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Charnley Low Friction Arthroplastyfor Osteoarthritis

in

Congenital Dislocation, Subluxation, Dysplasia

Professor B.M. Wroblewski

Mr P. D. Siney

Ms P. A. Fleming

Mr P. Bobak

The John Charnley Research Institute, Wrightington Hospital

Research supported by the Peter Kershaw & John Charnley Trusts

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"This type of problem is regarded as too extreme for this type of technical procedure, inviting more technical

hazards than the degree of disability warrants.”

Low Friction Arthroplasty in Congenital Subluxation of the Hip.J. Charnley, J.A. Feagin

CORR. No. 91 1973

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CDS/OA - % of all LFAs

% of LFAs

0

10

20

30

40

50

1962 1972 1982 1992 2002

Year

21263 LFAs

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% of LFAs

0

10

20

30

40

50

1962 1967 1972 1977 1982 1987

Year

CDS/OA - % of Young Patients

1434 LFAs

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CDS/OA - % of LFAs

% of LFAs

0

10

20

30

40

50

1962 1972 1982 1992 2002

Year

Young Patients : 1434 LFAs

All Cases : 21263 LFAs

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Number %

Primary O.A. 298 20.8

CDS/OA 395 27.6

Quadrantic head necrosis 69 4.8

Slipped upper femoral epiphysis 55 3.8

Rheumatoid arthritis 292 20.4

Trauma 85 5.9

Fracture neck of femur 38 2.7

Underlying Hip Pathology

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Age at LFAMean 41 years 4 months

Range: 15 - 51

0

20

40

60

80

100

120

140

<=20 <=25 <=30 <=35 <=40 <=45 <=50

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Number %

MaleMale 42 42 14 14 FemaleFemale 258258 8686

LeftLeft 212212 5454RightRight 183183 4646

Ratio : 6 Females to 1 Male

300 Patients : 395 LFAs

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Weight

Mean 61.5 kgsRange 40 - 98

0

50

100

150

<=40 <=50 <=60 <=70 <=80 <=90 <=100

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Bilateral LFAs : 48.1%

Patients Hips

Bilateral 95 190

Consecutive 22 44

Staged 73 146

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Hartofilakidis Classification

%

A: Dysplastic hip 32.2

B: Low dislocation 56.6

C: High dislocation 11.2

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Previous Surgery

Number %

None 296 75.0

Osteotomy (femoral / pelvic) 59 15.0

Open reduction 17 4.3

Fusion / attempted fusion 10 2.5

Cup arthroplasty 3 0.8

Other (soft tissue procedures) 33 8.6

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Cup Used

%

Offset-bore (38 mm) 10.6

40 mm 47.6

43 mm 41.8

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0

10

20

30

40

0 5 10 15 20 25 30 35

Follow up

Mean 16.6 yearsRange: 1 - 35

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Clinical ResultsMerle d’Aubigne and Postel grading

0

1

2

3

4

5

6

Pain Function Movement

Pre op Post op

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Clinical Results

Pain free / Occasional discomfort 89.8 %

Normal or near normal function 74.5 %

Normal or near normal movement 72.9 %

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Complications within one year

Number %

None 348 88.0

Trochanteric non union 13 3.3

DVT (clinical) 10 2.5

PE (clinical - non fatal) 8 2.0

Dislocation 2 0.5

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Complications after one year

Number %

None 264 66.8

Loose cup 72 18.2

Loose stem 20 5.1

Dislocation 5 1.3

Infection 3 0.8

Fractured stem 3 0.8

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Revisions

77 LFAs77 LFAs 19.5%19.5%

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Indications for Revision

Number %

Loose cup 59

Cup wear 7

Loose stem 17 4.3

Infection 2 0.5

Exploration 8 2.0

} 16.7

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Wear Cup Loosening / Revision

0

20

40

60

80

100

0 <=1 <=2 <=3 <=4 <=5 > 5

Penetration (mm)

%

Loose Revised

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Post-op 13 years

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Follow up

Number %

Lost Patients 26 6.7

LFAs 32 8.8

Died Patients 17 4.4

LFAs 24 6.1

Revised Patients 56 15.0

LFAs 77 19.5

Attending Patients 201 60.2

LFAs 262 66.3

Follow-up 19 years(10-35)

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33 year old Male

Pre-op

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18 yearsfollow-up

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Author No Mean FU Revised Loose (years) % %

  MacKenzie 1996 59 16.0 10 32 

Pagnano 1996 145 14.0 19 40 

Numair 1997 182 9.9 10 6

Results of THR for DDH without femoral head autograft

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Results of THR for DDH with femoral head autograft

Author No Mean FU Revised Loose

(years) % %

 

Mulroy 1990 46 11.8 20 26

Spangehl 2001 44 7.5 9 0

Kobayashi 2003 37 19.0 0 0

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45 Charnley LFA's41 patients

Women 36

Men 9

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Age at LFAAverage 46 years 3 months

0

2

4

6

8

10

12

14

16

< 30 31 - 40 41 - 50 51 - 60 > 60

Age at surgery

Nu

mb

er

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Preoperative Radiographic Evaluation Hartofilakidis Classification 1988

   

Dysplasia 1

Low dislocation 29

High dislocation

15

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  Femoral osteotomy

14 Open reduction

6 Conservative treatment 6 Pelvic osteotomies

3

Soft tissue release 1

Previous Surgery

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Surgical Technique

Trochanteric osteotomy Identification of the tear-drop

Acetabular preparation

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Surgical Technique Bone graft preparation and fixation

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Surgical Technique

Socket fixation

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Average: 26 %

Range: 16 - 35 %

Socket coverage by the bone-graft

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Type Number  

Offset-bore (38 mm) 940 mm 2743 mm 9  

Socket used

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0

1

2

3

4

5

6

Pain Function Movement

Pre-op

Post-op

Clinical Results

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Union rate 100 %

Bone Graft

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  Resorption No of hips 

None 18

Mild 24

  Moderate 2

Major 1

Time to appearance 3.6 years

Bone Graft

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Average : 17 years 1 month

Range: 15 - 21 years

Follow-up

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- Aseptic cup loosening 2

- Infection 1

 

Time to revision 13.1 years

Revised : 3 hips

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Radiographic Results

Socket No of hips

Migrated 3

Fully demarcated 4

Hodgkinson et al COOR 1986

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Post-op 5 years

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24 sockets showed demarcation

Demarcation in zone 1 rare

Radiographic Results : Cup

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Post-op 16 years

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Post-op 18 years

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Post-op 21 years

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45 Charnley LFA's 5 died 40 attending follow-up

 Average Follow-up: 16 years 5 months

Conclusion

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Sound fixation at primary surgery essential.

 

Solid graft + impaction bone grafting.

 

Better bone stock at revision.

The long-term outcome will depend on the rate of cup penetration.

Conclusion

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Wear Cup Loosening / Revision

0

20

40

60

80

100

0 <=1 <=2 <=3 <=4 <=5 > 5

Penetration (mm)

%

Loose Revised