Combination of known methods of bone autoplasty in Hartofilakidis grade 2 dysplastic hip arthroplasty in a patient with severe associated pathology

Abstract

Introduction. Hip dysplasia is a current problem that requires a special approach for surgical treatment. The Crowe and Hartofilakidis classifications, which include grade 3 and 4 dysplasia respectively, are widely used. There are various methods for increasing the surface of the acetabulum: osteoclase of the medial wall, grafting with volumetric bone grafts and impaction grafting with bone chips. There are no definite recommendations that prescribe the surgical technique in any given clinical and radiological case. Therefore, the choice of acetabular grafting is individual and variable for each patient with hip dysplasia.The aim of the work was to evaluate the treatment of patients with stage 3 coxarthrosis combined with Hartofilakidis dysplasia degree I−II after total hip replacement using bone autoplasty with crumb and/or bone graft volume from the resected femoral head, using the patient with haemophilia and concomitant pathology of the musculoskeletal system as an example.Materials and Methods. Patient with Hartofilakidis hip dysplasia grade II with a history of right hip arthroplasty, haemophilia, multiple soft tissue mobilisations associated with joint contractures of the upper and lower extremities. Harris Scale score − 19.Results. Endoprosthesis of the left hip joint with combined acetabular roof plasty with a femoral head graft and bone shavings was performed. Six months later, the patient had increased range of motion, improved the biological axis of the limb, and residual shortening − 1.4 cm (due to deforming knee arthrosis). The prosthesis is stable. The method of plastic grafting with a bone graft showed a 100 % survival rate of the endoprosthesis, a decrease in pain and an increase in the function of the joint.Discussion. In this study, patients were followed up for five years. In similar studies, the time range was 10 years, at which point the survival rate of the arthroplasty decreased. The present case showed a good result because of its complexity due to concomitant pathology. In order to draw accurate conclusions, more such surgeries and follow-ups over a period of 10 years should be performed.Conclusion. Bone grafting makes it possible to effectively replace acetabular defects without excessive medialisation and to improve the degree of prosthetic coverage while preserving the native bone mass.