Longevity of Total Hip Arthroplasty in Patients with Gaucher Disease

Ehud Lebel 1,2 Dina Kogan 1,3 Amir Rubin 1,2 Deborah Elstein 1 Ari Zimran 1
1Gaucher Clinic, Shaare-Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
2Orthopaedic Suregery, Shaare-Zedek Medical Center, affiliated with the Hebrew university school of Medicine, Jerusalem, Israel
3School of Medicine, The Hebrew University, Jerusalem, Israel

Total hip arthroplasty (THA) is recommended in patients with Gaucher disease and osteonecrosis of femoral head. Long term outcome has not been evaluated specifically in large cohorts of patients. This study reports the outcome of all patients monitored in a referral clinic who have undergone THA. Forty-eight patients (54 implants) have undergone THA since 1973. We collected demographic information, current status of the prosthesis and/or need for revision as well as general characteristics of their disease and current daily function. Data was complete for 45 patients (93%). Seven patients (14%) have passed away. Primary arthroplasty was performed at mean age of 43 (range 17-69) years. Revision of implant was performed in 19/54 (35%) implants, representing 17/48 (35%) patients, within a mean follow up time of 12 (range 1-33) years. In the 19 revised implants, revision was performed anywhere from the first year (one case of poor implant positioning) and the 20th year (wear of bearing surface and loosening). Fifteen (27%) of non-revised implants are already surviving >15 years and patients remain functional. Poor revision rates were observed in metal-on-metal implants. Good to excellent function was found in almost all patients either with primary or revised implant. Longevity of approximately 15 years for THA in otherwise healthy individuals is fairly predictable, with continued pain relief and sustained functionality. The causes of THA failure (revision) in Gaucher disease will be discussed in detail. Based on our extensive experience, we predict that with proper use of implants and newer bearing surfaces, THA may allow more than 20 revision-free years for most patients with Gaucher disease.