Arthroplasty in Individuals With Skeletal Dysplasias: Updated Surgical Outcomes and Complications Following Multidisciplinary Preoperative Screening.

BACKGROUND

Skeletal dysplasias are a heterogeneous group of genetic disorders characterized by atypical cartilage and bone development. Affected individuals often experience joint pain and asymmetric alignment, leading to early-onset degenerative joint disease requiring early surgical intervention. This study provides an updated analysis of patients with skeletal dysplasias undergoing arthroplasty at a single institution following implementation of a multidisciplinary preoperative screening protocol, including implant survival and complications by type of procedure.

METHODS

This institutional review board-approved, retrospective study included 55 skeletal dysplasia patients who underwent total hip and/or knee arthroplasty at Hospital for Special Surgery in New York, NY, between April 1985 and June 2024. Chart review included demographics, history, imaging studies, surgical indications, and complications.

RESULTS

Fifty-five individuals had 103 arthroplasties, including 75 hips and 28 knees. Almost half of hips (49%) and knees (54%) required custom components. Fifteen of 75 hip surgeries and 6/28 knee surgeries were revisions. Five-year implant survival was 86.6% for hips and 88.7% for knees. Implant survival at 10 years was 86.6% for hips and 59.1% for knees; hip survival at 20 years was 57.7%. Postoperative complications occurred in 29/75 hip arthroplasties (38.7%) and 15/28 knee arthroplasties (53.6%), although orthopaedic/surgical complications were less frequent, affecting 8/75 hip arthroplasties (10.7%) and 3/28 knee arthroplasties (10.7%).

CONCLUSIONS

Presurgical advance planning remains essential in this patient population, including custom component design. Surgeries performed after 2018, when preoperative consultation with a dedicated multidisciplinary skeletal dysplasia team was initiated, showed a reduction in complication severity, highlighting improvements in care associated with specialized perioperative management.