Clinical and Radiological Outcomes of Revision Total Hip Arthroplasty for Patients with Prior Hartofilakidis Type C Hip Dysplasia

Objective To investigate the clinical and radiological results of revision total hip arthroplasty (THA) for patients with previously diagnosed Hartofilakidis type C hip dysplasia, which is technically challenging and lacks literature. Methods We enrolled 20 patients with previously diagnosed Hartofilakidis type C hip dysplasia who underwent revision THA between November 2008 and July 2015 at our hospital. Patients were followed up for an average of 87 months. Data pertaining to the Harris hip score (HHS), modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), general satisfaction, and the level of satisfaction related to 16 hip functions or issues experienced after revision THA were collected. The vertical and horizontal center of rotation (COR) of the hips were measured bilaterally based on preoperative and postoperative anteroposterior radiographs. Categorical variables were analyzed by the chi-square test. Continuous variables were analyzed using the student's t test or non-parametric Wilcoxon Rank Sum test. Results There were significant postoperative improvements in the HHS (47.4 +/- 31.6 vs 70.1 +/- 39.0), modified WOMAC (48.5 +/- 27.9 vs 75.7 +/- 36.8), and the vertical (45.7 +/- 33.7 mm vs 21.6 +/- 21.8 mm) and horizontal (41.8 +/- 17.0 mm vs 31.4 +/- 14.7 mm) offset of the COR after revision THA (P < 0.05). Fifteen (75.0%) patients were satisfied with the procedure. The satisfaction rate for each of the 16 items ranged from 45% to 100%. The top three dissatisfactory items were squatting, getting into/out of cars, and leg-length discrepancy. Postoperatively, dissatisfied patients had a significantly higher visual analogue scale pain score and lower WOMAC pain, HHS pain, WOMAC total, and HHS total scores, a lower satisfaction rate for pain relief, and a higher vertical COR. Conclusion There is a high rate (25%) of dissatisfaction with the outcome after revision THA for patients with prior Hartofilakidis type C hip dysplasia. The most likely reasons for dissatisfaction were inadequate pain relief and a higher vertical COR measured on radiography.