5 research outputs found
Congenital hip dysplasia treated by total hip arthroplasty using cementless tapered stem in patients younger than 50 years old: results after 12-years follow-up
Background
Congenital hip dysplasia may lead to severe acetabular and femoral abnormalities that can make total hip arthroplasty a challenging procedure. We assessed a series of patients affected by developmental hip dysplasia treated with total hip arthroplasty using cementless tapered stem and here we report the outcomes at long-term follow-up.
Materials and methods
Twenty-eight patients (24 women and 4 men) aged between 44 and 50 years (mean 47 years) were observed. Clinical evaluation was rated with the Harris Hip Score. Radiographic evaluation consisted in standard anteroposterior and axial view radiographs of the hip. According to Crowe’s classification, 16 hips presented dysplasia grade 1, 14 grade 2, and 4 grade 3. All patients were treated with total hip arthroplasty using a cementless tapered stem (Wagner Cone Prosthesis). Six patients were operated bilaterally, with a totally of 34 hips operated. After surgery, the patients were clinically and radiographically checked at 3, 6, and 12 months and yearly thereafter until an average follow-up of 12 years (range 10–14 years).
Results
Average Harris Hip Score was 56 ± 9 (range 45–69) preoperatively, 90 ± 9 (range 81–100) 12 months after surgery, and 91 ± 8 (range 83–100) at last follow-up. Radiographic evaluation demonstrated excellent osteointegration of the implants. Signs of bone resorption were present in 6 hips, nevertheless no evidence of loosening was observed and none of the implants has been revised.
Conclusions
Even in dysplasic femur, the tapered stem allowed adequate stability and orientation of the implant. We consider tapered stem a suitable option for total hip arthroplasty in developmental hip dysplasia, also in case of young patients, thanks to the favourable long-term results
One-stage Metatarsal Lengthening by Allograft Interposition: A Novel Approach for Congenital Brachymetatarsia
Background Congenital brachymetatarsia, a shortened
metatarsal bone, can be corrected surgically by callus
distraction or one-stage lengthening using bone graft.
Questions/purposes We asked whether one-stage metatarsal
lengthening using metatarsal homologous bone graft
could improve forefoot function, lead to metatarsal healing,
restore metatarsal parabola, and improve cosmetic
appearance.
Patients and Methods We retrospectively reviewed 29
patients (41 feet) in whom we lengthened 50 metatarsals.
Surgery consisted of a transverse proximal osteotomy of
the metatarsal shaft and interposition of a metatarsal
homologous bone graft (average, 13 mm long) fixed with
an intramedullary Kirschner wire. Minimum followup was
3 years (mean, 5 years; range, 3–11 years).
Results Bone union was achieved in all cases. The mean
preoperative American Orthopaedic Foot and Ankle Society
score was 37 points (range, 28–53 points) and the mean
postoperative score was 88 points (range, 74–96 points), with
an average improvement of 51 points. Radiographically, the
mean gain in length was 13 mm (range, 10–15 mm), and the
mean percentage increase was 23%.
Conclusions One-stage metatarsal lengthening using
interposition of metatarsal homologous bone graft to correct
congenital brachymetatarsia has low morbidity for the
patient, limited complications, short recovery times, and
restores forefoot anatomy.
Level of Evidence Level IV, therapeutic study. See
Guidelines for Authors for a complete description of levels
of evidence