Total hip arthroplasty with structural bone-grafting for high congenital dislocation of adult hip / 中国矫形外科杂志

ABSTRACT

[Objective] To discuss the effect of total hip arthroplasty with structural bone-grafting for high congenital dislocation of adult hip.[Method]From August 2003 to October 2006,22 patients(29 hip)with congenital dislocation of hip were treated with total hip arthroplasty and structural bone-grafting.There were 10 males and 12 females.There were 13 left and 26 right.The ages were from 23 to 42 years old,with the average of 34.6 years.Clinical symptoms included hip pain,hip instability and limping.The preoperative average Harris scores was 46.8.The preoperative average length difference between two legs was 3.8 cm.The femoral head dislocation height from normal position was 3.9 cm on average(range,3.2 to 5.6cm).The average range of motion of the hipflexion 66.5?,abduction 23.8?,external rotation 20.4?,internal rotation 5.3?.Posterolateral approach was used during operation and all the acetabular cups were reconstructed at the true acetabular location and were covered completely with femoral head autograft.The reduction of prosthesis was achieved by releasing surrouding soft tissue.The acetabular reconstruction was done with the cemented acetabular component in 18 hips,the small acetabular component in 5 and common cementless acetabular component in 6.Cementless shaft was used in 10 hips,common cemented shaft in 13,steno-vertical cemented shaft in 4 and long cemented shaft in 2.The clinical effects were evaluated with operative time,blood loss,Harris scale,joint range of motion,length difference between two legs and complications.[Result]The average operative time was 95 minutes(range from 70 to 135 rain).The average blood loss was 400 ml(range from 300 ml to 650 ml).Primary healing of wound was observed in all patients without infection.Position of prothesis judged by X-ray was fine at 1 week postoperatively,the average abduction angle of the cup was 39?,and the average anterior angle was 13?.Twenty-two cases were followed up from 10 months to 47 months(average 17.6 months)after surgery,the average score was 89.2 points(ranged from 72 points to 93 points),according to the evaluate of Harris.The average range of motion of the hip was 115.3? for flexion,44.6? for abduction,49.5? for external rotation,26.8? for internal rotation.The preoperative average length difference between two legs was 1.2 cm.There were 2 postoperative femoral nerve palsy which resolved completely within 4 months.Femoral head autografts were not absorbed.Neither loosening nor dislocation of the prostheses occurred in the time of follow-up.[Conclusion]Total hip arthroplasty with structural bone-grafting is an effective method for high congenital dislocation of adult hip.It improves symptoms,functions and shapes.Structural bone-grafting can provide reliable acetabular coverage and restore bone stock.In case of the altitude of femoral head dislocation upward from normal position less than 4cm,reduction of prosthesis can achieve by releasing surrouding soft tissue without femoral nerve palsy.