THA May Benefit Patients with Down Syndrome, OA

Osteoarthritis of the hip in patients with Down syndrome can
be effectively treated with total hip arthroplasty (THA), according to an
orthopedic investigator.

  John J. Callaghan
  John J. Callaghan

“If you look at the literature, somewhere between 8% and 28% of
individuals with Down syndrome develop osteoarthritis,” John J. Callaghan,
MD, said at the 2010 Current Concepts in Joint Replacement Winter Meeting.

According to Callaghan, an increased life expectancy of individuals with
Down syndrome, along with improved health care and biomaterials, favor THA in
this patient population. However, general factors such as noncompliance, young
age, cardiac abnormalities, cervical instability and proneness to infection may
compromise THA in these patients. Hip-specific factors that can impact the
procedure in this population include instability, dysplasia, deformed femoral
necks, narrow femoral canals and technically challenging surgery.

Callaghan stressed the importance of relying on the health care team in
combating compromising factors such as noncompliance.

“Their caregivers are the most important members of your health
care team and usually includes one or both parents or a special needs social
worker,” he said. “As many of you know, these patients tend to have
incredibly great parents with good support systems at home.”

Callaghan and colleagues conducted a multi-center study, which included
25 patients with Down syndrome who underwent THA. Two-thirds of the patients
had dysplasia. The average follow-up was 105 months.

Cementless acetabular fixation with screws was used in all cases. All
but one femoral component was cementless, and constrained liners were used in
eight cases.

Five of the 25 hips required revision — one each for femoral
loosening, periprosthetic fracture, acetabular component recurrent dislocation,
acetabular component wear and metallosis, and infection.

“These people are living a lot longer, and we will see that they
will have the same problems that other THA patients will have,” Callaghan
said. “Total hip replacement is a reliable treatment for patients with
osteoarthritis and Down syndrome. Anesthetic challenges are the cardiac
abnormalities and cervical instability.” — by Thomas M.

For more information:

  • Callaghan JJ. The down syndrome patient: Not a downer. Paper #31.
    Presented at the 2010 Current Concepts in Joint Replacement Winter Meeting.
    Dec. 8-11, 2010. Orlando, Fla.

Disclosure: John J. Callaghan, MD has
received royalties for intellectual property transfer from DePuy.


Bernard N. Stulberg
Bernard N. Stulberg

In our practice, these patients are often in an assisted-living
environment, and they have a great support system. The faster you get them back
to their support system, the better they do. In this particular patient
population, I have just gone straight to a constrained liner scenario and that
has worked the best for me.

— Bernard N. Stulberg, MD
Disclosure: Bernard N. Stulberg, MD has direct financial interests
with Stryker and Exactech.

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