title: Total hip arthroplasty performed in patients with residual poliomyelitis: does it work?
abstract: BACKGROUND
  Patients with residual poliomyelitis can have advanced degenerative arthritis of the hip in the paralytic limb or the nonparalytic contralateral limb. Although THA is a treatment option for some of these patients, there are few studies regarding THA in this patient population.
  
  
  OBJECTIVE
  We therefore reviewed a group of patients with residual poliomyelitis who underwent cementless THA on either their paralytic limb or nonparalytic limb to assess (1) Harris hip scores, (2) radiographic results, including implant loosening, (3) complications, including dislocation, and (4) limb length discrepancy after recovery from surgery.
  
  
  METHODS
  From January 2000 to December 2009, 10 patients with residual poliomyelitis (10 hips, four paralytic limbs and six nonparalytic contralateral limbs) underwent THA using cementless prostheses. Harris hip scores, complications, and leg length discrepancy were determined by chart review, and confirmed by questionnaire and examination; radiographs were reviewed by two observers for this study. Followup was available for all 10 patients at a minimum of 3 years (median, 7 years; range, 3.4-13 years). Surgery was done at the same side of the paralytic limb in four hips and contralateral to the paralytic limb in six.
  
  
  RESULTS
  All patients had pain relief and improvement in function; the Harris hip score improved from mean of 68 preoperatively to 92 at last followup (p = 0.043). However, only three patients had complete pain relief. One hip dislocated, which was treated successfully with closed reduction and a hip spica cast for 2 months. There was no loosening or osteolysis in this series. Leg length discrepancy improved after the index operation, but only in the THAs performed in the paralytic limbs.
  
  
  CONCLUSIONS
  Cementless THA may be suitable for painful hips in adult patients with residual poliomyelitis. Nonetheless, these patients should be informed of the possibility of mild residual pain and persistent leg length discrepancy, particularly patients whose THA is performed on the limb that was not affected by polio (ie, the nonparalytic contralateral limb).
  
  
  METHODS
  Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Byung-Ho
authors.initials: BH
authors.lastname: Yoon
authors.forename: Young-Kyun
authors.initials: YK
authors.lastname: Lee
authors.forename: Jeong Joon
authors.initials: JJ
authors.lastname: Yoo
authors.forename: Hee Joong
authors.initials: HJ
authors.lastname: Kim
authors.forename: Kyung-Hoi
authors.initials: KH
authors.lastname: Koo
mesh_terms: D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D005260:Female; D006617:Hip Dislocation / Q000209:etiology / Q000601:surgery; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007870:Leg Length Inequality / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D010147:Pain Measurement; D011051:Poliomyelitis / Q000150:complications*; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome