잠시만 기다려 주세요. 로딩중입니다.

Total Hip Arthroplasty for Secondary Coxarthrosis in Patients with Hereditary Multiple Exostoses: Minimum 5-Year Follow-up Results and Surgical Considerations

Clinics in Orthopedic Surgery 2020년 12권 4호 p.435 ~ 441
윤재연, 박찬우, 박연수, 유정준, 김희중,
소속 상세정보
윤재연 ( Yoon Jae-Youn ) - Dongguk University Ilsan Hospital Department of Orthopedic Surgery
박찬우 ( Park Chan-Woo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Orthopedic Surgery
박연수 ( Park Youn-Soo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Orthopedic Surgery
유정준 ( Yoo Jeong-Joon ) - Seoul National University College of Medicine Department of Orthopedic Surgery
김희중 ( Kim Hee-Joong ) - Seoul National University College of Medicine Department of Orthopedic Surgery

Abstract


Background: Hereditary multiple exostoses (HME) is an autosomal dominant disorder. The lesion in the proximal femoral metaphysis can bring about hip dysplasia and subsequent degenerative arthritis. Due to its rare prevalence, there have been a few case reports of total hip arthroplasty (THA) for osteoarthritis secondary to HME. The aim of this study was to report mid- to long-term outcomes of THA in HME patients and discuss special considerations that should be taken into account during surgery.

Methods: We retrospectively evaluated the clinical and radiological results of THA for osteoarthritis secondary to HME in 11 hips of 9 patients after a minimum follow-up of 5 years (mean, 9.9 years). There were 3 men (3 hips) and 6 women (8 hips), with a mean age of 53.6 years (range, 46.8?58 years) at the index surgery in this study. Harris hip score (HHS) was used for clinical outcome assessment, and radiologically, implant stability, radiolucent lines, liner wear, and any sign of osteolysis or implant loosening were evaluated. Postoperative complications including infection, deep vein thrombosis, and dislocations were also investigated.

Results: Cemented stems and cementless cups with the conventional polyethylene liner were used in bilateral hips of a single patient. In the other cases, cementless implants were used with ceramic-on-ceramic bearings. The mean HHS improved from 34.8 preoperatively to 92.5 postoperatively. Polyethylene liner wear and osteolysis were observed in 1 patient with cemented stems. Radiolucent lines were observed in 2 different cases. However, the femoral stems remained stable. There were no surgery-related complications except heterotopic ossification during follow-up.

Conclusions: Despite the several surgical considerations, the mid- to long-term clinical and radiological outcomes of THA in HME patients were satisfactory. The abnormal, wide mediolateral diameter of the proximal metaphysis should be considered in selecting and inserting the stem with adequate anteversion. Leg length discrepancy was also common, so teleradiographs should be obtained before surgery. Intraoperative leg length evaluation might be difficult due to the morphologic changes in the proximal femur after mass excision and individual bone length differences.

키워드

Hip joint; Multiple hereditary exostoses; Osteochondromas; Osteoarthritis; Total hip arthroplasty

원문 및 링크아웃 정보

 

등재저널 정보