a recent study found that 27% of first-degree and second- degree relatives of an individual with DDH had unsuspected radiographic dysplasia. Many of these subjects with occult acetabular dysplasia (OAD) were younger than 30 years of age. After age 30 many of these individuals developed symptoms of OA, and their Western Ontario and McMaster Universities Osteoarthritis Index questionnaire (WOMAC) scores were significantly worse than those without OAD (P = 0.023; (Carroll et al., 2016). The natural history of DDH is variable and is dependent on the anatomical variations. The development of secondary OA is thought to occur due to altered and increased contact stresses where there is contact between the femoral head and acetabulum (Kosuge, Yamada, Azegami, Achan, & Ramachandran, 2013). Over time this increased contract stress can result in pain and reduced motion, necessitating a THA. Typically the greatest challenge in performing a THA in this Proximal hip fracture Management of femoral neck fractures has traditionally included either open-reduction internal fixation (ORIF), in the form of screws or pins or an acute arthroplasty in the form of a hemiarthroplasty (HA), or a THA. Internal fixation is frequently used where nondisplaced fractures occur or in younger patients with displaced fractures (Archibeck, Carothers, Tripuraneni, & White, 2013). Where displacement of the bony fragments has Additional conditions Other reasons leading to THA include damage to the joint following RA, a chronic autoimmune disease that causes repeated episodes of joint inflammation that erode and destroy the cartilage and bone. However, due to the improved successes of medical management of RA, fewer patients with RA are presenting for THA (Mellon et al., 2013). In addition, avascular necrosis (AVN), a condition where the femoral head loses its blood supply and dies, can cause collapse of the Functional indications Regardless of the underlying condition, the most significant indication for an elective THA is unremitting pain that increasingly interferes with activities of daily living, the ability to sleep at night, occupational tasks, and recreational pursuits. Most patients first try conservative treatment methods such as PT, exercise, acupuncture, weight loss programs, and medication before approaching a joint replacement. When these methods are no longer effective in controlling hip pain, and when pain Surgical contraindications When deciding on the type of surgery, a THA cannot be performed if there is an active infection, cancerous tumor, or significant osteoporosis, as the quality of bone will not support the prosthetic implant. Unfortunately, unsuitable bone quality may inadvertently be advanced by the long-term (greater than 5 years) use of bisphosphonates, a class of medications designed to treat osteoporosis and reduce the risk of fractures by preventing the loss of bone mass. Ironically, the prolonged
population is a result of the anterolateral bone deficiency and increased acetabulum anteversion (Nawabi, Meftah, Nam, Ranawat, & Ranawat, 2014). The potential for a more complex surgery, in particular with implant placement, can lead to additional postoperative precautions with this population of patients undergoing THA. Clear communication with the surgeon following surgery is essential to be aware of any prohibited motions or altered weight-bearing abilities. Despite the potential complexity of THA for patients with DDH a recent study identified satisfying results in primary THA in patients with DDH at a mean follow-up of 20 years (Colo, Rijnen, Gardeniers, van Kampen, & Schreurs, 2016). In this review of these cases the authors found that the use of cement and impaction bone grafting led to a 7% revision rate during the range of 16 to 29 years. occurred, a HA or THA is the preferred method of management. When the HA is performed only the femoral component is replaced and the acetabulum remains untouched. The benefit of a HA over a THA is that there is less risk of dislocation, the surgery is shorter, and the cost is less. There is ongoing debate regarding which is the more favorable option. femoral head and hip joint degeneration, necessitating a joint replacement. A review of the National Hospital Discharge Survey revealed that younger, male African Americans with medical comorbidities were more likely to undergo THA for AVN than other populations. Their review also found that the number of THAs for AVN had increased over the past 10 years, but the rate of primary THA for hip OA had increased at a much more rapid rate (Mayers et al., 2016). interferes with health-related quality of life such as sleep, work, and play, many surgeons simply tell patients that “they’ll know when it’s time.” At this time the patient must consider his or her desired quality of life and individual tolerance or threshold for pain in making that final decision to undergo this elective procedure. A THA would not be considered an elective procedure when a fracture has occurred that requires surgical intervention, such as a THA or HA. use of bisphosphonates, such as risedronate and alendronate, may actually inhibit bone turnover and can lead to unexpected stress fractures (Khatod et al., 2015). Severe comorbidities, such as uncontrolled diabetes mellitus, heart disease, lung disease, neurological disease, vascular disease, and other systemic diseases that result in an unacceptable surgical risk, should also be considered as surgical contraindications for THA.
SURGICAL DETAILS
Hip replacement surgery is one of the most common orthopedic procedures being performed today, and this surgery has a consistently good outcome (J. M. Brown et al., 2016). The authors of a recent systematic review of mid-term quality of life after THA found THA provides significant health-related quality of life benefits across a broad range of health domains not limited to but including bodily pain, and physical and emotional health (Shan et al., 2014). Many designs of THA prostheses are on the market today with manufacturers marketing different versions of the components (Mellon et al., 2013). The key components of a THA, the femoral prosthesis and acetabular cup, are displayed in Figure 7.
Figure 7: The Components of a THA for the Left Hip
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