Failure of Cementless Total Hip Arthroplasty in a Patient with Contralateral Hip Arthrodesis: A Case Report

Introduction The utilization of hip arthrodesis for the treatment of end-stage hip degenerative joint disease has significantly declined due to the success of total hip arthroplasty. In 2010, the Centers for Disease Control (CDC) reported that over 332,000 THA procedures were performed in the United States alone. Although fewer patients are undergoing primary hip fusion, patients that have previously undergone hip arthrodesis persist, and the risk of development of degenerative changes in ipsilateral and contralateral lower extremity joints increases over time. A biomechanical study examining body kinematics following hip arthrodesis revealed that loss of motion in one hip resulted in increased rotation of the pelvis and increased flexion of the ipsilateral knee. The altered mechanics of these joints had been shown to lead to accelerated development of degenerative joint disease. Therefore, it is expected that adjacent joint deterioration will follow hip arthrodesis and will occur over varying time periods as a function of the individual. Salvati and Insall published a case series in 1989 evaluating patients during the time period of 1972 to 1986 that had undergone total joint arthroplasty, contralateral hip or ipsilateral knee, following primary hip arthrodesis. In this study, patients that underwent THA for contralateral hip arthritis were treated with one of several different cemented THA components utilizing first generation cement technique. A total of 14 patients underwent THA and three (21%) patients required revision for mechanical failure of the implant. We report, to our knowledge, the first case of mechanical failure of a cementless Corresponding author: Jason Anari, M.D. Penn Medicine University City 3737 Market Street, 6th Floor Philadelphia, PA 19107 Phone: (215) 796-8974 [email protected] Jason B Anari, MD Neil Sheth, MD