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.

Cementless Acetabular Component Fixation with Circumferential Medial Wall Osteotomy in Severely Hypoplastic Acetabulum / 대한정형외과학회잡지

PURPOSE: To evaluate the results of the acetabular circumferential medial wall osteotomy in obtaining secure fixation of cementless hemispherical acetabular cup to the hypoplastic acetabulum. MATERIALS AND METHODS: Seventy-nine THAs with a circumferential acetabular medial wall osteotomy in the dysplastic acetabulum performed between 1987 to 1997 and followed up for more than 6 years were assessed. The indication of this technique was acetabular coverage that could not achieve more than 70% after cup fixation. In all cases, a cementless hemispherical acetabular cup was fixed in the true acetabulum. Additional procedures included soft tissue releases in 23 hips, a derotational femoral osteotomy in 10 hips, a structural bone graft in 7 hips and femoral shortening in 8 hips. Both clinical and radiographic parameters were evaluated. RESULTS: The Harris hip scores were improved from 68.4 to 92.2 postoperatively. Radiographic analysis revealed no aseptic loosening or radioluacent line, and showed stable bony fixation at the true acetabulum in all cases. 7 hips showed acetabular osteolysis. Two acetabular components were revised due to dissociation of the polyethylene liner and 4 polyethylene liners were exchanged because of severe wear or osteolysis. CONCLUSION: The circumferential acetabular medial wall osteotomy can provide appropriate positioning, sufficient coverage of the acetabular cup with a preservation of the medial wall thickness in cementless THA without additional bone grafting in the dysplastic acetabulum.