1
|
Ma Y, Chen S, Chen D. Mechanical influence of periacetabular osteotomy on late total hip arthroplasty. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3690. [PMID: 36846879 DOI: 10.1002/cnm.3690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 05/13/2023]
Abstract
Periacetabular osteotomy (PAO) is an effective technique to treat symptomatic hip dysplasia. However, following PAO, some patients still experience persistent pain or development of hip arthritis, requiring total hip arthroplasty (THA). Issues such as whether patients with PAO are necessarily at increased risk of post-THA complications and revision of the prosthesis remain debatable. The purpose of this study was to evaluate the biomechanical influence of PAO on the acetabulum after THA by finite element analysis. Eight patients with developmental dysplasia of the hip (DDH) diagnosed in the Fourth Medical Center of the PLA General Hospital were enrolled in this research. Patient-specific hip joint models were reconstructed from computed tomography scans, and the hip prosthesises, were established via computer-aided design (CAD) modeling technology. The finite element analysis was conducted to compare the surface and internal stress through the process mapping of the model due to the THA. Compared with the THA after PAO, the position of the high-stress area of the acetabular fossa of patients without PAO decreased, and the high-stress area developed toward the lower edge of the acetabulum. Although the high-stress area of the suprapubic branch did not change significantly, the peak stress was higher (t = .00237). The analysis of the section plane showed that the high-stress area of cancellous bone had a large distribution. The acetabular size and vertical distance of rotation center (VDRC) were significantly correlated with the maximum postoperative acetabular equivalent stress (p = .011, p = .001). In the Post group, both the horizontal distance of rotation center (HDRC) and A-ASA were significantly correlated with postoperative maximal acetabular equivalent stress, with a significance of 0.014 and 0.035, respectively. The risk of postoperative prosthetic revision following THA is not increased by PAO, although the risk of postoperative suprapubic branch fracture is increased.
Collapse
Affiliation(s)
- Yunqing Ma
- Department of Orthopaedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Songhao Chen
- School of Life Science, Beijing Institute of Technology, China
| | - Duanduan Chen
- School of Life Science, Beijing Institute of Technology, China
- Key Laboratory of Convergence Medical Engineering System and Healthcare Technology, The Ministry of Industry and Information Technology, Beijing Institute of Technology, China
| |
Collapse
|
2
|
Kinoshita K, Seo H, Matsunaga T, Doi K, Yamamoto T. Clinical Outcomes for Total Hip Arthroplasty with and without Previous Curved Periacetabular Osteotomy. J Clin Med 2023; 12:jcm12020694. [PMID: 36675623 PMCID: PMC9867272 DOI: 10.3390/jcm12020694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
There are currently no reports on the clinical outcomes after total hip arthroplasty (THA) with previous curved periacetabular osteotomy (CPO), although the outcomes after THA with non-CPO types of periacetabular osteotomy have been reported. This study aimed to clarify the differences in clinical outcomes and radiographic features after THA with or without previous CPO. We performed a retrospective case-control with individual matching study. The participants were 10 patients with 11 hips that underwent cementless THA between October 1998 and October 2018 with previous CPO (osteotomy group). For the control group, we matched age, sex, and follow-up period, and included 32 patients with 33 hips that underwent cementless THA without previous CPO at a 1:3 ratio. The Harris Hip Score (HHS), cup size, position, and alignment, global offset (GO), operative time, perioperative blood loss, frequency of osteophyte removal, and major complications were compared between the two groups. The osteotomy group had no cases with revision surgery and dislocation. No significant differences were found between the two groups as follows: mean HHS, 94.9 points in the osteotomy group versus 92.7 points in the control group at the final follow-up; mean GO, 70.1 mm in the osteotomy group versus 71.4 mm in the control group; cup size, position, and alignment after THA; operative time; and perioperative blood loss. The frequency of osteophyte removal was higher in the osteotomy group. The take-home messages were that the clinical outcomes, including HHS, and radiographic features, including GO, after THA were equivalent in the two groups.
