Telescoping Allograft Prosthetic Composite (APC) Reconstruction of the Femur Following Revision Arthroplasty for Neglected Developmental Dysplasia of the Hip (DDH)

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Abstract

Although uncommon, neglected developmental dysplasia of the hip (DDH) poses a technically demanding problem for treating surgeons. Due to the congenital malformation of the native hip joint and distortion of the surrounding soft tissue, addressing limb-length discrepancy is intricate. Despite detailed planning and meticulous soft tissue handling, complications can be difficult to avoid in these patients even under experienced hands. In this case report, we present a 73-year-old lady with neglected DDH who had undergone initial total hip arthroplasty and subsequent revision surgery that failed due to aseptic loosening. Due to limited length in the distal femur, we used a telescoping allograft prosthetic composite (APC) to provide adequate length to the native distal femur during revision with proximal femur fixation. This technique can help avoid the need for total femur replacement (TFR) surgery, which is more invasive and may require tibia replacement.

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Most cited references 12

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Evaluation and Referral for Developmental Dysplasia of the Hip in Infants

B Shaw, L S Segal (2016)

Developmental dysplasia of the hip (DDH) encompasses a wide spectrum of clinical severity, from mild developmental abnormalities to frank dislocation. Clinical hip instability occurs in 1% to 2% of full-term infants, and up to 15% have hip instability or hip immaturity detectable by imaging studies. Hip dysplasia is the most common cause of hip arthritis in women younger than 40 years and accounts for 5% to 10% of all total hip replacements in the United States. Newborn and periodic screening have been practiced for decades, because DDH is clinically silent during the first year of life, can be treated more effectively if detected early, and can have severe consequences if left untreated. However, screening programs and techniques are not uniform, and there is little evidence-based literature to support current practice, leading to controversy. Recent literature shows that many mild forms of DDH resolve without treatment, and there is a lack of agreement on ultrasonographic diagnostic criteria for DDH as a disease versus developmental variations. The American Academy of Pediatrics has not published any policy statements on DDH since its 2000 clinical practice guideline and accompanying technical report. Developments since then include a controversial US Preventive Services Task Force "inconclusive" determination regarding usefulness of DDH screening, several prospective studies supporting observation over treatment of minor ultrasonographic hip variations, and a recent evidence-based clinical practice guideline from the American Academy of Orthopaedic Surgeons on the detection and management of DDH in infants 0 to 6 months of age. The purpose of this clinical report was to provide literature-based updated direction for the clinician in screening and referral for DDH, with the primary goal of preventing and/or detecting a dislocated hip by 6 to 12 months of age in an otherwise healthy child, understanding that no screening program has eliminated late development or presentation of a dislocated hip and that the diagnosis and treatment of milder forms of hip dysplasia remain controversial.

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Proximal femoral replacements with megaprostheses.

Javad Parvizi, F Sim (2004)

The exact role of proximal femoral replacement (megaprosthesis) in revision hip surgery is unclear. During the past decade remarkable advances in the field of revision hip reconstruction have been made including the availability of allograft cancellous and cortical bone. With the increased use of cortical strut grafts to augment host bone, the indications for the use of megaprostheses have narrowed. Currently, we reserve the use of megaprostheses for elderly or sedentary patients with massive proximal femoral bone loss that cannot be reconstructed by other reconstructive procedures. This may include failed total hip arthroplasty (THA), nonunion of the proximal femur with multiple failed attempts at osteosynthesis, and hip salvage after a failed resection arthroplasty.

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Minimising aseptic loosening in extreme bone resections: custom-made tumour endoprostheses with short medullary stems and extra-cortical plates.

J Stevenson, C. Wigley, H. Burton … (2017)

Following the resection of an extensive amount of bone in the treatment of a tumour, the residual segment may be insufficient to accept a standard length intramedullary cemented stem. Short-stemmed endoprostheses conceivably have an increased risk of aseptic loosening. Extra-cortical plates have been added to minimise this risk by supplementing fixation. The aim of this study was to investigate the survivorship of short-stemmed endoprostheses and extra-cortical plates.

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Author and article information

Journal

Journal ID (nlm-ta): Cureus

Journal ID (iso-abbrev): Cureus

Journal ID (issn): 2168-8184

Title: Cureus

Publisher: Cureus (Palo Alto (CA) )

ISSN (Electronic): 2168-8184

Publication date (Electronic, pub): 3 June 2023

Publication date (Electronic, collection): June 2023

Volume: 15

Issue: 6

Electronic Location Identifier: e39925

Affiliations

[1 ] Orthopaedics, Hospital Tengku Ampuan Afzan, Kuantan, MYS

[2 ] Orthopedics, Singapore General Hospital, Singapore, SGP

[3 ] Orthopaedics, Traumatology & Rehabilitation, International Islamic University Malaysia, Kuantan, MYS

Author notes

Ren Yi Kow renyi_kow@ 123456hotmail.com

Article

DOI: 10.7759/cureus.39925

PMC ID: 10318195

SO-VID: eba79452-31ee-41ca-bab3-0c2f1aaceaf6

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date accepted : 30 May 2023

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