Total hip arthroplasty in patients with Down syndrome

Hip osteoarthritis is prevalent in 8% to 28% of patients with Down syndrome. Presence of disabling hip pain is increased along with prolonged life expectancy, suggesting total hip arthroplasty (THA). Seven consecutive patients (9 hips) with Down syndrome underwent primary THA. Coxarthrosis was secondary to developmental hip dysplasia in 6 patients and slipped capital epiphysis in 1 patient. In 5 patients (7 hips), a previous hip surgery was performed. Average clinical and radiological follow-up was 9.9±6.4 years (range, 2-22.5 years; median, 9.3 years). Average patient age at THA was 34.8±7.5 years (range, 25- 47 years; median, 35.4 years). In 2 patients (3 hips), a trochanteric slide was used for the surgical approach, while a lateral transgluteal approach was used in the remaining patients. One-way analysis of variance test was used to compare Harris Hip Scores (HHS) at postoperative follow-up.Harris Hip Scores improved significantly (P=.008) from 4.1±15.1 (range, 18.5-65; median, 45) to 84.8.3±7.7 (range, 70-93; median, 85.8) at 4-year follow-up. Harris Hip Scores (average, 70.9±6.2; range, 66.5-80; median, 68) remained essentially unchanged (P=.43) at 8-year follow-up. Two patients required revision THA for stem loosening at 6 and 16 years post-THA, respectively. The first patient is 7 years post-revision and ambulates without aids. The second patient is 6.1 years post-revision and ambulates with a walker. Six of the THAs required a constrained liner. No dislocations or deep infections were encountered. At last follow-up, all patients had a functional range of motion without evidence of discomfort related to their THA.