected. New-generation uncemented implants may improve implant survivorship.

Custom hemiarthroplasties for retention of existing hardware associated with osteogenesis imperfecta

Osteogenesis imperfecta is a rare genetic disorder that presents with heterogeneous phenotypes ranging from brittle bones to impaired hearing. Because of the decreased bone mineral density frequently observed in this patient population, many patients experience recurring and long-term fractures, which often require orthopaedic management. With the advancement of nonsurgical and surgical management and increased longevity of patients with osteogenesis imperfecta, the incidence of osteoarthritis has risen, presenting new orthopaedic challenges. However, compromised bone integrity and size combined with frequent existing hardware render traditional surgical therapies for osteoarthritis technically challenging in this patient population. In this report, we present a case in which we retained a portion of the patient's existing hardware, while performing staged bilateral custom hemiarthroplasties in a patient with osteogenesis imperfecta.

[Hip arthroplasty in the presence of proximal femoral deformity]

INTRODUCTION

Proximal femoral deformities may result in pain in the ipsilateral hip joint and profound functional disability, ultimately requiring arthroplasty. 

PROCEDURE

Primary hip replacement procedures in the presence of markedly altered anatomy of the proximal femur present a technical challenge for the orthopedic surgeon. The deformity and its underlying condition, whether congenital or acquired, may complicate canal preparation and affect the choices of implant, exposure and postoperative physiotherapy protocol. Furthermore, a two- or multi-stage treatment may be required, e.g. for implant removal, for femoral osteotomy or to rule out infection.

DISCUSSION

Treatment strategies must be individually tailored, respecting patient needs, the etiology, the anatomic site and the geometry of the deformity encountered, bone quality, soft tissue deficits, the presence of retained implants in the proximal femur, infection status and comorbidities.