title: Does prior conservative surgery affect survivorship and functional outcome in total hip arthroplasty for congenital dislocation of the hip? A case-control study in 159 hips.
abstract: BACKGROUND
  The results of total hip arthroplasty (THA) in congenital dislocation of the hip (CDH) are well known, but such is not the case for the impact of prior conservative surgery on THA function and survivorship. The present study compared THA in CDH with prior conservative bone surgery (BS group) versus no prior bone surgery (NBS group), to (1) assess the impact of prior conservative surgery on function and survivorship after THA, and (2) determine whether a particular type of conservative surgery affected function or survivorship.
  
  
  OBJECTIVE
  Prior conservative surgery for CDH does not affect function or survivorship of subsequent THA.
  
  
  METHODS
  A multicenter retrospective case-control study analyzed 430 THAs in CDH patients (332 patients: 269 female, 63 male; mean age, 56 years [range, 17-80 years]) at a mean 13.2±5.4 years' follow-up (range, 1-29 years). The BS group included 159 hips (37%) (64 pelvic, 81 femoral and 14 combined pelvic and femoral osteotomies), and the NBS group 271 (63%). Groups were comparable for gender, age at surgery, Devane activity score, preoperative Postel Merle d'Aubigné (PMA) functional score and CDH radiographic type following Crowe.
  
  
  RESULTS
  At follow-up, PMA scores were comparable: BS, 16.8±1.4 (11-18); NBS, 16.9±1.5 (7-18). Fifteen-year survivorship censored for implant revision for whatever reason did not significantly differ: BS, 87% (95% CI: 83-91%); NBS, 89% (95% CI: 86-92%). Ten-year survivorship on the same criterion did not significantly differ according to type of prior surgery: hip shelf arthroplasty, 97% (95% CI: 95-99%); Chiari osteotomy, 100%; femoral osteotomy, 95% (95% CI: 92-98%); and Milch osteotomy 96% (95% CI: 93-99%).
  
  
  CONCLUSIONS
  Conservative surgery for CDH does not impair the functional results or survivorship of subsequent THA.
  
  
  METHODS
  III, case-control study.
authors.affiliation: Service d'orthopédie C, département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille, France; Faculté de médecine, université Lille-Nord-de-France, place de Verdun, 589045 Lille, France. Electronic address: hemigaud@nordnet.fr.
authors.forename: H
authors.initials: H
authors.lastname: Migaud
authors.affiliation: Service d'orthopédie C, département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille, France; Faculté de médecine, université Lille-Nord-de-France, place de Verdun, 589045 Lille, France.
authors.forename: S
authors.initials: S
authors.lastname: Putman
authors.affiliation: Faculté de médecine, université Lille-Nord-de-France, place de Verdun, 589045 Lille, France; Service d'orthopédie-traumatologie, centre hospitalier de Valenciennes, avenue Désandrouin, 59322 Valenciennes cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Berton
authors.affiliation: Service de chirurgie orthopédique et de traumatologie, hôpital Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Lefèvre
authors.affiliation: Service de chirurgie orthopédique et de traumatologie, CHU de Rennes, 16, boulevard de Bulgarie, BP 90347, 35000 Rennes, France.
authors.forename: D
authors.initials: D
authors.lastname: Huten
authors.affiliation: Institut du mouvement et de l'appareil locomoteur, service de chirurgie orthopédique, hôpital Sainte-Marguerite, université Aix-Marseille, CHU de Marseille, AP-HM, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France.
authors.forename: J-N
authors.initials: JN
authors.lastname: Argenson
authors.affiliation: Service de chirurgie orthopédique et de traumatologie, Hôtel-Dieu, rue Roger-Signor, 29120 Pont l'Abbé, France.
authors.forename: F
authors.initials: F
authors.lastname: Gaucher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005602:France / Q000453:epidemiology; D006618:Hip Dislocation, Congenital / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D011379:Prognosis; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
keywords: Congenital dislocation; Conservative surgery; Osteotomy; Survivorship; Total hip arthroplasty