Ömer Faruk BİLGEN, Kemal DURAK, Bartu SARISÖZEN, Oğuz KARAEMİNOĞULLARI, TEOMAN ATICI, Aytun TEMİZ

Doğumsal kalça çıkığı ve displazisinin tedavisinde çimentosuz total kalça protezi sonuçları

Amaç: Doğumsal kalça çıkığı ve dizplazisine bağlı sekonder osteoartrit nedeniyle çimentosuz total kalça protezi uygulamasının klinik ve radyolojik sonuçları değerlendirildi. Çalışma planı: Yirmi hastanın (18 kadın, 2 erkek; ort. yaş 46; dağılım 31-65) 23 kalçasına total kalça protezi uygulandı. Yedi kalça (%30.4) Crowe tip II, sekizi (%34.8) tip III, sekizi (%34.8) tip IV idi. Asetabulumun yetersiz olduğu altı kalçada (%26) femur başı greft olarak kullanıldı. Sekiz kalçada (%34.8) subtrokanterik femoral kısaltma osteotomisi uygulandı. Klinik değerlendirme Harris ve d’Aubigné’nin kalça değerlendirme kriterleri ile yapıldı. Radyolojik değerlendirme ameliyat öncesi ve sonrası ve kontrollerde çekilen ön-arka grafilerle yapıldı. Ortalama takip süresi 35.1 ay (dağılım 12-85 ay) idi. Sonuçlar: Ameliyat öncesi ve sonrası Harris kalça puanları 38.6 ve 91.1; d’Aubigné kalça değerlendirme puanları ağrı için 1.66 ve 5.7, hareket açıklığı için 3.1 ve 5.4, yürüme için 3.2 ve 5.3 bulundu. Radyolojik incelemede ortalama greft örtümü %32 idi. Yedi kalçada (%30.4) asetabuler komponentin tamamı asetabular kemik tarafından örtüldü. On kalçada (%43.4) asetabular komponentin desteksiz kalan bölümü ortalama %18 (%6.5-%22) bulundu. Asetabular komponent 10 kalçada (%43.4) hemen hemen yerinde, sekiz kalçada (%34.8) aşağıda, beş kalçada (%21.7) yukarıda yerleşimliydi. Olgularda siyatik ve femoral sinir hasarı gelişmedi. Crowe tip IV’lü bir olguda (%4.4) asetabuler malpozisyon nedeniyle disloke olan kalçaya asetabuler revizyon uygulandı. Yeniden çıkık gelişmedi. Çıkarımlar: Doğumsal kalça çıkığı veya displazili olgularda, çimentosuz küçük asetabuler komponentin gerçek asetabuluma yerleştirilmesi, kemik örtümü yetersiz olgularda greft kullanılması, gereken olgularda femoral kısaltma osteotomisi yapılması gerektiği sonucuna varıldı.

Anahtar Kelimeler:

Asetabulum, Kalça çıkığı, doğumsal, Nakil, otolog, Artroplasti, Kemik çimentosu, Femur başı, Kalça protezi, Osteoartrit

Results of uncemented total hip prosthesis for congenital hip dislocation and dysplasia

Objectives: We evaluated clinical and radiologic results of uncemented total hip arthroplasty for secondary osteoarthritis in patients with congenital hip dislocation and dysplasia. Methods: Total hip arthroplasty was performed in 23 hips of 20 patients (18 females, 2 males; mean age 46 years; range 31 to 65 years). Seven (30.4%), eight (34.8%), and eight hips were Crowe type-II, III, and IV, respectively. Femoral head autografting was used in six patients with acetabular deficiency. Eight hips (34.8%) underwent subtrochanteric femoral osteotomy. Clinical evaluation was made using the Harris hip scores and Merle d'Aubigné's criteria, and radiological evaluations with pre- and postoperative, and control A-P radiographs. The mean follow-up was 35.1 months (range 12 to 85 months). Results: Pre- and postoperative mean Harris hip scores were 38.6 and 91.1, respectively. The mean Merle d'Aubigné scores were 1.66 and 5.7 for pain, 3.1 and 5.4 for mobility, and 3.2 and 5.3 for walking, respectively. Radiologically, graft coverage was 32%. In seven hips (30.4%) the acetabular component was fully covered by the acetabular bone. In 10 hips (43.4%), 18% of the acetabular component was uncovered. The location of the acetabular component was almost in the desired place in 10 hips (43.4%), lower in eight hips (34.8%), and above in five hips (21.7%). No sciatic or femoral nerve injuries were observed. One patient (4.4%) with Crowe type-IV hip required acetabular revision for dislocation due to acetabular malposition. No recurrences occurred. Conclusion: Correct placement of the uncemented small acetabular component, graft usage in cases with inadequate coverage of the acetabular component, and femoral shortening osteotomy where necessary should be considered in congenital hip dislocation or dysplasia.

Keywords:

Acetabulum, Hip Dislocation, Congenital, Transplantation, Autologous, Arthroplasty, Bone Cements, Femur Head, Hip Prosthesis, Osteoarthritis,

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