Cemented total hip arthroplasty following previous femoral osteotomy: an average 16-year follow-up study.
The indications for proximal femoral osteotomy would be substantially limited if it significantly compromised the outcome of a subsequent hip arthroplasty. Previous reports have followed only early cementing techniques over intermediate duration. This study comprised 22 primary cemented total hip arthroplasties performed by a single surgeon following failed proximal femoral osteotomies at an average follow-up period of 15.8 years. Three patients who died prior to the 11-year minimum follow-up period are not included, leaving 19 hips for long-term review. All stems were cemented with second-generation techniques. Stem placement and collar-calcar contact, however, were substantially worse compared with historical control subjects. Eight reconstructions required custom miniature or calcar replacement components, and in 6 hips, the stems were inserted only in the diaphysis. Two of 19 femoral components (10.5%) were revised for aseptic loosening and 2 additional femoral components were loose. The average Harris hip score of those not revised was 80.4. Five acetabular components (26.3%) required revision. Four additional cups were loose, yielding a total acetabular loosening rate of 47.4% at 15.5 years. Intertrochanteric osteotomy in general did not affect the expected excellent results of the femoral component using modern cementing techniques. Severe deformity following subtrochanteric osteotomy, however, did adversely affect the outcome.
Shinar
A A
AA
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston 02114, USA.
Harris
W H
WH
D000293:Adolescent; D000328:Adult; D019644:Arthroplasty, Replacement, Hip; D002484:Cementation; D002648:Child; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D008875:Middle Aged; D010027:Osteotomy; D011475:Prosthesis Failure; D011859:Radiography; D016896:Treatment Outcome