Document Type: RESEARCH PAPER

Authors

Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India

Abstract

Background: Optimum component positioning and orientation is required to optimize the functional result during total
hip arthroplasty for dysplastic hips.
Methods: Sixty-two patients (66 hips) including 33 males and 29 females underwent total hip arthroplasty using
modular stem prosthesis at an average age of 40.6 years (range 17 to 49 years). Nineteen hips were classified
as Type I, 24 hips as Type II, 13 hips as Type III and 10 hips as Type IV dysplastic hips according to Crowe’s
classification. Eighteen hips (27.2%) underwent sub trochanteric osteotomy and 23 hips (34.8%) required adductor
tenotomy at the time of surgery.
Results: Sixty-one patients (65 hips) were available for the latest follow up. The median follow-up was 57.4 months
(range12 to 100 months). The mean Harris Hip Score was 90.6 (range 72 to 96), which was significant improvement
from the preoperative Score of 44.8 (range 38 to 62). The clinical outcome was graded as excellent in 39, good in
13, fair in 7 patients and poor in 2 patients respectively. Only one hip (1.5%) had underwent revision surgery for
the stem at 18 months following the index surgery. Postoperative dislocation following a fall was seen in one hip
of a female patient who was operated on both sides. The radiographs revealed that all the remaining 65 hips had
stable femoral component and the osteotomy sites were healed. The Kaplan-Meier survivorship with revision as
endpoint (including open reduction for dislocation) was found to be 96.4% at 100 months (95% Confidence Interval;
86.3-99.1).
Conclusion: This study in South-Asian patients using the modular stem strengthened the premise that cementless
modular total hip arthroplasty provides a satisfactory outcome in treating secondary osteoarthritis due to dysplastic
hips.
Level of evidence: IV

Keywords

Main Subjects

1. Herring JA. Developmental dysplasia of hip.
Tachdjian’s pediatric orthopaedics. 5th ed. New York:Elsevier; 2013. P. 483-585.

2. Kumar JN, Kumar JS, Wang VT, Das De S. Medium-

term outcome of total hip replacement for dysplastic
hips in Singapore. J Orthop Surg (Hong Kong). 2010;
18(3):296-302.

3. Li PL, Ganz R. Morphologic features of congenital
acetabular dysplasia: one in six is retroverted. Clin
Orthop Relat Res. 2003; 416(1):245-53.
4. Steppacher SD, Tannast M, Werlen S, Siebenrock KA.
Femoral morphology differs between deficient and
excessive acetabular coverage. Clin Orthop Relat Res.
2008; 466(4):782-90.
5. Hartofilakidis G, Yiannakopoulos CK, Babis GC. The
morphologic variations of low and high hip dislocation.
Clin Orthop Relat Res. 2008; 466(4):820-4.
6. Wu X, Li SH, Lou LM, Cai ZD. The techniques of
soft tissue release and true socket reconstruction
in total hip arthroplasty for patients with severe
developmental dysplasia of the hip. Int Orthop.
2012; 36(9):1795-801.
7. Van Bosse H, Wedge JH, Babyn P. How are dysplastic
hips different? A three-dimensional CT study. Clin
Orthop Relat Res. 2015; 473(5):1712-23.
8. Clohisy JC, Nunley RM, Carlisle JC, Schoenecker PL.
Incidence and character- istics of femoral deformities
in the dysplastic hip. Clin Orthop Relat Res. 2009;
467(1):128-34.
9. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement
in congenital dislocation and dysplasia of the hip. J
Bone Joint Surg Am. 1979; 61(1):15-23.
10. Moore AT. The self-locking metal hip prosthesis. J
Bone Joint Surg Am. 1957; 39-A(4):811-27.
11. Harris WH. Traumatic arthritis of the hip after
dislocation and acetabular fractures: treatment by
mold arthroplasty. An end-result study using a new
method of result evaluation. J Bone Joint Surg Am.
1969; 51(4):737-55.
12. Gruen TA, McNeice GM, Amstutz HC. “Modes of
failure” of cemented stem-type femoral components:
a radiographic analysis of loosening. Clin Orthop Rel
Res. 1979; 141(1):17-27.
13. Johnston RC, Fitzgerald RH, Harris WH, Poss R,
Müller ME, Sledge CB. Clinical and radiographic
evaluation of total hip replacement. A standard
system of terminology for reporting results. J Bone
Joint Surg Am. 1990; 72(2):161-8.
14. Loudon JR. Femoral prosthetic subsidence after lowfriction
arthroplasty. Clin Orthop. 1986; 211(1):134-9.
15. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip
replacement. The factors governing bone ingrowth,
stress shielding, and clinical results. J Bone Joint
Surg Br. 1987; 69(1):45-55.
16. DeLee JG, Charnley J. Radiological demarcation of
cemented sockets in total hip replacement. Clin
Orthop Relat Res. 1976; 121(1):20-32.
17. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr.
Ectopic ossification following total hip replacement.
Incidence and a method of classification. J Bone Joint
Surg Am. 1973; 55(8):1629-32.
18. Bernasek TL, Haidukewych GJ, Gustke KA, Hill
O, Levering M. Total hip arthroplasty requiring
subtrochanteric osteotomy for developmental hip
dysplasia: 5- to 14-year results. J Arthroplasty. 2007;22(6 Suppl 2):145-50.

