Total Hip Arthroplasty in Patients of Post Polio Residual Paralysis: A Retrospective Case Series

Abstract

Background: Poliomyelitis is a viral, nervous system disease that affects both the upper and the lower extremities. The treatment of severe coxarthrosis in these patients with total hip arthroplasty (THA) has been widely questioned because of the high risk of subsequent complications. The aim of the present study was to describe both radiological and medium term clinical results in a series of patients with post polio residual paralysis that underwent THA.

Materials and methods: We report a retrospective review of a series of 5 five patients diagnosed with severe coxarthrosis secondary to post polio residual paralysis who were operated between 2008 and 2012. Uncemented THA was performed in all cases by the same surgeon. Clinical evaluation was carried out using the Harris Hip Score (HHS) at the preoperative visit, at 6 months, and annually after surgery.

Results: The median age was 47 years, and the median followup was 55 months (interquartile range P25-P75: range 31-72 months). According to the HHS, a significant clinical improvement was observed in all patients with a median score of 81 points (interquartile range P25-P75: range 74-89) at 1 year of followup. A case of relapsing dislocation that required revision surgery of the implant was recorded. No cases of component loosening were found.

Conclusion: THA surgery in patients with post polio residual paralysis is a complex procedure with a significant complication rate, but a predictable clinical improvement may encourage surgeons to perform in patients with severe coxarthrosis and moderate functional expectations.

Keywords: Paretic limb; Poliomyelitis; coxarthrosis; hip; paralysis; poliomyelitis; retrospective studies; total hip arthroplasty.

Figure 1

Preoperative pelvis anteroposterior X-ray of a patient with severe left coxarthrosis (Case 5)

Figure 2

Computed tomography scan used for preoperative planning

Figure 3

(a) X-ray pelvis anteroposterior view showing anterior dislocation of the left total hip arthroplasty at the early postoperative period (Case 5) (b) X-ray pelvis anteroposterior view at third- month visit (Case 5). Instability was managed by optimizing femoral version using a modular stem

Figure 4

X-ray pelvis anteroposterior view showing pseudoarthrosis of the greater trochanter osteotomy 5 years after total hip arthroplasty (Case 4)