Mh. Huo et al., CUSTOM-DESIGNED FEMORAL PROSTHESES IN TOTAL HIP-ARTHROPLASTY DONE WITH CEMENT FOR SEVERE DYSPLASIA OF THE HIP, Journal of bone and joint surgery. American volume, 75A(10), 1993, pp. 1497-1504
A custom-designed femoral prosthesis was implanted with cement and a s
tandard acetabular component was used to treat nineteen severely dyspl
astic hips in fourteen consecutively managed patients. Components that
had been custom-designed with the use of plain radiography were used
because the anatomical reconstructive goals could not be achieved with
commercially available implants. These goals were to match the offset
of the femoral head and the length of the lower limb with those on th
e normal side for patients who had unilateral involvement and to provi
de an average (thirty to forty-millimeter) offset with equal limb leng
ths for patients who had bilateral involvement. A retrospective clinic
al and radiographic analysis was performed. The diagnoses included cox
a vara (one hip), congenital dislocation (twelve hips), achondroplasia
(three hips), and spondyloepiphyseal dysplasia (three hips). The mean
age at the time of the reconstruction was forty-nine years (range, tw
enty-two to seventy-three years), and the mean duration of follow-up w
as fifty-seven months (range, twenty-seven to 108 months). In five hip
s, bone-grafting of the acetabulum was needed to obtain superolateral
coverage. The clinical result was excellent in eighteen hips and good
in one. No revisions have been performed to date. Two femoral componen
ts were possibly loose radiographically. One was associated with a def
inite loosening of the acetabular cup. In addition, one other cup was
possibly loose. There was a 100 per cent rate of survival if only a re
vision procedure was considered as a failure. The probability of survi
val of the custom-designed femoral component was 93 per cent (confiden
ce interval, 95 per cent [range, 57.5 to 99.2 per cent]) at nine years
if possible radiographic failures were included. The custom implants
were designed with a varus neck to reduce impingement, and there was a
53 per cent average gain in the effective abductor lever arm. The use
of a custom femoral component in hips with severe dysplasia allows fo
r a good fit of the stem, preservation of bone stock in the superomedi
al aspect of the proximal part of the femur, restoration of length of
the lower limb, achievement of the desired offset, and, therefore, imp
rovement of the biomechanics of the hip. The use of custom prostheses
in patients in whom standard devices cannot provide anatomical restora
tion is justified on the basis of clinical results and apparent cost-e
ffectiveness.