Total hip arthroplasty in patients with Down's syndrome

Abstract

Patients with Down's syndrome (DS) have an increased incidence of coxarthrosis which may become symptomatic with prolonged life expectancy. We present seven consecutive patients (nine hips) with DS who had primary total hip arthroplasty (THA). Average clinical and radiological follow-up was 9.9 ± 6.4 years (range 2-22.25). Harris hip scores (HHS) improved significantly (p < 0.01) from 41.1 (range 18.5-65) to 80.2 (range 67.5-91) at latest follow-up. Two patients required revision arthroplasty for stem loosening at 16 (osteolysis) and six years (trauma) following THA, respectively. Six of the THAs required a constrained liner. No dislocations or deep infections were encountered. We contend that THA is a reliable surgical intervention in patients with DS and may be performed in symptomatic patients.

Fig. 1

Preoperative X-ray of a patient with Down syndrome and bilateral developmental hip dysplasia (DDH)

Fig. 2

Postoperative X-ray of the patient. Total hip arthroplasty (THA) was performed through a modified trochanteric slide bilaterally. A shelf autograft was performed to support the left dysplastic acetabulum. Trochanteric slides had a bony union bilaterally

Fig. 3

Harris hip scores (HHS) recorded at patient's follow-up visits. Please note that HHS reached a lasting plateau at one year after total hip arthroplasty (THA). THA 7 had a sudden drop in her HHS due to a periprosthetic fracture and returned to pre fracture levels after the revision THA. THA 3 had a gradual decline of his HHS in the last few years prior to his hip revision due to stem loosening