Collapse
|
3
|
Total hip arthroplasty after periacetabular osteotomy versus primary total hip arthroplasty: a propensity-matched cohort study. Arch Orthop Trauma Surg 2021; 141:1411-1417. [PMID: 33625543 DOI: 10.1007/s00402-021-03817-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Controversy still exist regarding the outcomes of total hip arthroplasty (THA) after periacetabular osteotomy (PAO). The purpose of this study was to compare the clinical and radiologic outcomes of THA after PAO with primary THA based on balanced baseline characteristics with propensity score matching. METHODS Using propensity score matching, 1:2 matched cohort to facilitate comparison between patients who underwent primary cementless THA with or without previous PAO. Then, we compared the operative time, blood loss, complications, postoperative clinical score, cup size, position, and alignment of acetabular cup, and degree of bony coverage on cup between the two groups. RESULTS Thirty-five patients with 37 hips who underwent THA after PAO were successfully matched to 70 patients with 74 hips who underwent primary THA. The operative time and blood loss in THA after PAO were significantly longer and larger than those in primary THA (P < 0.001 and = 0.0067, respectively). Clinical score showed no difference between the groups (P > 0.05). For THA after PAO, the cup size and bony coverage were larger (P = 0.0014 and < 0.001, respectively), and the hip center was significantly higher and laterally (P < 0.001 and < 0.001, respectively) comparing primary THA. CONCLUSION This study demonstrated longer operative time and larger blood loss without difference in the postoperative clinical score or complications between THA after PAO and primary THA. Furthermore, THA after PAO provided larger cup size and superolaterally positioned cup center without difference in the cup inclination or anteversion comparing primary THA.
Collapse
|
4
|
Shapira J, Annin S, Rosinsky PJ, Maldonado DR, Lall AC, Domb BG. Total hip arthroplasty after pelvic osteotomy for acetabular dysplasia: A systematic review. J Orthop 2021; 25:112-119. [PMID: 34017159 PMCID: PMC8113803 DOI: 10.1016/j.jor.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/14/2021] [Indexed: 12/25/2022] Open
Abstract
The purposes were (1) to investigate and compare the findings of patients undergoing total hip arthroplasty (THA) following a corrective pelvic osteotomy (PO), to a control group of patients who underwent THA but not PO and (2) to evaluate the outcomes and complications for secondary THA after PO. Three studies recorded reduced cup anteversion in the osteotomy group. Two studies reported higher PROs for the control group. The most common complication after failed PAO was dislocations. PO may entail challenges on a subsequent THA, illustrated by higher intraoperative blood loss, lower consistency in cup positioning and compromised patients reported outcomes.
Collapse
Affiliation(s)
- Jacob Shapira
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Shawn Annin
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | | | | | - Ajay C. Lall
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
- American Hip Institute, Chicago, IL, 60018, USA
- AMITA Health St. Alexius Medical Center, Hoffman Estates, IL, 60169, USA
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
- American Hip Institute, Chicago, IL, 60018, USA
- AMITA Health St. Alexius Medical Center, Hoffman Estates, IL, 60169, USA
| |
Collapse
|
5
|
Papachristou GC, Pappa E, Chytas D, Masouros PT, Nikolaou VS. Total Hip Replacement in Developmental Hip Dysplasia: A Narrative Review. Cureus 2021; 13:e14763. [PMID: 34094728 PMCID: PMC8168999 DOI: 10.7759/cureus.14763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The reconstruction of the hip joint in patients suffering from developmental hip dysplasia (DDH) is a demanding procedure and presents many challenges to the reconstructive surgeon. Higher rates of mechanical complications are present in this group of patients. The results of cemented and uncemented implants used in DDH patients are very promising, according to recent outcomes. However, the surgeon has to be aware of several complications, in order to establish an uneventful surgical management of DDH. The specific article investigates the technical challenges and clinical results of total hip arthroplasty in patients with DDH.
