|
J.Orthopaedics 2007;4(3)e66
Introduction:
The reversal of hip arthrodesis with a Total Hip Arthroplasty
has been well documented. We describe the case of a
reversal of an ankylosed hip in a 69-year-old man using a
Birmingham Hip Resurfacing device. No surgical
complication occurred. Six months following surgery, the
patient exhibited good clinical function and remained satisfied
with the outcome. We conclude that metal-on-metal
resurfacing arthroplasty represents a viable alternative for the
reversal of hip arthrodesis. To our knowledge, no similar
cases have been reported in the literature to date
Case Report :
A sixty-nine-year-old
retired man presented with difficulty with personal toilet
function because of poor hip abduction.
He has a history of childhood TB infection treated on
traction with bilateral ankylosis of the hips. He was able to
work for 45 years as a London black cab taxi driver. On
examination, no movement could be obtained in either hip.
There had been a left femoral fracture resulting in
shortening of 10 cm on the affected side.
Radiographs show bilateral ankylosis of the hips (figure
1). A posterior
approach was used to explore the left hip.
Curved osteotomes were used to open the joint and a
Birmingham Hip Resurfacing device was implanted routinely.
The acetabular cup was loose on impaction and the
decision was taken to cement the component due to poor bone
stock.
At 8 months follow-up the patient was asymptomatic with a
painless range of movement of 30° of flexion, 30° of
abduction, 10° of adduction, 30° of external rotation and
60° of internal rotation (figure 2).
The patient was satisfied with the outcome of the
operation and with an appropriate heel-raise, reported improved
mobility and toilet function.
Radiological
studies
Figure
1. Pre-operative anteriorposterior radiograph of both hips
showing bilateral arthrodesis.
Figure
2 .Post operative anteriorposterior radiograph of the both
hips, showing Birmingham Hip Resurfacing components in position
Discussion :
Several
authors have reported on the reactivation of quiescent
tuberculosis in Total hip Arthroplasty. [i] [ii] [iii]
Berbari reported only a minority of hip revision procedures had
reactivation in patients who had received Tuberculosis
prophylaxis.[iv] Y.H. Kim 1 and Hardinge 2 reported no
reactivation in their series of patients with over ten and
twenty years of quiescent infection prior to arthroplasty
respectively. Pre- or post-operative anti-tuberculosis
prophylaxis was deemed unnecessary in our patient.
Several studies have shown the long term efficacy of the Total
Hip Arthroplasty in arthrodesis conversion. Retrospective
reviews conducted by Atul[v] and Schuh[vi]
concluded that although the procedure had a favourable outcome,
it was a technically demanding operation and had a higher risk
of complications including, nerve palsies, heterotopic
ossification and revision arthroplasty.
Although few long term comparisons between Hip Resurfacing Arthroplasty and full hip replacement have been reported, short
term results for metal-on-metal hip resurfacing have been
promising. Hip resurfacing is becoming a more popular
procedure in younger patients with primary osteoarthritis.[vii]
[viii]
A series of retrospective studies in the UK have shown that Hip
Resurfacing Arthroplasty in younger patient groups resulted in
increased range of movement, enhanced stability, and greater
preservation of femoral bone stock as well as better quality of
life and activity scores.[ix], [x], [xi] A retrospective
study by Itayem[xii] evaluating the stability of Birmingham Hip
Resurfacing in a small group of patients over 2 years showed a
reduced incidence of migration of the components in Birmingham
Hip Arthroplasty compared to Total Hip Arthroplasty.
