Faldini Cesare, Nanni Matteo, Leonetti Danilo, Miscione Maria Teresa, Acri Francesco, Giannini Sandro
Department of Orthopaedic Surgery, University of Bologna, Rizzoli Orthopaedic Institute, Via G. Pupilli 1, Bologna, Italy.
Hip Int. 2011 Jul-Aug;21(4):415-20. doi: 10.5301/HIP.2011.8588.
Acetabular and femoral abnormalities make total hip arthroplasty in developmental hip dysplasia a challenging procedure. We present details of long-term follow-up of a series of patients affected by developmental hip dysplasia treated with total hip arthroplasty using a cementless tapered stem. Thirty-five hips in 20 patients (18 women and 2 men) aged between 44 and 60 years (mean 51 years) were observed. Clinical evaluation was conducted using the Harris Hip Score (HHS). Radiographic evaluation consisted in standard anteroposterior and axial view radiographs of the hip. According to Crowe's classification, 25 hips had grade 2 and 10 hips grade 3 dysplasia. All patients were treated with total hip arthroplasty using a cementless tapered stem (Wagner Cone Prosthesis™). After surgery the patients were clinically and radiographically evaluated at 1, 2, 3, 6 and 12 months and annually thereafter. The average follow-up was 12 years (range 10-14 years). The average HHS was 57±7 (range 45-66) preoperatively, 90±7 (range 81-100) 12 months after surgery and 90±6 (range 83-100) at last follow-up. Radiographic evaluation demonstrated excellent osseointegration of the implants in most cases. Signs of bone resorption were present in 5 hips, but no evidence of loosening was observed and none of the implants have been revised. The tapered stem achieved adequate stability and orientation, and may be a suitable option for total hip arthroplasty for arthritis following developmental hip dysplasia.
髋臼和股骨异常使得发育性髋关节发育不良患者的全髋关节置换术成为一项具有挑战性的手术。我们展示了一系列发育性髋关节发育不良患者接受无水泥锥形柄全髋关节置换术的长期随访细节。观察了20例患者（18名女性和2名男性）的35个髋关节，年龄在44至60岁之间（平均51岁）。使用Harris髋关节评分（HHS）进行临床评估。影像学评估包括髋关节的标准前后位和轴位X线片。根据Crowe分类，25个髋关节为2级发育不良，10个髋关节为3级发育不良。所有患者均接受了使用无水泥锥形柄（Wagner Cone Prosthesis™）的全髋关节置换术。术后在1、2、3、6和12个月以及此后每年对患者进行临床和影像学评估。平均随访时间为12年（范围10 - 14年）。术前平均HHS为57±7（范围45 - 66），术后12个月为90±7（范围81 - 100），最后一次随访时为90±6（范围83 - 100）。影像学评估显示大多数情况下植入物骨整合良好。5个髋关节存在骨吸收迹象，但未观察到松动迹象，且没有植入物需要翻修。锥形柄实现了足够的稳定性和定位，可能是发育性髋关节发育不良后继发性关节炎全髋关节置换术的一个合适选择。
