The corresponding author of this article has been invited to respond to Dr. Eskelinen, et al but has not done so.

To the Editor:

We read with interest the article, “Total Hip Arthroplasty with Cement and without Acetabular Bone Graft for Severe Hip Dysplasia” (2005: 87; 280-5), by Klapach et al., in which the authors reported the results of total hip arthroplasty for fifty-six patients with severe hip dysplasia. The authors had placed the acetabular component at the anatomic hip center, the superolateral defect was filled with cement, and no bone- graft was used to supplement the acetabular wall. Minimum follow-up of twenty years after surgery was presented.

While the study was well-conceived and executed. We believe, however, that there were serious shortcomings in the review of the literature presented in the article. In Table IV the authors compared the results of their surgical technique with other published techniques for arthroplasty in patients with developmental dysplasia. We were surprised to find out, that previously published, excellent European studies by Hartofilakidis et al. (1,2,3) and Paavilainen (4,5) were neglected in the Discussion.

In their classical article published in the Journal of Bone and Joint Surgery in 1996, Hartofilakidis et al. presented a classification of acetabular deficiencies, and results of total hip arthroplasty combined with acetabuloplasty in sixty-six patients with developmental dysplasia of the hip (DDH) (1). In 1998, Hartofilakidis et al. published results of the same technique in sixty-seven patients with high congenital dislocation of the hip (2). Recently they published long-term results of 229 total hip arthroplasties in 168 patients with DDH in the Journal of Bone and Joint Surgery (3).

Paavilainen et al. reported short-term results of 100 cementless total hip replacements in 52 severely dysplastic and 48 totally dislocated hips (4). In 1993, Paavilainen et al. reported the results of sixty-seven dislocated or severely dysplastic treated with cementless total hip arthroplasty (5). The authors used distal advancement of the greater trochanter and anatomic replacement of the acetabular component at the anatomic site with good results. For patients with previous low-seated Schanz osteotomy, the authors recommended a segmental angular correction and shortening osteotomy fixed with a modular fluited stem.

We feel, that results of these excellent studies should be presented and discussed, whenever results of total hip arthroplasty for DDH are presented in peer-reviewed orthopedic journals.

Yours sincerely,

Antti Eskelinen, MD, Consultant Orthopedic Surgeon

Ville Remes, MD, PhD, Consultant Orthopedic Surgeon

Department of Orthopedics and Traumatology Helsinki University Central Hospital P.O. Box 266, 00029 HUS Helsinki, Finland

References

1. Hartofilakidis G, Stamos K, Karachalios T, Ioannidis TT, Zacharakis N. Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg Am. 1996;78:683- 92.

2. Hartofilakidis G, Stamos K, Karachalios T. Treatment of high dislocation of the hip in adults with total hip arthroplasty. Operative technique and longterm clinical results. J Bone Joint Surg Am. 1998;80:510 -7.

3. Hartofilakidis G, Karachalios T. Total hip arthroplasty for congenital hip disease. J Bone Joint Surg Am. 2004;86:242-50.

4. Paavilainen T, Hoikka V, Solonen KA. Cementless total replacement for severely dysplastic or dislocated hips J Bone Joint Surg Br. 1990;72:205-11.

5. Paavilainen T, Hoikka V, Paavolainen P. Cementless total hip arthroplasty for congenitally dislocated or dysplastic hips. Technique for replacement with a straight femoral component. Clin Orthop. 1993;297:71- 81.