Causes of total hip replacement in children: part 1

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Abstract

Background. Total hip arthroplasty (THA) is one of the most frequently performed and effective surgical procedures in patients with hip osteoarthritis of various origin. According to a variety of large arthroplasty registries, in 10-33% of cases, the causes of end-stage hip osteoarthritis in people under the age of 25 are such orthopedic diseases of the hip as dysplasia, SCFE and Perthes disease. However, there are practically no scientific publications examining the causes of the development of end-stage hip osteoarthritis in patients under the age of 21, as well as in children, in the foreign literature and there are none at all in the domestic literature.

The aim of the study is to analyze the causes of the development of end-stage hip osteoarthritis requiring total hip arthropasty in children who had suffered major orthopedic diseases of the hip.

Methods. The retrospective study is based on the medical records of 500 patients (530 hip joints) aged between 10 and 18 years (15.1±1.5) who had underwent total hip replacement at the Department of Hip Pathology of the G.I. Turner National Research Medical Center for Pediatric Traumatology and Orthopedics, in the period from 2008 to 2023. The main subject of the study was the anamnesis of the course of the orthopedic disease and previous treatment.

Results. After studying the medical records and archival X-rays, we have identified the main diagnostic and tactical errors in the treatment of patients with major diseases of the hip, which are specific to childhood. Additionally, according to these nosological entities we have identified the most “endemic” federal regions and subjects of the Russian Federation.

Conclusions. The main causes of the development of end-stage hip osteoarthritis requiring total hip arthroplasty in patients under the age of 18 with major orthopedic diseases of the hip are: diagnostic defects, methodological choice of both conservative and surgical treatment, and iatrogenic damage to the joint components.

About the authors

Pavel I. Bortulev

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: pavel.bortulev@yandex.ru
ORCID iD: 0000-0003-4931-2817
SPIN-code: 9903-6861

Cand. Sci. (Med.)

Russian Federation, St. Petersburg

Sergei V. Vissarionov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; Mechnikov North-Western State Medical University

Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048

Dr. Sci. (Med.), Professor

Russian Federation, St. Petersburg; St. Petersburg

Alexey G. Baindurashvili

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: turner01@mail.ru
ORCID iD: 0000-0001-8123-6944

Dr. Sci. (Med.), Professor

Russian Federation, St. Petersburg

Valentin A. Neverov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; Mechnikov North-Western State Medical University

Email: 5507974@mail.ru
ORCID iD: 0000-0002-7244-5522

Dr. Sci. (Med.), Professor

Russian Federation, St. Petersburg; St. Petersburg

Vladimir E. Baskov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: dr.baskov@mail.ru
ORCID iD: 0000-0003-0647-412X
SPIN-code: 1071-4570

Cand. Sci. (Med.)

Russian Federation, St. Petersburg

Dmitry B. Barsukov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: dbbarsukov@gmail.com
ORCID iD: 0000-0002-9084-5634
SPIN-code: 2454-6548

Cand. Sci. (Med.)

Russian Federation, St. Petersburg

Ivan Y. Pozdnikin

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: pozdnikin@gmail.com
ORCID iD: 0000-0002-7026-1586
SPIN-code: 3744-8613

Cand. Sci. (Med.)

Russian Federation, St. Petersburg

Tamila V. Baskaeva

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: tamila-baskaeva@mail.ru
ORCID iD: 0000-0001-9865-2434
SPIN-code: 5487-4230
Russian Federation, St. Petersburg

Makhmud S. Poznovich

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: poznovich@bk.ru
ORCID iD: 0000-0003-2534-9252
Russian Federation, St. Petersburg

Dmitry V. Vyrikov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: dvyrikov@gmail.com
Russian Federation, St. Petersburg

Timofey S. Rybinskikh

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: Timofey1999r@gmail.com
ORCID iD: 0000-0002-4180-5353
Russian Federation, St. Petersburg

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Supplementary files

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2. Fig. 1. Distribution of patients with a particular hip joint disease that caused the development of end-stage hip osteoarthritis by the federal districts of the Russian Federation

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3. Fig. 2. Distribution of patients with a particular hip joint disease that caused the development of end-stage hip osteoarthritis by the subjects of the Russian Federation

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4. Fig. 3. Distribution of patients with hip dysplasia of various severity by the number of operations performed

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5. Fig. 4. Surgical interventions sequence of a 14-year-old patient: а — X-ray of the hip joints at the initial specialist visit at the age of 1 year and 7 months (grade IV-1 left-sided hip dysplasia according to the supplemented D. Tönnis classification [16]); b — short-term result of the left hip joint surgical reconstruction (reluxation with pronounced dystrophic changes in the proximal femur); с — a repeated attempt to stabilize the left hip joint (absence of concentric reduction of the femoral head into the acetabulum, a high position of the large trochanter, malposition of metal structures in the form of their penetration into the joint cavity); d, e — long-term result of the surgical treatment (total lysis of the proximal femur, acetabulum as an anatomical structure is absent, shortening of the femur bone over 8 cm, extremely small sizes of the femoral canal and the location for endoprosthesis cup implantation in the anatomical position); f — mid-term result of cementless THA performed with the Zimmer Biomet system (TMT® 38 mm cup; Wagner cone® 13, metal-crosslinked polyethylene), the T. Paavilainen techniques of greater trochanter osteotomy and dilated osteotomy of the femur

