Developmental Dysplasia Treated With Cementless Total Hip Arthroplasty Utilizing High Hip Center Reconstruction: A Minimum 13-Year Follow-up Study.

ABSTRACT

BACKGROUND: The primary aim of this study was to determine the clinical outcomes at 13-year follow-up of patients diagnosed with developmental dysplasia of the hip and subsequently treated with total hip arthroplasty (THA). The secondary aim was to investigate the effect of hip center location on clinical outcomes and polyethylene wear. METHODS: We reviewed data from a consecutive series of 104 patients (123 hips) from a single center. Patients were treated with THA with the high hip center (HHC) technique using cementless acetabular shells and highly cross-linked liners. Radiographs were collected preoperatively and through 13-year follow-up to assess degree of dysplasia (Crowe classification), component positioning, occurrence of bone resorption, and polyethylene wear. The Harris Hip Score (HHS) was administered at 4 and 13 years. RESULTS: No patients were lost to follow-up, and one was revised for femoral loosening. Radiolucency was seen in 20% of patients and was not associated with HHC (P = .560). No patients developed osteolysis. The wear rate was low for all patients (mean 3 ± 19 µm/y) and not associated with HHC (P = .852). The median 13-year HHS was 91.9 (interquartile range 84.8-97.0). There was a statistically significant decline from the 4- to 13-year HHS (P < .001) for the Crowe II-IV group, although 82% of these patients remained above 80 points at 13 years. The nondysplastic and Crowe I group showed no longitudinal change in HHS (P = .243). CONCLUSION: This cup design and highly cross-linked polyethylene liner combination demonstrates excellent clinical outcomes, similar to THA for primary osteoarthritis, through 13-year follow-up in patients with various degrees of developmental dysplasia of the hip and HHC reconstructions.