Abstract
Aim
to compare the medium term clinical and functional results of total hip arthroplasty after intertrochanteric osteotomy and primary total hip replacement.
Material and methods
We compared 2 groups of patients: Group I-93 patients with total hip arthroplasty after intertrochanteric osteotomy and Group II-93 patients with primary total hip arthroplasty. The patients in the control group (Group II) were randomly chosen from the cases operated by the same surgical team using the same kind of implant like those in Group I. The osteotomies were of different types: medial displacement (27), varisation(19), valgisation (18), flexion(25), rotational (4). The demographic parameters were similar in the 2 groups. Technical intraoperative challenges were noted. The Harris Score was determined at 12 months and 3 years after surgery. Clinical and radiological check-ups were performed each year. The duration of each surgical procedure was recorded. Complications were noted during the entire follow-up. The mean follow-up was 77 months.
Results
The average time interval between osteotomy and total hip replacement was 76 months. The average Harris Score (HHS) at 1 year after surgery was 88 in Group I and 93 in Group II. At 3 years, the average values of HHS were 85 in the first group and 92 in the second. After an average follow-up of 6 years, 6 patients in group I (6,45%) required revision arthroplasty, while in the second group this procedure was not necessary. The indication of revision was loosening of the femoral component in 4 cases and of both components in 2 cases. The duration of a total hip arthroplasty after an ostheotomy was almost two times longer than a primary total hip replacement. In most cases, the surgical procedure implicated removal of a blade plate or others fixation devices, reaming of the femur, osteotomies of the greater trochanter, reverse osteotomies of the intertrochanteric region and the use of special design (thin or curved) femoral stems. In group I, intraoperative complications included fractures of the femoral diaphysis, fractures of the greater trochanter, false passage for the femoral component and malposition of the femoral stem. Postoperative complications consist in dislocations, early loosening, heterotopical ossifications, wound sepsis, etc.
Conclusions
Total hip arthroplasties after intertrochanteric osteotomies have clinical results a little bit inferior of those of primary total hip replacements, but the difference is not significative. The survival rate of prosthesis implanted after intertrochanteric osteotomies at 6 years is significantly inferior. Both the intraoperative and postoperative complications rates are far superior of those of the primary arthroplasties.
