Features of Total Arthroplasty in Dysplastic Coxarthrosis
Dysplastic coxarthrosis is one of the most severe lesions
of the locomotor system. Unlike idiopathic and post-traumatic
arthritis it is due to rather the diversity and complexity of progressive
anatomical and physiological changes in the musculoskeletal system
than to manifestation of degenerative and dystrophic process in
the hip joint. Most patients are young people of working age who
become disabled because of functional restrictions. On this stage
of the disease total hip arthroplasty is considered as no alternative
surgery that allows restore locomotor functioning.
In the scientific and practical aspects, the main objective of the
numerous studies is to fully restore or compensate biomechanical
disorders of the locomotor function, and provide the conditions for
long-term preservation of implant stability (prosthetic components)
in the pelvic bone and in the proximal femur.
The aim of the study is to analyze determining the choice of
surgical tactics and characteristics of primary total arthroplasty in
The retrospective study included 157 patients, 148 of whom were
women and 9 men aged 19 to 56 years old (mean age 37.4 ± 3.2
years old). According to X-rays 93 (59.2 %) patients had lesions in
both hip joints. Total number of primary arthroplasty operations
was 193 (100 %), including 36 (18.7 %) ones of both hip joints.
The treatment strategy was determines on the basis of the results of
radiographic studies and spiral computed tomography. The results
were systematized by the degree of dislocation of the proximal femur
(Crowe et al., 1979), as well as signs of pathological changes in the
acetabulum (Hartofilakidis et al., 1996).
There were noted the key points that determine the choice of
surgical treatment, surgery features: malformations and even lack of
vaults, malformations of back and especially anterior walls, reduced
depth of the cavity with the medial wall thinning, abnormal ratio of
dysplastic acetabulum and femoral head, deformity of the proximal
femur, bilateral lesions of the hip joints, deformity of the pelvic ring,
spine scoliotic deformity, imbalance and weakness of the pelvic
girdle muscles and concurrent limb deformity of dysplastic genesis.
Location of prosthetic cup according to physiological
parameters might ensure restoration of the natural center of hip
joint rotation, offset and muscles balance. In cases of too small
and thin anterior wall there should be kept its sub-chondral
cortical plate. Bone bed for the prosthetic cup is recommended
to be shaped by rimmers, mainly due to a strong and massive
posterior column. In central defects of the cavity medial wall bone
graft plastic was performed.
In defect of atsetabular component coverage more than 30
% there was used osteoplasty with cortical spongy graft. The hip
was mobilized by the gluteal muscles release, excision of the joint
capsule, adduktor miotomy, cutting off of m. iliopsoas tendon
from small trochanter, and large trochanter osteotomy with
adjoining muscles following by its further fixation and flapping
trochanter osteotomy. In 10 patients were undergone shortening
and corrective osteotomy of the femur.
Long-term results were investigated in 124 (78.98 %) patients
using a scale Harris Hip Score were operated on during 3–14 years
after arthroplasty. Thirty six patients were undergone arthroplasty of
both hip joints. The average duration of observation was 7.8 ± 1.1
years. General results were excellent (average score 93.67 ± 0.35) in
47 (37.9 %), good ones (average score 85.69 ± 0.52) in 48 (38.7 %),
satisfactory ones (average score 75.56 ± 0.58) in 22 (17.7 %) persons.
Bad results (average score 46.96 ± 3.05) in 7 (5.7 %) patients were
due to components instability development. Aseptic instability
occurred in 5 patients, in 3–5, 7 and 11 years after arthroplasty.
Septic instability occurred in 2 patients in 6 and 7 years. Five patients
had executed revision arthroplasty.
Various manifestations of anatomic and biomechanical
impairments of locomotor system, various forms of acetabulat and
femur components, possible use of bone grafting and restorations
should be regarded in difficult situations while hip arthroplastic
because of dysplastic coxarthrosis. There also could be intraoperative
changes in surgery.
Full Text:PDF (Українська)
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