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Hip: R. J. Sierra, R. T. Trousdale, and M. E. Cabanela Pregnancy and childbirth after total hip arthroplasty J Bone Joint Surg Br 2005; 87-B: 21-24 [Abstract] [Full text] [PDF]

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Response to Ginsel and Pijnenborg

Miguel E. Cabanela, RJ Sierra, RT Trousdale   (30 June 2005)

Letter from Ginsel and Pijnenborg

Johanna MA Pijnenborg, Bastiaan Ginsel and Johanna M.A. Pijnenborg   (17 June 2005)

Response to Ginsel and Pijnenborg 30 June 2005
Miguel E. Cabanela, orthopedic surgeon Mayo clinic, RJ Sierra, RT Trousdale Send letter to journal: Re: Response to Ginsel and Pijnenborg cabanela.miguel{at}mayo.edu Miguel E. Cabanela, et al.	Sir, We appreciate the comments of Drs Ginsel and Pijnenborg. Regarding their first statement, the reasons for cesarean section were specified in the paper. Eleven patients underwent caesarean section for obstetric reasons and there were six in whom the operation was elective. With so few statistics it was impossible to assess the effect of elective vs secondary caesarian section on the outcome of the arthroplasty. The total number of revision hip arthroplasties performed on the 47 women who had successful pregnancies after arthroplasty was 24, which is also stated in our paper. They also raise the issue of using revision of the arthroplasty as an appropriate parameter of outcome. We think it is the most objective recognised parameter. But while revision is an objective endpoint, it is possible that there may be patients with loose total hips which have not been revised, who have been omitted from the survey. However, it is likely that these patients would have pain and that is why we included groin pain in our survey as another endpoint. Our paper could not address the issue of whether an elective cesarean section increases the life of the arthroplasty compared with a vaginal delivery because we did not have sufficient data to carry out the appropriate statistical comparisons. R.J. SIERRA, M.D. R.T. TROUSDALE, M.D. M.E. CABANELA, M.D. Mayo Clinic, Rochester, USA.
Letter from Ginsel and Pijnenborg 17 June 2005
Johanna MA Pijnenborg, gynaecologist Tweesteden Hospital, Tilburg, The Netherlands, Bastiaan Ginsel and Johanna M.A. Pijnenborg Send letter to journal: Re: Letter from Ginsel and Pijnenborg H.Pijnenborg{at}planet.nl Johanna MA Pijnenborg, et al.	Sir, The study performed by Sierra, Trousdale and Cabanela is one of the largest series which focuses on pregnancy and childbirth after total hip arthroplasty. Data were collected retrospectively with a high response rate of 76%. Within a group of 47 women who delivered their first child after total hip arthroplasty, 30 women had a successful vaginal delivery, and no increased time to revision compared with those who had a caesarean section. However, it is not clear whether there is a difference between elective caesarean section and an emergency or secondary caesarean section with the primary intention to deliver vaginally. It is known that the morbidity of elective caesarean sections is quite different from secondary caesarean sections. Therefore it is likely that this will influence the outcome on arthroplasty, especially when caesarean section is performed because of delayed second stage. Unfortunately, the authors do not show the exact number of revisions of those 47 women. Furthermore, we wondered whether the risk of revision after total hip arthroplasty is a correct parameter of outcome, since it does not accurately demonstrate the life of arthroplasties. The clinical issues are firstly, whether the life of an arthroplasty will change when women have one or more children (or indeed none) and secondly, whether an elective caesarean section increases the life of the arthroplasty compared with a vaginal delivery. B. GINSEL, MD Radbound University, Mijmegen, The Netherlands. J. M. A. PIJNENBORG, MD Tweesteden Hospital, Tilburg, The Netherlands.