Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Total hip reconstruction in the anatomically distorted hip

Cemented versus hybrid total hip arthroplasty

Abstract

Recent reports in the literature strongly support the idea that cement is the optimum form of fixation of the femoral component in total hip replacement. For hybrid total hip arthroplasty, we used a cemented cup instead of an uncemented cup since this was inevitable in cases of poorly developed acetabulum. The uncemented cone femoral component is also beneficial in cases of extremely narrow and cylindrical configuration of the medullary cavity of untreated congenital dislocation of the hips (CDH) and tuberculosis or septic arthritis in childhood. We reviewed the clinical result of a consecutive series of patients with cemented total hip arthroplasty (THA) compared with recent studies on hybrid reconstruction using survivorship analysis. This subsequent study involved a hybrid uncemented Wagner cone femoral component and a cemented acetabular component with roof reinforcement by additional impacted cancellous allograft with hydroxyapatite (HA). We believe that early failure of the cemented components was due to an adverse effect of thin cement mantles around cemented femoral stems as well as the cemented cup in THA. In addition, 8 patients who received our modification of the Charnley CDH component had poor results even though we reduced the stem geometry and thickness. Furthermore, intraoperative fracture and splitting of the proximal femur was a major complication during implantation. Contrary to expectations, the results of these hybrid reconstructions were extremely encouraging (average follow-up period of 2–4.5 years). In addition to our experience of the cemented versus hybrid THA involving the uncemented Wagner femoral component, we have determined positive indications for the untreated and severely distorted anatomy of bilateral CDH for which surgical interventions for reconstruction were not recommended before.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Barlow TG (1962) Early diagnosis and treatment of congenital dislocation of the hip. J Bone Joint Surg [Br] 44:292

  2. 2.

    Brash JC (1955) Neuro-vascular hila of limb muscles. E & S Livingstone Edinburgh, pp 50–69

  3. 3.

    Buhler DW, Berlemann U, Frei HP, Nolte LP (1995) Three dimension motion of femoral prosthetic stems: an in vitro evaluation of a novel measuring concept. Orthopaedic Research Society, 41st Meeting, Orlando, Fla.

  4. 4.

    Charnley J (1979) Low friction arthroplasty of the hip. Theory and practice 130-1

  5. 5.

    Charnley J, Feagin JA (1973) Low-friction arthroplasty in congenital subluxation of the hip. Clin Orthop 91:98–113

  6. 6.

    Davey JR, Harris WH (1989) A preliminary report of the use of a cementless acetabular component with a cemented femoral component. Clin Orthop 245:150–115

  7. 7.

    DeLee JG, Chanley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop 121:20–32

  8. 8.

    Dunn HK, Hess WE (1976) Total hip reconstruction in chronically dislocated hips. J Bone Joint Surg [Am] 58:838–845

  9. 9.

    Gerber SD, Harris WH (1986) Femoral head autografting to augment acetabular deficiency in patients requiring total hip replacement: a minimum five-year and an average seven-year follow-up study. J Bone Joint Surg [Am] 68:1241–1248

  10. 10.

    Gie GA, Ling RSM, Timperley AJ, Linder L, Simon JP, Sloof TJJH (1993) Impacted cancellous allografts and cement for revision total hip arthroplasty. J Bone Joint Surg [Br] 75:18–20

  11. 11.

    Harley JM, Wilkinson JA (1987) Hip replacement for adults with unreduced congenital dislocation. J Bone Joint Surg [Br] 69:752–755

  12. 12.

    Harris WH, Malonly WJ (1989) Hybrid total hip arthroplasty. Clin Orthop 249:21–29

  13. 13.

    Hess WE, Umber JS (1978) Total hip arthroplasty in chronically dislocated hips: follow-up study on the protrusio socket technique. J Bone Joint Surg [Am] 60:948–954

  14. 14.

    Kim YY, Ko CU, Lee SW, Kwak BM (1979) Replacement arthroplasty using the Charnley prosthesis in old tuberculosis of the hip. Int Orthop 3:81–88

  15. 15.

    Kim YY, Alm JY, KO CU, Yoon YS, Kwak BM (1988) Chamley low friction arthroplasty in tuberculosis of the hip: an eight to 13-year follow-up. J Bone Joint Surg [Br] 70:756–760

  16. 16.

    McKibbin B (1970) Anatomical factors in the stability of the hip joint in the newborn. J Bone Joint Surg [Br] 52:158–159

  17. 17.

    Murray DW, Carr AJ, Bulstrode C (1993) Survival analysis of joint replacements. J Bone Joint Surg [Br] 75:697–704

  18. 18.

    Schenk RK, Wehrli U (1989) Zur Reaktion des Knochens auf eine zementfreie SL-Femurrevisionsprothese. Orthopade 18:454–462

  19. 19.

    Wagner H, Wagner M (1995) Conical stem fixation for cementless hip prostheses for primary implantations and revision. In: Morscher E (ed) Endoprosthetics. Springer, Berlin Heidelberg New York, pp 258–267

  20. 20.

    Campbell's operative orthopedics, 8th ed, Vol. I. Arthroplasty. p 518

Download references

Author information

Correspondence to Y. Y. Kim.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kim, Y.Y., Kim, B.J., Ko, H.S. et al. Total hip reconstruction in the anatomically distorted hip. Arch Orthop Trauma Surg 117, 8–14 (1998). https://doi.org/10.1007/BF00703431

Download citation

Keywords

  • Femoral Component
  • Septic Arthritis
  • Cement Mantle
  • Roof Reinforcement
  • Cancellous Allograft