Joint replacement in X-linked hypophosphatemia

Abstract

X-linked hypophosphatemia (XLH) is associated with a pervasive, severe degenerative osteoarthritis. We conducted a retrospective chart review/patient survey using the Knee or Hip Osteoarthritis Outcome Score Physical Function Short Form. Fourteen total knee arthroplasties and 7 total hip arthroplasties among 11 patients were included. The mean KOOS-PS score was 31.4 ± 9.7 with a mean follow up of 6.9 years. Mean HOOS-PS score was 14.8 ± 12.9 at a mean follow up of 7.6 years. One knee failed due to aseptic loosening and one hip was revised due to polyethylene wear. In conclusion, total joint arthroplasty is beneficial in XLH.

Keywords: Hip arthroplasty; Knee arthroplasty; Knee or hip osteoarthritis outcome score physical function short form; Osteomalacia; Phosphate-wasting disorders; X-linked hypophosphatemia.

Fig. 1

This is a 55 year old female (Table 1, patient 4) who presented with bilateral knee pain. (A) is an anteroposterior (AP) film of her bilateral knees 2 years post-operatively from her left TKA, which was a cemented posterior stabilized implant. (B) is an AP film one year post-operatively from her right TKA, which was a cementless posterior stabilized implant, and three yrs. post-operatively from her left TKA. (C) is an AP film three years post-operatively from her left TKA and five years post-operatively from her right TKA, showing no evidence of loosening or implant migration.

Fig. 2

This is a 50 year old female (Table 1, Patient 3) who presented with severe medial compartment osteoarthritis bilaterally (A). (B) She underwent cemented bilateral TKA, and this is an anteroposterior (AP) film one year post-operatively from her right TKA and two years post-operatively from her left TKA. The tibial component on the right side is malaligned with respect to the tibial canal (arrow). (C) This is an AP film six years post-operatively from her right TKA. She was not experiencing any pain, but there is clear evidence of tibial component loosening (arrow) and migration. (D) This is an AP film after revision right TKA.

Fig. 3

This is a 59 year old female (Table 2, Patient 8) presenting with bilateral hip pain who underwent bilateral cementless THA. (A) shows a pre-operative AP pelvis showing decreased bone quality and bilateral osteoarthritis (B) shows a post-operative AP X-Ray of the left hip with stable implant fixation and no evidence of complication.

Fig. 4

This is a 41 year old female (Table 2, Patient 11) who initially underwent cementless total hip arthroplasty and subsequently suffered a periprosthetic fracture. This is an anteroposterior film of her right hip post open reduction internal fixation of the fracture.