In
our case, the decision to use a Birmingham Hip Resurfacing
device instead of a Total Hip Replacement was based on several
factors including the patient’s expectations, the anatomy and
his atrophic musculature. Although recovering a full range
of movement was not expected, our objective was to restore
functional use and maximum passive movement. Wykman and
Olsson[xiii] found that although patients with bilateral hip
disease gained pain relief and improved walking speed after the
first hip replacement, optimal speed and mobility were only
achieved after both hips have been replaced. To reduce
instability and subsequent subluxation Hardinge[xiv] suggests
obtaining firm tension of the abductors in a Total Hip
replacement. The abductors in our patient would have
undergone considerable atrophy following long term ankylosis
leading to a higher probability of dislocation. The larger
bearing surface in the Birmingham Hip Resurfacing device would
theoretically reduce the risk of dislocation by offering greater
stability compared to a Total Hip replacement.9
In this case, the patient has retained adequate femoral neck
anatomy and minimal bone stock loss following a tuberculosis hip ankylosis. This allowed the Birmingham Hip Resurfacing
device to be used effectively. Provided the ankylosed
joint can be opened with minimal bone stock loss, metal-on-metal
resurfacing is a viable option for the reversal of a hip
arthrodesis.
Reference :
-
Kim YH, Han DY, Park BM. Total hip arthroplasty for tuberculous coxarthrosis. J Bone Joint Surg Am, 1987;69: 718-27.
-
Hardinge K, Cleary J, Charnley J. Low-friction arthroplasty for healed septic and tuberculous arthritis. J Bone Joint Surg Br, 1979;61: 144-7.
-
Dogra AS, Kulkarni SS, Bhosale PB. Total hip arthroplasty in healed tuberculous hip. J Postgrad Med 1995;41:114-6
-
Berbari EF, Hanssen AD, Duffy MC, Steckelberg JM, Osmon DR. Prosthetic joint infection due to Mycobacterium tuberculosis: a case series and review of the literature. Am J Orthop,
1998;27: 219-27.
-
Atul B. Joshi, Ljubisa Markovic, Kevin Hardinge and John C.M. Murphy. Conversion of a Fused Hip to Total Hip Arthroplasty. . J Bone Joint Surg Am, 2002;84:1335-1341
-
Schuh A, Zeiler G, Werber S. Results and experiences of conversion of hip arthrodesis. Der Orthopade. 2005 Mar;34(3):218, 220-4.
-
Laura Wyness, Luke Vale, Kirsty McCormack, Adrian Grant and Miriam Brazzelli The effectiveness of metal on metal hip resurfacing: a systematic review of the available evidence published before 2002 BMC Health Services Research 2004,4:39 doi:10.1186/1472-6963-4-39
-
Daniel J, Pynsent PB, McMinn DJ. Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis J Bone Joint Surg Br. 2004;86(2):177-84.
-
Loughead JM, Starks I, Chesney D, Matthews JN, McCaskie AW, Holland JP. Removal of acetabular bone in resurfacing arthroplasty of the hip: a comparison with hybrid total hip arthroplasty. J Bone Joint Surg Br. 2006 Jan;88(1):31-4.
-
Pollard TC, Baker RP, Eastaugh-Waring SJ, Bannister GC. Treatment of the young active patient with osteoarthritis of the hip: A five to seven year comparison of hybrid of Total hip arthroplasty and Metal-on-metal resurfacing. J Bone Joint Surg Br, 2006 May;88(5):592-600.
-
Back DL, Dalziel R, Young D, Shimmin A. Early results of primary Birmingham hip resurfacings. An independent prospective study of the first 230 hips. J Bone Joint Surg Br, 2005 Mar;87(3):324- 9.
-
Itayem R, Arndt A, Nistor L, McMinn D, Lundberg A. Stability of the Birmingham hip resurfacing arthroplasty at two years: A radiostereophotogrammetric analysis study. J Bone Joint Surg Br, 2005 Feb;87(2):158-62.
-
Wykman A, Olsson E. Walking ability after total hip replacement: a comparison of gait analysis in unilateral and bilateral cases. J Bone Joint Surg Br,1992;74-B:53–6.
-
Hardinge K, Williams D, Etienne A, McKenzie D, Charnley J. Conversion of fused hips to low friction arthroplasty. J Bone Joint Surg Br, 1977;59(4):385-92.
|
