Uncemented bipolar double-cup arthroplasty of the hip in inflammatory arthropathy

From 1979 to 1986, 42 uncemented surface arthroplasties were performed in 27 patients with an inflammatory arthropathy of the hip: median age at operation 40 years (range 19-65 ys), median follow-up period 73 months (range 36-120 mo). After 36 months, in 26 of 42 hips, the mean Harris Hip Score was excellent or good (mean 89, range 80-100). In 14 cases, the mean score was fair (76, range 70-79). Overall, those hips with the longest followup period (60-120 m) gradually improved over the years. No correlation was found between the clinical score and radiologic complications such as varus tilting of the femoral component, acetabular protrusion of the cup, or heterotopic ossification. Conversion to a conventional total hip arthroplasty was required in four patients. One patient required a total hip arthroplasty 86 months after the initial operation because of a femoral neck fracture. In two other patients, revision was performed after 60 and 32 months respectively because of a preexistent osteonecrosis and a severe foreign body response to polyethylene debris. Both patients had a varus tilting of the femoral component. In the fourth patient, in whom revision surgery was necessary 28 months after surface replacement there was no explanation for the varus shift of the femoral component. Regarding those problems that can appear after conventional total hip replacement in inflammatory arthropathy, we conclude that the uncemented surface replacement of the hip can be a reasonable alternative.