Cementless Total Hip Arthroplasty with Medial Wall Osteotomy for the Sequelae of Septic Arthritis of the Hip

BACKGROUND: We performed a retrospective study to evaluate the results of acetabular circumferential medial wall osteotomy, a procedure designed to provide secure fixation of a cementless hemispherical acetabular cup for the sequelae of septic arthritis of the hip. METHODS: We assessed 38 total hip arthroplasties (THAs) with circumferential acetabular medial wall osteotomies performed on patients with sequelae of septic arthritis of the hip between 1993 and 2000, who were followed up for > or = 3 years. The average follow-up period was 8.3 years (range, 3 to 12 years). The indication for this technique was poor acetabular cup coverage of < or = 70% on preoperative templating. In all cases, cementless hemispherical acetabular cups were fixed to the true acetabulum. Additional procedures included soft tissue release in 16 hips and femoral derotational and shortening osteotomies in 12 hips. We evaluated both clinical and radiological results. RESULTS: The Harris hip scores improved from 57 points preoperatively to 91 points postoperatively. Radiological analysis revealed no aseptic loosening or radiolucent lines around the acetabular cup. Stable bony fixation of the acetabular cup in the true acetabulum was seen in all cases. Acetabular osteolysis was demonstrated in 12 hips. Revision surgery was performed in 6 hips, but there were no complications related to acetabular circumferential medial wall osteotomy. CONCLUSIONS: Circumferential acetabular medial wall osteotomy can provide appropriate positioning and sufficient coverage of the acetabular cup and thus preserve the medial wall thickness in cementless THA without the need for additional bone grafting for the sequelae of septic arthritis of the hip.

Femoral Bone Resorption after Cementless Total Hip Arthroplasty / 대한정형외과학회잡지

Bone resorption around femoral stem as an effect of stress shielding and a subsequent adaptive remodeling process is a disturbing phenomenon. The purpose of this study is to analysis the degree, the location and the time of appearance of femoral bone resorption after cementless total hip replacement and to evaluate the factors affecting the degree, the location and the time of appearance of bone resorption. The authors analysed total 48 cases of standard radiographies which underwent operation between September, 1983 to May, 1994 at Korea University, Guro Hospital and the mean duration of follow up was average 16 months(range 7 months to 5 years). The results were as follows; 1. Bone resorption could be observed mostly in proximal portion of femur and the extent was limited to the first and the second degree according to Engh’s classification in most cases. 2. The degree of bone resorption was significantly correlated with the diameter of femoral stem. 3. The time of appearance of bone resorption after THR was not statistically correlated with the diameter of femoral stem. 4. The degree of bone resorption was not related with sex, age, preoperative diagnosis, type of femoral stem and degree of press-fitting. In conclusion bone resorption as an adaptive bone remodeling process after cementless total hip replacement could be observed in the proximal femur, and the factors affecting the degree of bone resorption were closely related with the size of femoral stem, but not related with sex, preoperative diagnosis, press-fitting and type of femoral stem. From the mechanical point of view, we could conclude that the bending stiffness of a prosthesis was the most important factor affecting the degree of bone resorption.