International Bipolar News

Dysplastic Degenerative Arthritis of the Hip Treated with Bipolar Prostheses

Arthur J. Bowman Jr., M.D. P.C.

March 1996

Over the past fifteen years we have almost exclusively performed bipolar arthroplasties for various degenerative arthritic conditions of the hip joint at the South Shore Hospital, Weymouth, Massachusetts. Early on in our clinical trials we recorded 72% good to excellent results in 47 patients with a minimum of two years follow up. At that time we discovered that failures were primarily due to movement of the femoral stem in the canal, presenting as anterio-lateral thigh pain. At that time we were using the straight Austin Moore stem design of the Bateman prostheses, initially with one size of stem to fit all patients (1). Several years later we reported on 100 consecutive patients average follow up of four years who had bipolar hip arthroplasty for degenerative arthritis and the good to excellent results were 78.8% using the modified Harris Hip Score (2). This particular bipolar Bateman design featured three stem sizes, small, medium and large. Our problem was basically the same antero-lateral thigh pain causing poor results. At the conclusion of these studies we suggested that proportionate size femoral stems be used, with a press fit technique as an attractive consideration.

We have continued to be enthusiastic proponents of bipolar arthroplasty as a primary surgical treatment for degenerative arthritis of the hip. We are presently using the Howmedica PCA bipolar prostheses which features right and left femoral stems, proximal porous coating for biological ingrowth with a wide variety of stem sizes. This bipolar combination appears to be producing much better results and anterio-lateral thigh pain has been virtually eliminated. We are presently reviewing a series of Howmedica PCA bipolar prostheses with a three to five year follow up and the good to excellent results using the modified Harris Hip Score in this preliminary study appears to be well over 90%.

In this brief newsletter we would like to present some results in a subgroup of patients with severe femoral head and acetabular deformities due to congenital problems such as congenital hip dysplasia, Legg-Perthes disease and slipped capital femoral epiphyses.

The following are case study presentations of these patients along with their x-ray evaluations.

1) M.G. - Forty-four year old man with a history of Legg-Perthes disease in the right hip presented with severe acetabular deformity, femoral head deformity and loss of cartilage space, (figs.1a, 1b). In July 1990 the patient underwent PCA bipolar prosthetic replacement with reaming of the acetabulum to concentricity. The only real problem encountered during the surgery was sclerotic bone in the proximal femoral canal, but this was good quality bone so a smaller stem was than expected was inserted. The patient has had no problems. Follow up October 1995, a little over five years, demonstrated an excellent result with no pain in the hip or the thigh (fig. 2).

Figure (1a,b) Pre-operative and post-operative x-ray for case (1)

Figure (2). Five year post-operative x-ray for case (1)

2) R.L. - A 47 year old man who presented in June '92 with pain, shortening and loss of motion in the left hip. This hip problem resulted from a mis-diagnosed slipped capital femoral epiphysis (fig. 3a). The patient underwent arthroplasty with a Zimmer bipolar prostheses in July '92. The acetabulum was reamed. The patient was seen in follow up three years later and he had no hip pain, good motion and no shortening. He is an excellent result (fig. 3b). The patient did suffer a transient sciatic nerve palsy that required about eighteen months before a full recovery was noted.

Figure (3a,b) Pre-operative and three-year post-operative x-ray for case (2)

3) R.T. - Fifty-six years of age. Legg-Perthes disease of the right hip, treated as a youth in Portugal. He presented with a deformed femoral head and acetabulum, long standing hip pain, thigh muscle atrophy and a limitation of motion. He also had about 3 cm shortening of the involved extremity. This patient had bipolar hip replacement, Howmedica PCA type with reaming of the acetabulum in January of 1995. Eight months after the surgery, there was no pain, hip motion improved, functionally a satisfactory result (figs. 4a, 4b).

Figure (4a,b) Pre-operative and eight month post-operative x-ray for case (3)

In conclusion, we have used bipolar hip arthroplasty for various conditions resulting in degenerative arthritis of the hip for the last fifteen years. In spite of the fact that our initial clinical results were disappointing, we were able to establish that the problem was due to femoral stem loosening in the canal. With improved stem designs, emphasizing press fit and proportionate stems with porous ingrowth design, our results seem to have improved considerably. We remain enthusiastic about the bipolar prostheses for use in hip arthroplasty. Our findings would support the conclusions of Torisu et al. that bipolar arthroplasty with acetabular reaming to concentricity without bone grafting in dysplastic hip osteoarthritis is an alternative to conventional total hip arthroplasty (3).

1 Bowman, A.J., Jr., Walker, M.W., Kilfoyle, R.M., O'Brien, P.I., and McConville, J.F.: Experience with the bipolar prosthesis in hip arthroplasty. Orthopedics 8: 460, 1985.

2 McConville, O.R., Bowman, A.J., Jr.; Kilfoyle, R.M., McConville, J.F. Mayo, R.A.: Bipolar hemiarthroplasty in degenerative arthritis of the hip. Clin. Orthop. 251: Feb., 1990,.

3 Torisu T., Izumi, H., Fujikawa, Y., Masumi, S.: Bipolar hip arthroplasty without acetabular bone-grafting for dysplastic osteoarthritis. J. Arthroplasty 10: 15-27 1995.

Author's address: Dr A.J. Bowman , Jr., M.D., P.C., 797, Main Street, South Weymouth, Massachusetts 02190, U.S.A

Copyright 1996, 1997 E-Tech Ltd. All Rights Reserved.

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