Collapse
Affiliation(s)
- George C Papachristou
- 2nd Department of Orthopaedics, School of Medicine. National and Kapodistrian University of Athens, Athens, GRC
| | - Eleni Pappa
- 5th Department of Orthopaedics, "KAT" General Hospital of Athens, Athens, GRC
| | - Dimitrios Chytas
- Department of Orthopaedics, European University of Cyprus, Nicosia, CYP
| | | | - Vasileios S Nikolaou
- 2nd Department of Orthopaedics, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| |
Collapse
|
6
|
Ma Y, Luo D, Cheng H, Xiao K, Chai W, Li R, Zhang H. Is cup positioning easier in DDH patients previously treated with Bernese periacetabular osteotomy? J Orthop Surg Res 2020; 15:501. [PMID: 33121540 PMCID: PMC7596929 DOI: 10.1186/s13018-020-02001-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/06/2020] [Indexed: 11/15/2022] Open
Abstract
Background Acetabular orientation changes after periacetabular osteotomy (PAO) lead to technical change when performing subsequent total hip arthroplasty (THA). There is no unified consensus regarding the solution for acetabular component installation after PAO. In the current study, we performed computed tomography (CT)-based simulation of acetabular component installation and compared the acetabular defect and component position following THA after PAO and the same patient before PAO. Methods From January 2014 to December 2018, pelvic models of 28 patients (28 hips) underwent PAO and with the risk factors to develop secondary osteoarthritis. The acetabular reconstruction process was simulated using 3D models from CT data, and the acetabular component coverage was calculated in 3D space based on the measurement and algorithm we proposed. We evaluated the anterior, posterior, superior, inferior acetabular sector angle (ASA), the medial wall thickness (MWT), and the distance from the hip center to the plane of pubic symphysis and ossa sedentarium in the study group (post-PAO group) and control group (pre-PAO group). In addition, we investigated the changes in the acetabular component covering and size between the two groups. Results A-ASA and I-ASA values were significantly smaller in the post-PAO group than in the pre-PAO group. The S-ASA and distance values were significantly bigger in the post-PAO group. Compared to the pre-PAO group, the post-PAO group has a bone defect in the anterior and inferior medial. However, the post-PAO group has to elevate the cup to improved component coverings. Conclusion Acetabular defection following simulation of cup installation after PAO was significantly changed compared to those without PAO. Elevation of hip joint centers as much as 4 mm and increase acetabular cup anteversion were therapeutic options for DDH patients following THA after PAO
Collapse
Affiliation(s)
- Yunqing Ma
- Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing, 100048, China
| | - Dianzhong Luo
- Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing, 100048, China
| | - Hui Cheng
- Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing, 100048, China
| | - Kai Xiao
- Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing, 100048, China
| | - Wei Chai
- Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing, 100048, China.,Department of Orthopedics, The First Medical Centre of Chinese PLA General Hospital, Beijing, 100853, China
| | - Rui Li
- Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing, 100048, China.,Department of Orthopedics, The First Medical Centre of Chinese PLA General Hospital, Beijing, 100853, China
| | - Hong Zhang
- Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing, 100048, China.
