Total hip arthroplasty in the young arthritic patient.

BACKGROUND: Hip disease is a major cause of immobility and pain in children and young adults with inflammatory arthritides. Total hip arthroplasty (THA) has previously been avoided in young patients because of the concern about durability of the prosthesis and the need for multiple revisions. There are now, however, growing reports of the success of such procedures in improving mobility and relieving pain in the young patient with severe hip disease. In this study we aimed to determine the clinical and radiological results in patients with inflammatory arthritides who had undergone THA before the age of 35 years. METHODS: Twenty-one patients who had undergone a total of 38 hip arthroplasties were identified. Patients' hips were scored both pre-operatively and at follow-up using the scoring system of the Hospital for Special Surgery, which allots a score for pain, walking, motion and muscle power, and function. Complications were noted and follow-up X-rays were compared to postoperative films to assess radiological loosening. RESULTS: The mean age at operation was 24 years, and the mean follow-up was 8.6 years. The results in terms of pain relief, mobility, movement and functional capacity were good. Revision was required in 13 hips (34%). This was mostly due to the failure of resurfacing prostheses. Radiological loosening was evident in a further six hips, five of which were asymptomatic. CONCLUSIONS: THA can dramatically improve the quality of life of the young patient with arthritis. The main concern is the likely need for multiple revisions, with progressive loss of bone stock.

Porous coated anatomic non-cemented total hip arthroplasty.

Between November 1984 and December 1989, 318 non-cemented Porous Coated Anatomic (PCA; How-medica, Rutherford, New Jersey) total hip replacements were performed by the authors. A follow-up of 1 to 6 years was allowed. The average age was 53.1 years (from 17 to 71 years). The distribution of right-to-left was approximately equal. There were 192 hip replacements for primary and post-traumatic osteo-arthritis, 42 for rheumatoid arthritis, 40 for avascular necrosis, 29 for congenital dislocation or hip dysplasia with secondary osteo-arthritis, 6 for Perthes disease, 5 for previous sepsis, 2 of whom had had a Girdlestone procedure, 2 for revision of a painful cup arthroplasty, and 1 for conversion of a previously fused hip. All patients were evaluated on a one hundred point Harrington Arthritis Research Centre Scale. Points were awarded for pain (0-35), function (0-35), motion (0-10), deformity (0-10) and gait (0-10). Pre-operative total scores averaged 45.5 (9-71) and postoperative scores averaged 83.9 (55-98). The overall results were excellent 20.5% (90-100), good 59.8% (80-90), fair 16.4% (70-80), and poor 3.3%. Postoperative radiographs were evaluated using zonal analysis. There was no deterioration on the radiographs after two years.

Intraluminal allograft restoration of the upper femur in failed total hip arthroplasty.

Deep-frozen cancellous allografts have been used to restore the proximal femur of 23 hips following failed total hip arthroplasty. The canal is cleared and reaming is performed under direct vision through a cortical window. A modified Huckstep prosthesis permits early weight-bearing on the distal femur regardless of the state of proximal bone, but retains the option for later restoration of proximal loading once grafts appear mature. This transfer has been performed on four occasions. All 23 patients have had relief of pain with early ambulation. The follow-up periods ranged from six to 30 months. With the exception of one deep infection, the grafts have not undergone resorption in this period of follow-up study. Consolidation appears slower when the defect has followed multiple operations than following an initial revision for prosthetic loosening. The basic bone bank facilities are required for the supply of frozen allografts.

A study of a myopathy presenting as idiopathic scoliosis. Multicore disease or mitochondrial myopathy?

Seven cases from a family with a myopathy categorized as "multicore disease" are presented. The clinical picture is unusual because of the predominant progressive involvement of the axial skeletal muscle, with scoliosis and disproportionate respiratory failure as the major clinical features. The propositus and his cousin have both suffered from scoliosis without limb weakness. There is a possibility that this myopathy may be responsible for some cases regarded as idiopathic scoliosis, especially idiopathic infantile scoliosis. The clinical picture is highly variable, and there are sub-clinical cases. The inheritance pattern is consistent with either autosomal dominant, sex-linked recessive or extra-chromosomally inherited disease. Electron microscopy revealed mitochondrial abnormalities, which may have resulted in the Z-disc pathology.