Clinical Results of Total Hip Arthroplasty in Two Patients with Charcot Hip Joints due to Congenital Insensivity to Pain with Anhydrosis

Abstract

Traditionally, Charcot arthropathy has been considered an absolute contraindication for total hip arthroplasty (THA). However, some recent reports have shown that good short- to mid-term results can be achieved by improving the durability of the implant. This paper reports the mid- to long-term results of THA in two patients with Charcot hip joints caused by congenital insensivity to pain with anhydrosis. Both patients suffered multiple posterior dislocations in the six months immediately following surgery. However, with the continuous use of a hard abduction brace, one patient was eventually able to walk with a lofstrand cane and the other with the use of one crutch. Although one patient experienced a dislocation five years after surgery, X-rays taken after nine years and five years, respectively, revealed no clinical signs of implant loosening. We conclude that, with careful planning and appropriate precautions, THA may be a viable treatment option for Charcot hip joints caused by congenital insensivity to pain with anhydrosis.

Figure 1

Case 1 preoperative hip X-ray. Right Charcot arthropathy of the hip shows typical radiographic changes.

Figure 2

Case 1 postoperative hip X-rays. (a) Immediately after operation. (b) Nine years after operation. There were no clinical signs of implant loosening in the hip X-ray.

Figure 3

Case 2 preoperative hip X-rays. (a) Two months before admittance to our hospital. (b) Preoperative hip X-ray. A hip X-ray revealed the disappearance of right femoral head and destructive changes in the right acetabulum.

Figure 4

Case 2 postoperative hip X-rays. (a) Immediately after operation. (b) Five years after operation. There were no clinical signs of implant loosening in the hip X-ray.