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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (1): 175-182. doi: 10.19723/j.issn.1671-167X.2021.01.026

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Short-term outcomes of total hip arthroplasty in the treatment of Tönnis grade 3 hip osteoarthritis in patients with spondyloepiphyseal dysplasia

KE Yan1,ZHANG Qiang2,MA Yun-qing2,LI Ru-jun1,TAO Ke1,Δ(),GUI Xian-ge3,LI Ke-peng4,ZHANG Hong2,LIN Jian-hao1   

  1. 1. Institute of Arthritis, Peking University People’s Hospital, Beijing 100044, China
    2. First Section of Orthopaedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100037, China
    3. First Section of Orthopaedics, Zhejiang Hospital, Hangzhou 310013, China
    4. Department of Orthopaedics, Baoding Second Central Hospital, Baoding 072750, Hebei, China
  • Received:2019-08-19 Online:2021-02-18 Published:2021-02-07
  • Contact: Ke TAO E-mail:keryee@163.com
  • Supported by:
    National Natural Science Foundation of China(81672183);Beijing Natural Science Foundation(7182172);Research and Development Funds of Peking University People’s Hospital(RDY2018-04);Research and Development Funds of Peking University People’s Hospital(RDY2016-15)

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Abstract:

Objective: Severe hip osteoarthritis, caused by bone or joint maldevelopment, biomechanical transformation and previous surgical intervention, is inclusively existed in spondyloepiphyseal dysplasia (SED). To investigate and discuss the short-term efficacy and possible effects of total hip arthroplasty in the treatment of Tönnis grade 3 hip osteoarthritis in patients with SED.Methods: From January 2017 to June 2019, 374 patients with hip osteoarthritis were involved for total hip arthroplasty conducted by senior professional surgeons, of whom 9 patients (6 males and 3 females) with 12 hip osteoarthritis secondary to the SED met the inclusive and exclusive criteria and received the above-mentioned hip operation. The short-term outcomes were observed.Results: All the patients were implanted with Johnson & Johnson ceramic on ceramic cementless hip prostheses within the arthroplasty. They were followed up for an average period of 20 months. Except for one muscular calf vein thrombosis case, no complications, such as aseptic loosening, joint dislocation, fracture, neurovascular injury, deep vein thrombosis and infection were observed in all the 9 patients. Before the surgery, the average Harris hip score was 35.55, while the average of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) was 56.56. The level of quality of life indicated by SF-12 score was 41.56 on average. The mean pre-operation visual analogue scale (VAS) was 7.44. At the last follow-up, the average Harris hip score increased to 89.56, whereas the average WOMAC declined to 41.11. Compared with the baseline point, the average SF-12 score went up to 56.33. Dramatic drop of the mean VAS value to 2.67 was also observed at the last follow-up. In addition, post-operative increase of several pelvic-related parameters including pelvic incidence, pelvic tilt and sacral slope could be observed in the SED patients. The average measured pelvic incidence, pelvic tilt and sacral slope were 68.95°±4.60°, 52.75°±1.06° and 17.45°±1.77° before operation, respectively; whilst the mean value of these specific parameters increased to 76.98°±5.12°, 60.51°±4.35° and 18.10°±2.02°, respectively. The even leg lengths of the lower extremities were obtained after total hip arthroplasty.Conclusion: Total hip arthroplasty is satisfactory in the short-term pain relieve and function recovery for the management of Tönnis grade 3 hip osteoarthritis secondary to the SED.

Key words: Total hip arthroplasty, Tönnis classification, Spondyloepiphyseal dysplasia, Hip osteoarthritis

CLC Number: 

  • R687.4

Figure 1

The anteroposterior and lateral position of X-ray examination of the pelvic in SED patients showed that the vertebral body of the lower thoracic and lumbar vertebrae was widened and flattened (A);the typical step-like profile and mild kyphosis were formed, the intervertebral space was obviously narrowed, and the spinal physiological reflex disappeared (B); lumbar 5 sacrum 1 vertebral body had clear sign of spondylolisthesis (C);and imbalance in spine-pelvic sagittal position (D)"

