gms | German Medical Science

Objectives: Dysplastic coxarthritis is a disease of the musculoskeletal system, which occupies the second place in the structure of orthopedic pathology. The main problem which occurs during total hip arthroplasty is the deficiency of acetabular walls, leading to a shortage of the cup and its early aseptic loosening.

The aim of the study was to improve the results of total hip arthroplasty in patients with dysplastic coxarthritis Crowe III-IV.

Methods: We analyzed the results of total hip replacement with bone grafting of the upper acetabular wall in 52 patients with dysplastic coxarthritis Crowe III-IV who were operated on from January 2015 to December 2016. The study involved 38 women and 14 men. The average age of patients was 42 ± 4,9 years. Surgical approach - Moore,s approach, rarely antero-lateral approach. The operation included the formation of a rectangular bone allograft from the filled femoral head which placed into the defect of upper acetabular wall and was fixing by 2 screws, following installation of acetabular component. Statistical data processing was carried out using the Microsoft Excel AtteStat 12.0.5. with the use of Mann-Whitney U Test.

Results: Clinical and radiological results of total hip replacement were evaluated in all patients after 1 year. X-ray signs of full reconstruction bone graft were noted in all patients (100%) after 6 months. The average coverage of the cup was 92% (range, 84% to 100%). The average Harris score increased from 29.3 points to 86.9 points (p<0.01) after 1 year. Aseptic acetabular loosening was recorded in 1 patient (1,9%) due to a fall in the early postoperative period.

Conclusions: The using of bone grafting improves the coverage of the cup and helps to reduce the aseptic acetabular loosening in patients with dysplastic coxarthritis Crowe III-IV.