Primary hip arthroplasty for the treatment of alkaptonuric hip arthritis: 3- to 24-year follow-ups

Abstract

Background: The objective of this study is to share our experience in total hip replacement for the treatment of ochronotic hip arthritis, in particular to report how to establish the diagnosis and some tips to limit complications.

Method: A cohort comprised of 10 patients (12 hips) with alkaptonuric hip arthritis. There were six men and four women with the mean age of 62.80 ± 7.57 years. All patients had a stiff spine, grossly restricted movements of hip joints, and severely limited daily routine activities. Total hip replacement was performed in all patients. The patients were evaluated at 6, 12, and 24 months after surgery, as well as every 4 years thereafter. Harris hip score was used to assess the functional outcome. The level of significance was set at p < 0.05.

Results: The mean follow-up lasted 16.70 ± 6.82 years (3 to 24 years). At the final available follow-up, nine patients returned to work, ambulate without an orthosis, and achieve complete pain relief. Harris hip score was improved from poor to excellent. One patient died 16 years after surgery due to breast cancer. No complication relating to prosthetic failures was detected.

Conclusion: Total hip replacement gives long-term satisfactory results in patients with alkaptonuric hip arthritis, resulting in comparable function of the hips in patients who undergo primary osteoarthrosis.

Keywords: Alkaptonuric arthritis; Harris hip score; Ochronosis; Total hip replacement.

Fig. 1

a & b Anteroposterior and lateral X-ray films of the pelvis, with both hip joints showing reduced join space with degenerative changes, irregularity, and flattening of femoral head

Fig. 2

a & b Anteroposterior and lateral spine X-ray films revealed osteoporosis, flattened, and intra-discal calcification (doubling signs), and variable degrees of fusion of the vertebral bodies

Fig. 3

Black discoloration over the tensor fascia lata, and calcification of the hard tissues with blackish deposit over the gluteus muscles

Fig. 4

a A classical black painted articular cartilage of the femoral head; b A black painted articular cartilage of the acetabulum with sclerosis

Fig. 5

Cutaneous signs of ochronosis that include changes of the color of the sclera and ears

Fig. 6

Pelvis and both hips on X-rays. a preoperative anteroposterior view; b lateral view c anteroposterior view immediately after surgery; d anteroposterior view 5 years after surgery; e Lateral view 5 years after surgery; f anteroposterior view 10.5 years after surgery; g Lateral view 10.5 years after surgery

Fig. 7

Pelvis and hips on X-rays. a an anteroposterior view preoperatively (left); follow-up X-rays after 2 years (uncemented ASR with S-ROM; right); b preoperative lateral view of left hip; c an anteroposterior view immediately after surgery (left) and follow-up after 2 years (right); d anteroposterior view at the final follow-up of 15.7 years (Uncemented ASR with S-ROM; right) and left hip (13.7 years; Pinnacle with Summit)