Figure 2

Cross-section and three-dimensional reconstruction imaging of pelvic computed tomography (CT) in SED patients showed that the bilateral double hip joint degeneration was obvious, and a large number of osteophytes were formed, with subluxation (A), which was grade 3 in Tönnis score; the right hip joint was fully observed through the right side of pelvis, with serious degeneration and obvious osteophytes (B); the left hip joint was carefully recorded through the left side of pelvis, with serious degeneration and obvious osteophytes (C); focusing on the center of the left femoral head, a large number of osteophytes in the acetabulum and femoral head and neck, subluxation of the hip joint, and cystic deformation of the femoral head were seen in the coronal position (D); bilateral hip severe degeneration, anterior and posterior osteophytes, and even the formation of pseudo-articular capsule surrounding the femoral head by the osteophytes were observed in the axial position (E); similarly, focusing on the center of the right femoral head, a large number of osteophytes in the acetabulum and femoral head and neck, the formation of pseudo-articular capsule surrounding the femoral head by the osteophytes, and cystic deformation of the femoral head and acetabular weight-bearing areas were detected in the sagittal position (F)"

Figure 3

Successful concurrent bilateral THA were performed in a SED patient younger than 40 years with ceramic-on-ceramic artificial prostheses. Typical SED, hip osteoarthritis with grade 3 in Tönnis score, severe bilateral degeneration, osteophytes and cystic changes were confirmed in the preoperative hip (A-C); the artificial prostheses well fixed with normal position were observed in the anteroposterior and lateral position of X-ray radiograph at 12 months postoperative follow-up (D)"

Figure 4

Successful single THA was performed in a SED patient older than 50 years with ceramic-on-ceramic artificial prostheses. Typical SED,hip osteoarthritis with grade 3 in Tönnis score, severe hip degeneration, osteophytes and cystic changes were seen in the preoperative right hip (A, B), with the offset (32.34±0.88) mm; the artificial prostheses well fixed without any sign of early osteolysis prosthesis loosening or infection such as translucent line at 24 months postoperative follow-up (C), with the offset (36.15±0.54) mm"

Table 1

Analysis of SED patient characteristics undergoing THA with hip osteoarthritis"

Gerder Age/
years		 Height/cm BMI Course of
disease/month		 Left or right Operation
duration/min		 Operative
blood loss/mL		 Time of standing
after operation/d		 Peri-operative
complication		 Follow-up/
month
M 28 165 27.92 7 Right 135 350 2 0 10
M 35 164 24.54 31 Right 120 280 2 0 13
M 44 173 27.73 70 Left 106 195 2 0 19
M 50 172 24.00 8 Right 120 240 3 0 13
M 47 158 23.63 9 Left 107 410 2 0 25
M 38 163 29.73 29 Both 189 530 3 0 37
F 36 144 30.38 44 Both 178 720 7 1 25
F 29 153 33.32 25 Both 223 550 3 0 13
F 37 147 31.47 33 Both 110 270 2 0 7

Figure 5

Pre-operative and post-operative changes in SED patients with THA for pelvic-related parameters such as pelvic incidence, pelvic tilt, and sacral slope A, the pre-operative average pelvic incident, pelvic tilt, and sacral slope were 68.95°±4.60°, 52.75°±1.06°, and 17.45°±1.77°, respectively; B, the post-operative average pelvic incident, pelvic tilt, and sacral slope were 76.98°±5.12°, 60.51°±4.35°, and 18.10°±2.02°, respectively."

Table 2

Evaluation of short-term therapeutic effect of THA in SED with hip osteoarthritis (x-±s)"

Observation
time point		 Harris hip scores WOMAC SF-12 VAS
Pain Function Deformity Range of
motion		 Pain Stiffness Physical
function
Pre-operation 14.22±4.18 19.44±3.84 0.78±0.83 1.11±0.33 12.22±1.86 4.56±1.13 39.78±5.52 41.56±4.22 5.89±1.27
Last follow-up 38.78±5.12 42.89±3.89 3.56±0.73 4.33±0.71 7.44±2.96 3.11±0.93 30.56±5.32 56.33±3.291 2.67±1.58
t value 124.36 165.51 56.82 152.91 16.81 8.78 13.04 59.51 22.73
P value <0.001 <0.001 <0.001 <0.001 0.001 0.009 0.002 <0.001 <0.001
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