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6. Fig. 5. Surgical interventions sequence of a 16-year-old patient: a — X-ray of the hip joints at the initial specialist visit at the age of 11 months (grade III-1 left-sided hip dysplasia according to the supplemented D. Tönnis classification); b — an attempt at conservative treatment (closed hip reduction under anesthesia with a plaster cast put in the Lorenz position 1) — reduction has not been achieved; c, d — short-term result of the left hip joint surgical reconstruction (reluxation with lysis of the proximal femur due to damage of medial circumflex femoral artery caused by perforation of the posterior surface of the femoral neck with a blade plate); е — mid-term result of the surgical treatment (pathological dislocation with absent proximal epiphysis, femoral neck and forming secondary deformation of the acetabular arch); f — X-ray of the hip joints just before total arthroplasty (gross deformation of the acetabulum, extremely small femoral canal sizes); g — mid-term result of cementless THA performed with the Zimmer Biomet system (Continuum® cup 44 mm; Trabecular metal support augment 50-30 mm, Wagner cone® 13, ceramic-crosslinked polyethylene), the T. Paavilainen techniques of greater trochanter osteotomy and dilated osteotomy of the femur

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7. Fig. 6. X-ray series of the hip joints of a 16-years-old patient: a — before reconstructive intervention (Crowe I grade bilateral dysplastic hip subluxation); b — after correcting osteotomy of the femur (detorsion-varus), triple pelvic osteotomy on both sides (accompanied by hypercorrection of acetabulum positioning, external rotational position of the lower extremities, which may indicate small values of the proximal femur anteversion); с — X-ray just before THA (total joint space narrowing with total retroversion of the acetabulum); d — mid-term result of THA performed with the Zimmer Biomet system (Continuum® cup 50 mm; Wagner cone® 15, ceramic-crosslinked polyethylene)

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8. Fig. 7. X-ray series of a 14-years-old patient with 3 grade left-sided hip osteoarthritis as a result of SCFE treatment: a, b — X-ray of the hip joints 6 months after closed reduction with a K-wires fixation (accompanied by uncorrected displacement of the femoral head relative to the femoral neck with a significant joint space and malposition of the K-wires); c — X-ray of the hip joints just before THA (in addition to the classic signs of 3 grade hip osteoarthritis, typical for acetabulum chondrolysis protrusion with cranial displacement of the femoral head is observed); d — mid-term result of THA performed with the Zimmer Biomet system (Trilogy IT® 62 mm cup; Alloclassic® 6, ceramic-crosslinked polyethylene) and autoplasty of the acetabular floor

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9. Fig. 8. X-ray series of a 16-years-old patient with 3 grade right-sided osteoarthritis as a result of SCFE treatment: a, b — X-rays of the hip joints in the anteroposterior and axial views at the time of initial admission (a posterior displacement of the head of the right femur by 50° is observed); c, d — X-rays of the hip joints in the anteroposterior and axial views just after rotational femoral osteotomy and osteosynthesis performed with an angle stable plate (spatial relations in the “acetabulum — femoral head — femoral neck” system are restored due to anterior rotation of the proximal part in horizontal plane by 50°); e — X-ray of the hip joints in a year and a half after primary surgical treatment (signs of end-stage hip osteoarthritis with hip subluxation are observed); f — mid-term result of THA performed with the Zimmer Biomet system (Trilogy IT® 52 mm cup; Alloclassic® 4, ceramic-crosslinked polyethylene) and autoplasty of the acetabular arch

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10. Fig. 9. X-ray series of a 16-years-old patient with 3 grade left-sided osteoarthritis as a result of SCFE treatment: a, b — X-rays of the hip joints in the anteroposterior and axial views at the time of initial admission (a posterior displacement of the head of the right femur by 63° with developing osteophyte at the “head-neck” junction and signs of the epiphysial cartilage formation are observed); c, d — X-rays of the hip joints in the anteroposterior and axial views just after intraarticular corrective osteotomy of the femoral neck (spatial relations in the “acetabulum — head — femoral neck” system are restored); e — X-rays of the hip joints in a year after primary surgical treatment (signs of aseptic necrosis of the femoral head with its gross multiplanar deformation and hip subluxation are observed); f — mid-term result of THA performed with the Zimmer Biomet system (Trilogy IT® 48 mm cup; Alloclassic® 5, ceramic-crosslinked polyethylene)

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11. Fig. 10. X-ray of the hip joints of a 16-years-old patient with end-stage left-sided hip osteoarthritis as a result of LCPD: a — before THA (aspherical femoral head with secondary deformation of the acetabulum, a dystrophic cyst in its arch and hip subluxation are observed); b — mid-term result of THA performed with the B. Braun Aesculap system (Plasmafit ® 50 cup, Metha® Short Hip Stem 4, ceramic-crosslinked polyethylene)

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