| |
Collapse
|
7
|
Association between total hip arthroplasty following periacetabular osteotomy and acetabular component overhang. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1431-1439. [PMID: 32572632 DOI: 10.1007/s00590-020-02714-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is limited understanding of anterior acetabular component overhang, which induces groin pain, in post-periacetabular osteotomy (PAO) hips during conversion to total hip arthroplasty (THA). The aim of the study were to determine the following: (1) the differences in the amount of acetabular component overhang among pre-PAO hips and post-PAO hips in simulating THA; (2) the factors associated with the amount of component overhang in THA following PAO; (3) whether high component placement with elevation of the hip center by 10 mm reduces the amount of component overhang compared to the anatomical component position in THA following PAO. METHODS Computer-based simulations of acetabular component implantation were performed using preoperative and postoperative CT data from 30 patients undergoing PAO. Implantation was performed thrice in each patient: in pre-PAO hips (anatomical component position) and post-PAO hips (anatomical and high component position). Component overhang was measured on the axial plane, which passes through the component center. RESULTS Overhang was greater in post-PAO hips [mean (SD) overhang: 5.2 (2.9) mm, pre-PAO hips: 10.2 (4.6) mm, post-PAO hips-mean difference, 5.0 mm; p < 0.001]. A smaller distance between the pubic osteotomy and the acetabulum, and greater overhang in pre-PAO hips was independent factors associated with increased overhang in post-PAO hips. Overhang was smaller with the high component position than with the anatomical component position in post-PAO hips [mean (SD) overhang-3.5 mm (2.9) with high component position among post-PAO hips; mean difference, 6.6 mm; p < 0.001). Ten post-PAO hips with the anatomical component position had overhang of at least 12 mm (the likely threshold for groin pain). Of these, 9 hips had reduced overhang (< 12 mm) with the high component position. CONCLUSIONS Acetabular component overhang was more severe in THA following PAO than in THA without prior PAO. Pubic osteotomy should be performed closer to the acetabular rim to prevent severe overhang in potential THA conversion cases. A high component position decreased the risk of severe overhang.
Collapse
|
8
|
Osawa Y, Seki T, Takegami Y, Kusano T, Ishiguro N, Hasegawa Y. Failed periacetabular osteotomy leads to acetabular defects during subsequent total hip arthroplasty. Arch Orthop Trauma Surg 2019; 139:729-734. [PMID: 30904985 DOI: 10.1007/s00402-019-03174-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acetabular wall defects after periacetabular osteotomy (PAO) lead to technical difficulties when performing subsequent total hip arthroplasty (THA). There is no unified consensus regarding the solution for THA socket installation after PAO. In the current study, we performed computed tomography (CT)-based simulation of socket installation and evaluated the acetabular defect following THA after PAO and after primary osteoarthritis (OA). PATIENTS AND METHODS The study group comprised 55 patients (56 hips) who underwent THA after PAO. For the control group, after matching for age, sex, and Crowe classification, we included 55 patients (56 hips) who underwent primary THA for hip dysplasia. We evaluated the anterior, posterior, and superior acetabular sector angle (ASA) and medial wall thickness (MWT) at the anatomical hip center (at the 20-mm vertical hip level from teardrop) in the study group (anatomical PAO group) and control group (primary OA group). In addition, we investigated the changes in the socket covering when the socket was positioned 10 mm above the anatomical hip center (30 mm above the teardrop; elevated osteotomy group). RESULTS All ASA and MWT values were significantly smaller in the anatomical PAO group than in the primary OA group. In particular, the individuals with a Crowe classification of II/III in the anatomical PAO group presented severe acetabular defects. However, the elevated PAO group had a significantly larger ASA compared to the anatomical PAO group, with improved socket coverings. CONCLUSION Acetabular defects in the anatomical hip center following THA after PAO were significantly common compared to those after primary THA. Elevation of hip joint centers as much as 10 mm is one therapeutic option in the case of severe acetabular defects following THA after PAO.
Collapse
Affiliation(s)
- Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Taiki Kusano
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare Science, Kashiwara, Japan
| |
Collapse
|
9
|
[Hip arthroplasty after pelvic and femoral osteotomies]. DER ORTHOPADE 2019; 48:308-314. [PMID: 30824969 DOI: 10.1007/s00132-019-03693-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pelvic and femoral osteotomies can be a challenge even for experienced orthopedic surgeons. Residual metal may complicate the insertion of the endoprosthesis in some cases. Sometimes, the anatomical modification of the previous osteotomy complicates the total hip replacement. This may require the use of an acetabular revision system for the primary implantation. Femoral deformities can require additional osteotomies of the femur during the implantation. In every case, accurate preoperative planning should be performed. A preoperative CT with 3D reconstruction is a powerful tool for further information beyond conventional imaging.
