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THA seen as a possibility for patients with neuromuscular disorders
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ORLANDO, Fla. — Although primary total hip arthroplasty was rarely performed in patients with neuromuscular disorders due to concerns about loosening, dislocation and uncertain functional benefit, a surgeon here said the operation is now an option for these patients.
“Total hip arthroplasty in this day and age is a feasible option in those patients with neuromuscular disorders, and that is the result of better understanding of the complications and outcomes of these procedures,” Matthew J. Kraay, MD, said at the Current Concepts in Joint Replacement Winter Meeting. He also cited the availability of modular cementless implants, constrained liners, larger articulation and improved medical management of these patients as reasons for this shift.
Kraay noted patients’ activity levels and types of deformities and contractures may influence the surgical approach for arthroplasty.
Matthew J. Kraay
“It is important to do what you are comfortable with and what you do best. There is a lot of data on some of these challenging patients done through a posterior approach who you would expect would have a high rate of dislocation and yet, that is not the case,” he said. “The key is to optimize the component position to maximize the stability of the arthroplasty.”
Surgeons should have a modular stem, 36-mm to 40-mm femoral heads, dual mobility heads and constrained liner available when performing hip arthroplasty in these patients. Surgeons also should consider implants designed for full weight-bearing and postoperative bracing for patients who undergo extensive soft tissue release.
“What about total hip arthroplasty in specific neuromuscular disorders? You have to understand there is limited data available regarding these patients. Up until a couple of years ago, there was nothing that dealt with total hip arthroplasty with contemporary type devices,” Kraay said.
He added, “In patients with cerebral palsy and polio, they have complex deformities and higher dislocation risk. Patients with Parkinson’s disease and stroke have medical comorbidities, but they do have an acceptable dislocation risk. Hip arthroplasty is contraindicated in patients with mild dysplasia or Charcot arthropathy.” – by Gina Brockenbrough, MA
Reference:
Kraay MJ. Paper #31. Presented at: the Current Concepts in Joint Replacement Winter Meeting; Dec. 9-12, 2015; Orlando, Fla.
Disclosure: Kraay reports no relevant financial disclosures.