title: Cementless total hip arthroplasty for patients previously treated with femoral osteotomy for hip dysplasia: the incidence of periprosthetic fracture.
abstract: Femur deformities can make stem fixation difficult in total hip arthroplasty (THA). We report the clinical results of cementless THA using a press-fit stem in patients who had previously undergone femoral osteotomy for hip dysplasia.
  
  
  
  The subjects included 66 hips in 64 patients, with the mean follow-up period of 7.3 years. THA was performed at a mean period of 17.1 years after intertrochanteric femoral osteotomy. Valgus osteotomy was performed in 42 hips, and varus osteotomy in 24. Clinical results were evaluated by using the Merle d'Aubigne-Postel score. Implant survival was determined with revision as the end point, and any related complications were investigated.
  
  
  
  The Merle d'Aubigne-Postel score improved from 9.4 to 16.1 at the final follow-up, without any implant loosening. However, periprosthetic femoral fractures were observed in four hips (6.0 %), one intra-operatively and three within three weeks after THA. Among these cases, three hips previously had varus osteotomy (12.5 %) and one hip had valgus osteotomy (2.3 %). Two hips were revised with full porous stems and circumferential wiring. The five and ten year cumulative survivorship rates were 97 % (range, 88.8-99.3 %) and 97 % (88.8-99.3 %), respectively.
  
  
  
  Although the use of a press-fit cementless stem yielded acceptable results in most of the patients, perioperative femoral fracture was a major complication especially in the patients previously treated with intertrochanteric varus osteotomy. Careful planning and implant selection could be emphasized for these cases.
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medical Sciences, Graduate School of Medicine, Kyushu University, 3-1-1 Maidashi Higashiku, Fukuoka, 812-8582, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Ohishi
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medical Sciences, Graduate School of Medicine, Kyushu University, 3-1-1 Maidashi Higashiku, Fukuoka, 812-8582, Japan. yasunaka@ortho.med.kyushu-u.ac.jp.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Nakashima
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medical Sciences, Graduate School of Medicine, Kyushu University, 3-1-1 Maidashi Higashiku, Fukuoka, 812-8582, Japan.
authors.forename: Takuaki
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medical Sciences, Graduate School of Medicine, Kyushu University, 3-1-1 Maidashi Higashiku, Fukuoka, 812-8582, Japan.
authors.forename: Goro
authors.initials: G
authors.lastname: Motomura
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medical Sciences, Graduate School of Medicine, Kyushu University, 3-1-1 Maidashi Higashiku, Fukuoka, 812-8582, Japan.
authors.forename: Jun-Ichi
authors.initials: JI
authors.lastname: Fukushi
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medical Sciences, Graduate School of Medicine, Kyushu University, 3-1-1 Maidashi Higashiku, Fukuoka, 812-8582, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hamai
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medical Sciences, Graduate School of Medicine, Kyushu University, 3-1-1 Maidashi Higashiku, Fukuoka, 812-8582, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kohno
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medical Sciences, Graduate School of Medicine, Kyushu University, 3-1-1 Maidashi Higashiku, Fukuoka, 812-8582, Japan.
authors.forename: Yukihide
authors.initials: Y
authors.lastname: Iwamoto
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000601:surgery*; D006621:Hip Joint; D006622:Hip Prosthesis; D006801:Humans; D015994:Incidence; D010027:Osteotomy; D057068:Periprosthetic Fractures; D012086:Reoperation; D016896:Treatment Outcome
keywords: Femoral osteotomy; Periprosthetic fracture; Total hip arthroplasty