Charnley Low Friction Arthroplasty for Osteoarthritis in Congenital

Charnley Low Friction Arthroplasty for Osteoarthritis in Congenital Dislocation, Subluxation, Dysplasia Professor B. M. Wroblewski Mr P. D. Siney Ms P. A. Fleming Mr P. Bobak The John Charnley Research Institute, Wrightington Hospital Research supported by the Peter Kershaw & John Charnley Trusts BMW - 2005

"This type of problem is regarded as too extreme for this type of technical procedure, inviting more technical hazards than the degree of disability warrants. ” Low Friction Arthroplasty in Congenital Subluxation of the Hip. J. Charnley, J. A. Feagin CORR. No. 91 1973 BMW - 2005

CDS/OA - % of all LFAs 21263 LFAs BMW - 2005

CDS/OA - % of Young Patients 1434 LFAs BMW - 2005

CDS/OA - % of LFAs BMW - 2005

Underlying Hip Pathology Number Primary O. A. CDS/OA Quadrantic head necrosis Slipped upper femoral epiphysis Rheumatoid arthritis Trauma Fracture neck of femur BMW - 2005 298 395 69 55 292 85 38 % 20. 8 27. 6 4. 8 3. 8 20. 4 5. 9 2. 7

Age at LFA Mean 41 years 4 months Range: 15 - 51 BMW - 2005

300 Patients : 395 LFAs Number % Male Female 42 258 14 86 Left Right 212 183 54 46 BMW - 2005 Ratio : 6 Females to 1 Male

Weight Mean 61. 5 kgs Range 40 - 98 BMW - 2005

Bilateral LFAs : 48. 1% Patients Hips Bilateral 95 190 Consecutive Staged 22 73 44 146 BMW - 2005

Hartofilakidis Classification % A: Dysplastic hip B: Low dislocation C: High dislocation BMW - 2005 32. 2 56. 6 11. 2

Previous Surgery None Osteotomy (femoral / pelvic) Open reduction Fusion / attempted fusion Cup arthroplasty Other (soft tissue procedures) BMW - 2005 Number % 296 59 17 10 3 33 75. 0 15. 0 4. 3 2. 5 0. 8 8. 6

Cup Used % Offset-bore (38 mm) 40 mm 43 mm 10. 6 47. 6 41. 8 BMW - 2005

Follow up Mean 16. 6 years Range: 1 - 35 BMW - 2005

Clinical Results Merle d’Aubigne and Postel grading BMW - 2005

Clinical Results Pain free / Occasional discomfort 89. 8 % Normal or near normal function 74. 5 % Normal or near normal movement 72. 9 % BMW - 2005

Complications within one year Number None Trochanteric non union DVT (clinical) PE (clinical - non fatal) Dislocation BMW - 2005 % 348 88. 0 13 10 8 2 3. 3 2. 5 2. 0 0. 5

Complications after one year Number None Loose cup Loose stem Dislocation Infection Fractured stem BMW - 2005 % 264 66. 8 72 20 5 3 3 18. 2 5. 1 1. 3 0. 8

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Revisions 77 LFAs 19. 5% BMW - 2005

Indications for Revision Number Loose cup Cup wear Loose stem Infection Exploration 59 7 17 2 8 BMW - 2005 } % 16. 7 4. 3 0. 5 2. 0

Wear Cup Loosening / Revision BMW - 2005

Post-op 13 years BMW - 2005

Follow up Number % Lost Patients LFAs 26 32 6. 7 8. 8 Died Patients LFAs 17 24 4. 4 6. 1 Revised Patients LFAs 56 77 15. 0 19. 5 Attending Patients LFAs Follow-up 201 262 19 years BMW - 2005 60. 2 66. 3 (10 -35)

33 year old Male Pre-op BMW - 2005

18 years follow-up BMW - 2005

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Results of THR for DDH without femoral head autograft Author Mac. Kenzie 1996 32 Pagnano 1996 40 Numair 1997 No Mean FU (years) 59 16. 0 145 14. 0 182 Revised % Loose % 10 19 9. 9 BMW - 2005 10 6

Results of THR for DDH with femoral head autograft Author No Mean FU (years) Revised % Mulroy 1990 46 11. 8 20 26 Spangehl 2001 44 7. 5 9 0 Kobayashi 2003 37 19. 0 0 0 BMW - 2005 Loose %

45 Charnley LFA's 41 patients Women 36 Men 9 BMW - 2005

Age at LFA Average 46 years 3 months BMW - 2005

Preoperative Radiographic Evaluation Hartofilakidis Classification 1988 Dysplasia 1 Low dislocation 29 BMW - 2005 High dislocation 15

Previous Surgery § § Femoral osteotomy Open reduction Conservative treatment Pelvic osteotomies § Soft tissue release 14 6 6 3 1 BMW - 2005

Surgical Technique § Trochanteric osteotomy § Identification of the tear-drop § Acetabular preparation BMW - 2005

Surgical Technique § Bone graft preparation and fixation BMW - 2005

Surgical Technique § Socket fixation BMW - 2005

Socket coverage by the bone-graft Average: 26 % Range: 16 - 35 % BMW - 2005

Socket used Type Number Offset-bore (38 mm) 40 mm 43 mm 9 27 9 BMW - 2005

Clinical Results BMW - 2005

Bone Graft Union rate 100 % BMW - 2005

Bone Graft Resorption No of hips None Mild Moderate Major 18 24 2 1 Time to appearance 3. 6 years BMW - 2005

Follow-up Average : 17 years 1 month Range: 15 - 21 years BMW - 2005

Revised : 3 hips - Aseptic cup loosening - Infection Time to revision BMW - 2005 2 1 13. 1 years

Radiographic Results Socket Migrated Fully demarcated No of hips 3 4 Hodgkinson et al COOR 1986 BMW - 2005

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Post-op 5 years BMW - 2005

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Radiographic Results : Cup 24 sockets showed demarcation Demarcation in zone 1 rare BMW - 2005

Post-op 16 years BMW - 2005

Post-op 18 years BMW - 2005

Post-op 21 years BMW - 2005

Conclusion 45 Charnley LFA's 5 died 40 attending follow-up Average Follow-up: 16 years 5 months BMW - 2005

Conclusion Sound fixation at primary surgery essential. Solid graft + impaction bone grafting. Better bone stock at revision. The long-term outcome will depend on the rate of cup penetration. BMW - 2005

Wear Cup Loosening / Revision BMW - 2005