Total Hip Arthroplasty for Childhood Septic Hip Residua / 대한정형외과학회잡지

ABSTRACT

Initial success with total hip arthroplasty on those severely crippled, painful hips in elderly people has prompted its application to a broad variety of conditions; namely, primary and secondary osteoarthritis, rheumatoid arthritis, avascular necrosis of the femoral head, and failed arthroplasties. Some have attempted it on previously arthrodesed hips, while others have successfully treated failed Girdlestone by total hip arthroplasty. To date, however, total hip arthroplasty remains essentially a procedure for older people. It has been greatly emphasized that total hip arthroplasty on 29 cases of residual hips secondary to pyogenic or tuberculous infection occurred during childhood. All were young adults ranging from 17 to 56 years of age, with a mean age of 32. 1 years. None of the hips had active infection at time of operation, although in 2 cases biopsy, at the arthroplasty, revealed chronic granulomatous inflammation. The hips had bony or fibrous ankylosis,or pseudarthrosis with dislocation, and presented marked flexion deformity, bony hypoplasia, limb shortening, and muscle atrophy. In 6 cases, arthroplasty was preceded by preliminary anterior soft tissue release and osteotomy of the ankylosis, followed by skeletal traction. In one case, anterior release through a separate incision was carried out on the same setting prior to arthroplasty. Lateral approach with trochanteric osteotomy was routinely employed, except in two in which the hip was approached posteriorly without trochanteric osteotomy. Trapezoidal-28 prosthesis was used in 17 cases, 5 of which were of short neck, thin stem sized, 7 of which were of medium neck small stem sized. Muller prosthesis was used in 8 cases, 7 of which were of standard neck standard stem sized. One small straight stem Charnley prosthesis failed and was later replaced by a custom-made Charnley stem prosthesis. Two offset bore ovoid cup and Charnley extra-small stem were used. In addition to routine preoperative, intraoperative, and postoperative antibiotics, Kanamycin was mixed to cement routinely. There was no postoperative wound infection. In two cases with presumably healed tuberculosis, infection recurred after arthroplasty. In all the remaning hips, painless serviceable function was restored, especially in view of diverse range of motion in orientals. In the oriental life style, the importance of a mobile hip cannot be overstressed.