19. Cameron HU, Keppler L, McTighe T. The role of
modularity in primary total hip arthroplasty. J
Arthroplasty. 2006; 21(4 Suppl 1):89-92.
20. Sanchez-Sotelo J, Berry DJ, Trousdale RT, Cabanela
ME. Surgical treatment of developmental dysplasia
of the hip in adults: II. Arthroplasty options. J Am
Acad Orthop Surg. 2002; 10(5):334-44.
21. Pagnano W, Hanssen AD, Lewallen DG, Shaughnessy
WJ. The effect of superior placement of the
acetabular component on the rate of loosening after
total hip arthroplasty. J Bone Joint Surg Am. 1996;
78(7):1004-14.
22. Krych AJ, Howard JL, Trousdale RT, Cabanela ME,
Berry DJ. Total hip arthroplasty with shorthening
subtrochanteric osteotomy in Crowe type-IV
developmental dysplasia: surgical technique. J Bone
Joint Surg Am. 2009; 91(9):2213-21.
23. Tabak AY, Celebi L, Muratli HH, Yagmurlu MF, Aktekin
CN, Biçimoglu A. Cementless total hip replacement
in patients with high total dislocation: the results of
femoral shortening by sub-trochanteric segmental
resection. Acta Orthop Traumatol Turc. 2003;
37(4):277-83.
24. Baz AB, Senol V, Akalin S, Kose O, Guler F, Turan A.
Treatment of high hip dislocation with a cementless
stem combined with a shortening osteotomy. Arch
Orthop Trauma Surg. 2012; 132(10):1481-6.
25. Tamegai H, Otani T, Fujii H, Kawaguchi Y, Hayama T,
Marumo K. A modified S-ROM stem in primary total
hip arthroplasty for developmental dysplasia of the
hip. J Arthroplasty. 2013; 28(10):1741-5.
26. Kido K, Fujioka M, Takahashi K, Ueshima K, Goto
T, Kubo T. Short-term results of the S-ROM-A
femoral prosthesis operative strategies for Asian
patients with osteoarthritis. J Arthroplasty. 2009;
24(8):1193-9.
27. Wang D, Li LL, Wang HY, Pei FX, Zhou ZK. long-term
results of cement less total hip arthroplasty with
subtrochanteric shortening osteotomy in Crowe
type IV developmental dysplasia. J Arthroplasty.
2017; 32(4):1211-9.
28. Li L, Yu M, Yang C, Gu G. Total hip arthroplasty
(S-ROM stem) and subtrochanteric osteotomy for
Crowe type IV developmental dysplasia of the hip.
Indian J Orthop. 2016; 50(2):195-200.
29. Dallari D, Pignatti G, Stagni C, Giavaresi G, Del Piccolo
N, Rani N, et al. Total hip arthroplasty with shortening
osteotomy in congenital major hip dislocation
sequelae. Orthopedics. 20118; 34(8):e328-33.
30. Kang JS, Moon KH, Kim RS, Park SR, Lee JS, Shin SH.
Total hip arthroplasty using S-ROM prosthesis for
dysplastic hip. Yonsei Med J. 2011; 52(4):655-60.
31. Takao M, Ohzono K, Nishii T, Miki H, Nakamura N,
Sugano N. Cementless modular total hip arthroplasty
with subtrochanteric shortening osteotomy for hips
with developmental dysplasia. J Bone Joint Surg Am.
2011; 93(6):548-55.
32. Imbuldeniya AM, Walter WL, Zicat BA, Walter WK.
Cementless total hip replacement without femoral
osteotomy in patients with severe developmental 

dysplasia of the hip: minimum 15-year clinical
and radiological results. Bone Joint J. 2014; 96-
B(11):1449-54.

33. Biant LC, Bruce WJ, Assini JB, Walker PM, Walsh
WR. Primary total hip arthroplasty in severe
developmental dysplasia of the hip. Ten-year results
using a cementless modular stem. J Arthroplasty.2009; 24(1):27-32.

34. Park MS, Kim KH, Jeong WC. Transverse
subtrochanteric shortening osteotomy in primary
total hip arthroplasty for patients with severe hip
developmental dysplasia. J Arthroplasty. 2007;
22(7):1031-6.