Clin Orthop Surg.  2009 Mar;1(1):19-26. 10.4055/cios.2009.1.1.19.

Cementless Total Hip Arthroplasty with Medial Wall Osteotomy for the Sequelae of Septic Arthritis of the Hip

• Yoo MC
• Cho YJ
• Kim KI
• Rhyu KH
• Chun YS
• Chun SW
• Oh H
• Kim EY

• KMID: 1127910
• DOI: http://doi.org/10.4055/cios.2009.1.1.19

Abstract

BACKGROUND: We performed a retrospective study to evaluate the results of acetabular circumferential medial wall osteotomy, a procedure designed to provide secure fixation of a cementless hemispherical acetabular cup for the sequelae of septic arthritis of the hip.
METHODS
We assessed 38 total hip arthroplasties (THAs) with circumferential acetabular medial wall osteotomies performed on patients with sequelae of septic arthritis of the hip between 1993 and 2000, who were followed up for > or = 3 years. The average follow-up period was 8.3 years (range, 3 to 12 years). The indication for this technique was poor acetabular cup coverage of < or = 70% on preoperative templating. In all cases, cementless hemispherical acetabular cups were fixed to the true acetabulum. Additional procedures included soft tissue release in 16 hips and femoral derotational and shortening osteotomies in 12 hips. We evaluated both clinical and radiological results.
RESULTS
The Harris hip scores improved from 57 points preoperatively to 91 points postoperatively. Radiological analysis revealed no aseptic loosening or radiolucent lines around the acetabular cup. Stable bony fixation of the acetabular cup in the true acetabulum was seen in all cases. Acetabular osteolysis was demonstrated in 12 hips. Revision surgery was performed in 6 hips, but there were no complications related to acetabular circumferential medial wall osteotomy.
CONCLUSIONS
Circumferential acetabular medial wall osteotomy can provide appropriate positioning and sufficient coverage of the acetabular cup and thus preserve the medial wall thickness in cementless THA without the need for additional bone grafting for the sequelae of septic arthritis of the hip.

Keyword

Sequelae of septic arthritis of the hip; Cementless THA; Circumferential medial wall osteotomy

MeSH Terms

Acetabulum/*surgery
Adult
Aged
Arthritis, Infectious/*surgery
Arthroplasty, Replacement, Hip/*methods
Female
Hip Joint/surgery
Hip Prosthesis
Humans
Male
Middle Aged
Osteotomy/*methods
Retrospective Studies
Young Adult

Figure

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  Fig. 1 Anteroposterior roentgenogram measurements in preoperative (A) and postoperative (B) diagrams of the pelvis. A: Abductor moment arm, M: Thickness of the medial wall of the acetabulum, C: Center body moment arm, CH: Center of hip.

• 

  Fig. 2 The line of the circumferential medial wall osteotomy. Schematic view (A) and intraoperative view (B). Osteotomy direction of the procedure (C).

• 

  Fig. 3 Pushing the osteotomized medial wall with a cup pusher after circumferential medial wall osteotomy. Schematic view (A) and intraoperative view (B). The medial wall was displaced medially, and thus the shallow acetabulum became deeper (C).

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  Fig. 4 Completely seated porous coated hemispherical acetabular cup after reaming of the acetabular fossa. Schematic view (A) and intraoperative view (B).

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  Fig. 5 (A) Preoperative (a) and postoperative (b) radiographs in a 57-year-old woman's hip in which a medial wall osteotomy was used in THA to obtain adequate coverage of the acetabular component and a natural center of rotation. (c) Anteroposterior radiograph, taken 11 years postoperatively, showing thick bone stock of the well remodeled medial acetabular wall. (B) Preoperative (a) and 6-month postoperative (b) radiographs in a 21-year-old woman's hip in which a medial wall osteotomy was used in THA to obtain adequate coverage of the acetabular component and a natural center of rotation. (c) Anteroposterior radiograph, taken 11 years postoperatively, showing thick bone stock of the well remodeled medial acetabular wall.

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