Functional results of cementless total hip arthroplasty in coxarthrosis secondary to developmental hip dysplasia

Introduction: Coxarthrosis secondary to developmental hip dysplasia begins in thethird decade of life in untreated patients and progresses to total hip arthroplasty. In thesecases, arthroplasty is difficult and open to complications because of high hip center,insufficiency of the acetabular bone mass, hypoplastic femur, excessive anteversion andaccompanying soft tissue anomalies. In these patients, the rate of revision is high because ofarthroplasty at young ages. The aim of this study is to evaluate the functional results ofcementless total hip arthroplasty in patients with coxarthrosis secondary to developmental hipdysplasia.Patients and Methods: Between January 2002 and January 2008, fifty four patientswere admitted to Gazi University Faculty of Medicine, Department of Orthopaedics andTraumatology, with the diagnosis of coxarthrosis secondary to developmental hip dysplasia.We performed cementless total hip arthroplasty in 73 hips of 54 patients (19 bilateral).Indications for surgery were pain and excessive functional disability with radiologic evidenceof advanced coxarthrosis. Eleven patients were male and 38 were females. The average ageon the time of index operation was 51.47 years. Functional evaluation of the patients has beendone preoperatively and at the last follow-up with Visual Analog Pain Scale, Harris Hip Scoreand Charnley modification of Merle D?Aubigne-Postel Hip Score.Results: Mean follow-up time was 39.7 months (between 13-72 months). Accordingto Hartofilakidis classification, 18 hips were Type A, 28 hips were Type B and 27 hips wereType C. Average leg length discrepancy was 3.02 cm preoperatively and became 0,95 cmafter arthroplasty operations. Femoral head autogenous grafts were used for augmentation ofthe superolateral rim of the acetabulum in 23 hips. Subtrochanteric shortening osteotomy wasperformed in 22 hips in order to avoid any neurovascular complications. Mean amount of94shortening was 3.4 cm. Overall complication rate was 20.5%. Two patients underwentacetabular revision because of early aseptic loosening. In two patients, sciatic nerve palsydeveloped after surgery. Visual analog pain scale score was 7.96 preoperatively and became2.23 at the last follow-up. Harris Hip Scores raised to 89.09, from 33.33 preoperatively.Charnley modification of Merle d?Aubigne?Postel Hip Score was 2.19 preoperatively andbecame 4,83 at the last follow-up.Conclusions: Despite all the difficulties that may be encountered, total hiparthroplasty for coxarthrosis secondary to developmental hip dysplasia is a successfultreatment method, when performed for right indications and after appropriate preoperativeplanning, individualized to patient specific pathology.