Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 18;22(1):29.
doi: 10.1186/s10195-021-00590-y.

Survival rates and reasons for revision of different stem designs in total hip arthroplasty for developmental dysplasia: a regional registry study

Alberto Di Martino  1   2 , Francesco Castagnini  3 , Niccolò Stefanini  4 , Barbara Bordini  5 , Giuseppe Geraci  4 , Federico Pilla  4 , Francesco Traina  6   3 , Cesare Faldini  4   6
Affiliations

Survival rates and reasons for revision of different stem designs in total hip arthroplasty for developmental dysplasia: a regional registry study

Alberto Di Martino et al. J Orthop Traumatol. .

Abstract

Introduction: Total hip arthroplasty (THA) in dysplastic hips is challenging, and each specific implant used in this context has been associated with specific complications. A registry study was performed to query survival rates, hazard ratios, and reasons for revision of different stem designs in THAs after developmental dysplasia of the hip.

Materials and methods: A regional arthroplasty registry was inquired about cementless THAs performed for hip dysplasia from 2000 to 2017. Patients were stratified according to stem design in tapered (TAP; wedge and rectangular), anatomic (ANAT), and conical (CON), and divided on the basis of modularity (modular, M; nonmodular, NM). In total, 2039 TAP stems (548 M and 1491 NM), 1435 ANAT (1072 M and 363 NM), and 2287 CON (1020 M and 1267 NM) implants were included. Survival rates and reasons for revisions were compared.

Results: The groups were homogeneous for demographics, but not fully comparable in terms of implant features. NM-CON stems showed the highest risk of failure (significant) and a high risk for cup aseptic loosening (2.5%). The adjusted risk ratio showed that NM-CON was more prone to failure (HR versus NM-ANAT: 3.30; 95%CI 1.64-7.87; p = 0.0003). Revision rates for dislocations and stem aseptic loosening did not differ between cohorts.

Conclusions: NM-CON stems showed the highest risk of failure, especially high rates of cup aseptic loosening. NM-CON implants were not more prone to dislocations and stem aseptic loosening. Clinical comparative studies are required to investigate the causes of NM-CON failures, which may be due to abnormal acetabular morphology or imperfect restoration of the proximal biomechanics.

Keywords: Anatomic; Conical; DDH; Dislocation; Dysplasia; Loosening; Modular; Stem; Tapered.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A representative stem model was provided for every cohort. M-ANAT: Ancafit, Cremascoli Ortho; NM-ANAT: AptaFix, Adler Ortho; M-CON: Acuta, Adler Ortho; NM-CON: Wagner Cone, Zimmer; M-TAP: SMF, Smith & Nephew; NM-TAP: Corae, Adler Ortho
Fig. 2
Fig. 2
NM-CON achieved the lowest survival rates (p < 0.05, Wilcoxon test; endpoint: any revision). M-ANAT: red line; NM-ANAT: green line; M-CON: blue line; NM-CON: orange line; M-TAP: cyan line; NM-TAP: violet line
Fig. 3
Fig. 3
The six survival rates were similar when the endpoint was revision due to stem aseptic loosening (p = 0.0462, close to significance). M-ANAT: red line; NM-ANAT: green line; M-CON: blue line; NM-CON: orange line; M-TAP: cyan line; NM-TAP: violet line
Fig. 4
Fig. 4
The six survival rates were similar when the endpoint was revision due to dislocations (p = 0.2571). M-ANAT: red line; NM-ANAT: green line; M-CON: blue line; NM-CON: orange line; M-TAP: cyan line; NM-TAP: violet line
See this image and copyright information in PMC

References

    1. Gustke K. The dysplastic hip: not for the shallow surgeon. Bone Joint J. 2013;95-B((11 Suppl A)):31–36. doi: 10.1302/0301-620X.95B11.32899. - DOI - PubMed
    1. Engesaeter LB, Furnes O, Havelin LI. Developmental dysplasia of the hip—good results of later total hip arthroplasty: 7135 primary total hip arthroplasties after developmental dysplasia of the hip compared with 59774 total hip arthroplasties in idiopathic coxarthrosis followed for 0 to 15 years in the Norwegian Arthroplasty Register. J Arthroplast. 2008;23(2):235–240. doi: 10.1016/j.arth.2007.03.023. - DOI - PubMed
    1. Thillemann TM, Pedersen AB, Johnsen SP, Søballe K. Danish hip arthroplasty. Registry implant survival after primary total hip arthroplasty due to childhood hip disorders: results from the Danish Hip Arthroplasty Registry. Acta Orthop. 2008;79(6):769–776. doi: 10.1080/17453670810016830. - DOI - PubMed
    1. Swarup I, Marshall AC, Lee YY, Figgie MP. Implant survival and patient-reported outcomes after total hip arthroplasty in young patients with developmental dysplasia of the hip. Hip Int. 2016;26(4):367–373. doi: 10.5301/hipint.5000354. - DOI - PubMed
    1. Perry KI, Berry DJ. Femoral considerations for total hip replacement in hip dysplasia. Orthop Clin North Am. 2012;43(3):377–386. doi: 10.1016/j.ocl.2012.05.010. - DOI - PubMed