Collapse
|
10
|
Aalirezaie A, Anoushiravani A, Cashman J, Choon D, Danoff J, Dietz M, Gold P, Schwarzkopf R, Sheehan E, Vigante D. General Assembly, Prevention, Host Risk Mitigation - Local Factors: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S37-S41. [PMID: 30343966 DOI: 10.1016/j.arth.2018.09.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
|
11
|
Shigemura T, Yamamoto Y, Murata Y, Sato T, Tsuchiya R, Wada Y. Total hip arthroplasty after a previous pelvic osteotomy: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2018; 104:455-463. [PMID: 29581068 DOI: 10.1016/j.otsr.2018.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND There are several reports regarding total hip arthroplasty (THA) after a previous pelvic osteotomy (PO). However, to our knowledge, until now there has been no formal systematic review and meta-analysis published to summarize the clinical results of THA after a previous PO. Therefore, we conducted a systematic review and meta-analysis of results of THA after a previous PO. We focus on these questions as follows: does a previous PO affect the results of subsequent THA, such as clinical outcomes, operative time, operative blood loss, and radiological parameters. METHODS Using PubMed, Web of Science, and Cochrane Library, we searched for relevant original papers. The pooling of data was performed using RevMan software (version 5.3, Cochrane Collaboration, Oxford, UK). A p-value<0.05 was judged as significant. Standardized mean differences (SMD) were calculated for continuous data with a 95% confidence interval (CI) was reported. Statistical heterogeneity was assessed based on I2 using standard χ2 test. When I2>50%, significant heterogeneity was assumed and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity. RESULTS Eleven studies were included in this meta-analysis. The pooled results indicated that there was no significant difference in postoperative Merle D'Aubigne-Postel score (I2=0%, SMD=-0.15, 95% CI: -0.36 to 0.06, p=0.17), postoperative Harris hip score (I2=60%, SMD=-0.23, 95% CI: -0.50 to 0.05, p=0.10), operative time (I2=86%, SMD=0.37, 95% CI: -0.09 to 0.82, p=0.11), operative blood loss (I2=82%, SMD=0.23, 95% CI: -0.17 to 0.63, p=0.25), and cup abduction angle (I2=43%, SMD=-0.08, 95% CI: -0.25 to 0.09, p=0.38) between THA with and without a previous PO. However, cup anteversion angle of THA with a previous PO was significantly smaller than that of without a previous PO (I2=77%, SMD=-0.63, 95% CI: -1.13 to -0.13, p=0.01). CONCLUSION Systematic review and meta-analysis of results of THA after a previous PO was performed. A previous PO did not affect the results of subsequent THA, except for cup anteversion. Because of the low quality evidence currently available, high-quality randomized controlled trials are required. LEVEL OF EVIDENCE Level III, meta-analysis of case-control studies.
Collapse
Affiliation(s)
- T Shigemura
- Department of orthopaedic surgery, Teikyo university, Chiba Medical Center, 3426-3 Anesaki, 2990111 Ichihara, Chiba, Japan.
