Total joint replacement in paralytic hip

Purpose Frequency of hip impairment, with sub-luxation or dislocation, duri ng evolution of neuromuscular diseases depends on intensity and spreading o f palsy. At the end of growth or at the beginning of adult life, secondary arthritis can induce pain and lack of mobility. The importance of the chond ropathy and irreductible lack of congruence may doom to failure a conservat ive articular or periarticular surgery Total hip arthroplasty is an alterna tive, but the risks of dislocation, ectopic ossifications and infection mak e often refute this indication. We report our experience of total arthropla sty for paralytic hip, about 18 cases. Materials and methods We reviewed retrospectively 14 consecutive patients w ith neuromuscular disease, who had 18 total arthroplasties of paralytic hip s. The origin of neuromuscular disease was cerebral for 7 patients (6 cereb ral palsy: 4 spastic or athetosic tetraplegies, 1 spastic diplegy, 1 hemipl egies; 1 head trauma), 6 medullar desorders (1 Friedreich disease, 2 acute anterior polyomyelitis, 1 vascular injury, 1 malformative spine with sacral agenesis and 1 cervical spine trauma) and 1 muscular affection (Steinert d isease). Mean age of the patient was 40 year old (19 to 64). Mean follow up was 5 years. Intensity and diffusion of weakness were variables, compatibl es with gait with or without help for 11 patients, and for 3 patients with sitting posture and transfer. The coxopathy, with pain stiffness and viciou s attitudes, induced the loss of gait or sitting posture and transfer. The goal of the arthroplasty was the restitution of the initial function. 11 hi p had previous surgery, with infection in 2 cases. Arthritis was secondary to hip palsy in 14 cases (4 dislocations, 6 subdislocations, 3 complication s of surgery of paralytic hip dislocation in childhood, 1 nervous arthropat hy), and independant of palsy in 4 cases (1 femoral head avascular necrosis ans 3 primary arthritis). The prosthesis were LFA Charnley Kerboull in all cases except 1. We used transtrochanteric approach. Results Mean follow-up is 5,6 years. Functional initial goal has been obtai n in all cases. Ectopic ossifications occured in 3 cases, without functiona l consequence. One acetabular loosening occured after 13 years and has been reoperated on. There was no polyethylene wear. We noticed 1 mechanical and 2 chemical femoral loosening. Prosthetic dislocation occured in 4 cases, a lways during the 4 post-operative months, without recurrence after this cri tical period. There were no infection. Discussion If gait is possible, there is no satisfactory alternative to tot al hip arthroplasty. In absence of gait, total hip arthroplasty gives also the best functional results. Girdlestone procedure is not indicated because it will induce the loss of transfer and side effects as ascension of proxi mal femur with recurrence of adduction bringing out pain and sometimes scab s. Conclusion Total arthroplasty of paralytic hip induced restitution of initi al function for all patients and an acceptable rate of complication after s trict selection of patients and indications, specific operative technique a nd rehabilitation for each patient. This results encourage us to carry on w ith this therapeutic orientation.