| | - Y Yamamoto
- Department of orthopaedic surgery, Teikyo university, Chiba Medical Center, 3426-3 Anesaki, 2990111 Ichihara, Chiba, Japan
| | - Y Murata
- Department of orthopaedic surgery, Teikyo university, Chiba Medical Center, 3426-3 Anesaki, 2990111 Ichihara, Chiba, Japan
| | - T Sato
- Department of orthopaedic surgery, Teikyo university, Chiba Medical Center, 3426-3 Anesaki, 2990111 Ichihara, Chiba, Japan
| | - R Tsuchiya
- Department of orthopaedic surgery, Teikyo university, Chiba Medical Center, 3426-3 Anesaki, 2990111 Ichihara, Chiba, Japan
| | - Y Wada
- Department of orthopaedic surgery, Teikyo university, Chiba Medical Center, 3426-3 Anesaki, 2990111 Ichihara, Chiba, Japan
| |
Collapse
|
12
|
Osawa Y, Hasegawa Y, Seki T, Takegami Y, Amano T, Ishiguro N. Patient-reported outcomes in patients who undergo total hip arthroplasty after periacetabular osteotomy. J Orthop Sci 2018; 23:346-349. [PMID: 29187291 DOI: 10.1016/j.jos.2017.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND There has been constant discussion about whether the clinical outcome of THA after periacetabular osteotomy (PAO) is equivalent to that after primary total hip arthroplasty (THA). However, there have been few reports about patient-reported outcomes (PRO) for those who undergo THA after PAO. We compared the pre- and postoperative PRO of patients who underwent THA after PAO and those who underwent primary THA alone. METHODS We performed a case-control study. Twenty-seven patients (29 hips) underwent THA after PAO (osteotomy group); their mean age at surgery was 57.2 years, and they underwent postoperative follow-up for a mean period of 3.0 years. For the control group, after matching age, sex, and Crowe classification, we included 54 patients (58 joints) who underwent primary THA for hip dysplasia. Assessment performed preoperatively and at the last follow-up included the Harris hip score, the Short Form 36 (SF-36) for the Physical Component Summary (PCS), Mental Component Summary (MCS), and Role/Social Component Summary (RCS) domains, Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) for pain, movement, and mental health, and the visual analog scale (VAS) score of hip pain and satisfaction. RESULTS The two groups demonstrated no significant difference in the preoperative Harris hip score, each domain of the SF-36, JHEQ, and the VAS score of hip pain and satisfaction. The osteotomy group demonstrated significantly poor Harris hip scores for gait and activity, and JHEQ for movement at the last follow-up. There was no significant difference in each domain of the SF-36 and the VAS score of hip pain and satisfaction at the last follow-up. CONCLUSION Previous PAO affects the quality of physical function in patients who undergo subsequent THA.
Collapse
Affiliation(s)
- Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yukiharu Hasegawa
- Department of Hip and Knee Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takafumi Amano
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
13
|
Amstutz HC, Le Duff MJ. Effects of Previous Osteotomy on Outcome of Hip Resurfacing Arthroplasty. Orthopedics 2017; 40:e609-e616. [PMID: 28418575 DOI: 10.3928/01477447-20170411-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/27/2017] [Indexed: 02/03/2023]
Abstract
The effect of previous conservative surgeries on the outcome of metal-on-metal hip resurfacing arthroplasty (HRA) has not been studied. This study compared postoperative clinical scores and survivorship results of hips with and without previous osteotomies in a population of patients who underwent HRA. A total of 1101 patients (1375 hips) with a mean age of 51.3 years at the time of surgery underwent HRA at a single center. Sixty-nine patients had undergone prior surgery on the operated hip including 14 osteotomies (1 pelvic, 6 femoral, and 7 combined pelvic and femoral osteotomies). Mean follow-up was comparable for patients with prior osteotomy and patients in the control group (101 months vs 96 months, P=.6916); however, patients with prior osteotomies were much younger at the time of surgery (34 years vs 51 years, P=.0001). Kaplan-Meier survival estimates were calculated, and the Cox proportional hazard ratio was used to adjust for the covariates that differed between the 2 groups and affected the survivorship of hip resurfacing. Patients who underwent prior osteotomy showed lower pain and activity scores. In addition, patients who underwent prior osteotomy had a greater chance of revision than the rest of the cohort (hazard ratio, 3.87; 95% confidence interval, 1.54-9.68; P=.004). For patients in whom the natural anatomy or the bone quality of the hip has been severely altered by a prior osteotomy, HRA may be contraindicated if good component fixation cannot be achieved and hip biomechanics restored. [Orthopedics. 2017; 40(4):e609-e616.].
Collapse
|
14
|
Osawa Y, Hasegawa Y, Okura T, Morita D, Ishiguro N. Total Hip Arthroplasty After Periacetabular and Intertrochanteric Valgus Osteotomy. J Arthroplasty 2017; 32:857-861. [PMID: 27667535 DOI: 10.1016/j.arth.2016.08.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/28/2016] [Accepted: 08/18/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We performed periacetabular osteotomy (PAO) combined with intertrochanteric valgus osteotomy (TVO) to obtain better congruity for patients with acetabular dysplasia and nonspherical femoral head. These patients with PAO-combined TVO demonstrate long-term progression of osteoarthritis, thereby, needing conversion to total hip arthroplasty (THA) and is difficult due to morphological changes. The objective of the present study was to investigate outcomes of patients who underwent THA after PAO-combined TVO. METHODS We performed 3 groups' case-control study. The participants were 20 patients (20 hips) who underwent THA after PAO-combined TVO (PAO-TVO group); these patients had a mean age at surgery of 56.3 years and underwent postoperative follow-up for a mean period of 6.8 years. For the control group, we included 53 patients (57 joints) who underwent THA after PAO and 76 patients (80 joints) who underwent primary THA for hip dysplasia matching age, sex, and time of surgery. RESULTS Harris hip score at the last follow-up was significantly poorer in PAO-TVO group compare with PAO group and primary group. Short Form-36 of Physical Component Summary was significantly poorer in PAO-TVO group compared with primary group. The socket position in the PAO-TVO group was significantly superior and lateral compared with that in the primary THA group. Considering socket placement in Lewinnek's safe zone and stem malalignment, there were no significant differences in the 3 groups. CONCLUSION Harris hip score and Short Form-36-Physical Component Summary for THA after PAO-combined TVO were significantly poorer compared to those of primary THA.
Collapse
Affiliation(s)
- Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukiharu Hasegawa
- Department of Hip and Knee Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshiaki Okura
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daigo Morita
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
15
|
Osawa Y, Hasegawa Y, Seki T, Amano T, Higuchi Y, Ishiguro N. Significantly Poor Outcomes of Total Hip Arthroplasty After Failed Periacetabular Osteotomy. J Arthroplasty 2016; 31:1904-9. [PMID: 27036922 DOI: 10.1016/j.arth.2016.02.056] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/15/2016] [Accepted: 02/24/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Periacetabular osteotomy (PAO) is an effective treatment for preosteoarthritis and early osteoarthritis in young and active patients with hip dysplasia. However, conversion to total hip arthroplasty (THA) for failed PAO is difficult owing to morphologic changes. The objective of the present study was to investigate outcomes of patients who underwent THA for failed PAO. METHODS We performed a case-control study. The participants were 48 patients (52 hips) who underwent THA after PAO (the osteotomy group); type of PAO was eccentric rotational acetabular osteotomy in 36 hips and rotational acetabular osteotomy in 16 hips. These patients had a mean age at surgery of 56.5 years and underwent postoperative follow-up for a mean period of 5.4 years. For the control group, after matching age, gender, and time of surgery, we included 96 patients (104 joints) who underwent primary THA for hip dysplasia. RESULTS The 2 groups demonstrated no significant difference in the preoperative Harris Hip Score. However, the osteotomy group demonstrated a significantly poor Harris Hip Score at the last follow-up, with particularly low scores for gait and activity. The osteotomy group demonstrated significantly poor range of motion at the last follow-up. Although neither group had any cases of revision surgery, both groups had 1 case of postoperative dislocation. Considering socket placement in Lewinnek's safe zone, the osteotomy group had significantly poorer results compared to that obtained after primary THA. CONCLUSION The therapeutic outcomes and socket positioning for THA after PAO were poorer compared to those of primary THA.
Collapse
Affiliation(s)
- Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukiharu Hasegawa
- Department of Hip and Knee Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takafumi Amano
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshitoshi Higuchi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|