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Mimendia I, Lakhani K, Núñez JH, Barro V, Guerra-Farfán E, Collado D, Hernández A. Total hip arthroplasty associated with transverse subtrochanteric shortening osteotomy and conical stem fixation in Crowe type IV hip dysplasia. Musculoskelet Surg 2023; 107:367-372. [PMID: 36869994 DOI: 10.1007/s12306-023-00779-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 02/26/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Total hip arthroplasty (THA) in high-dislocated hip dysplasia is a surgical challenge, presenting difficulties in the biomechanical reconstruction of the hip. The purpose of the present study is to analyze clinical and radiological outcomes of a series of patients with Crowe type IV hip dysplasia who underwent a THA with transverse subtrochanteric shortening osteotomy and conical stem fixation in our Hip surgery unit. METHODS This non-interventional retrospective study included all patients diagnosed with Crowe type IV hip dysplasia who underwent a THA using a subtrochanteric shortening osteotomy and uncemented conical stem fixation between January 1, 2008, and December 31, 2015. Demographic, clinical and radiologic data were analyzed, including Harris Hip Score and Oxford Hip Score. RESULTS Seventeen hips in 13 patients were included in the final analysis. All patients were women and mean age was 39 years (range 35-45). Mean follow-up was 5.6 years (range 1-8). Average length of the osteotomy was 3.4 cm (range 3-4.5) and mean lowering of the center of rotation was 5.67 cm (range 3.8-9.1). Mean time for bone union was 5.5 months. No nerve palsy or non-union was detected at the end of follow-up period. CONCLUSION The use of cementless conical stem fixation associated with a transverse subtrochanteric shortening osteotomy for treating Crowe type IV hip dysplasia permits to correct the rotational alterations of the femur and provides good stability of the osteotomy, with very low risk of nerve palsy and non-union rates.
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Affiliation(s)
- I Mimendia
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - K Lakhani
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
- Traumatology and Rehabilitation, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebrón, 119., 08035, Barcelona, Spain.
| | - J H Núñez
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - V Barro
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - E Guerra-Farfán
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - D Collado
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - A Hernández
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
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Takahashi D, Noyama Y, Shimizu T, Terkawi MA, Iwasaki N. Finite Element Analysis of Optimal Positioning of Femoral Osteotomy in Total Hip Arthroplasty With Subtrochanteric Shortening. Arthroplast Today 2022; 14:105-109. [PMID: 35252515 PMCID: PMC8891993 DOI: 10.1016/j.artd.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/22/2021] [Accepted: 01/15/2022] [Indexed: 11/09/2022] Open
Abstract
Background Total hip arthroplasty with femoral shortening is frequently recommended for patients with high hip dislocation. However, the possibility of postoperative rotational deviation of the stem presents a challenge for surgeons. We aimed to determine the optimal position for osteotomy in total hip arthroplasty under full weight-bearing and turning torque by using finite element analysis. Methods Four models of femoral osteotomy with 30-mm transverse shortening at 30% (model 30), 40% (model 40), 50% (model 50), and 60% (model 60) from the proximal end of the full length of the Exeter stem were constructed. Using finite element analysis, the constructs were first analyzed under an axial load of 1500 N and then with an added torsional load of 10°. Results The analyses under torsional loading conditions revealed that the maximum von Mises stress on the stem in each model occurred at the proximal end of the distal fragment and the distal side of the stem. The maximum stress values at the stem were 819 MPa (model 30), 825 MPa (model 40), 916 MPa (model 50), and 944 MPa (model 60). The maximum stress values at the osteotomy site of the medullary cavity side of the distal bone fragment were 761 MPa (model 30), 165 MPa (model 40), 187 MPa (model 50), and 414 MPa (model 60). Conclusions The osteotomy level should be around the proximal 40% of the full length of the Exeter stem, which is most suitable for rotation stability in the early postoperative period.
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Affiliation(s)
- Daisuke Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshihiro Noyama
- Department of Pharmaceutical Affairs Division, Teijin Nakashima Medical Company Limited, Okayama, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Mohamad Alaa Terkawi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Sun J, Guo L, Ni M, Shen J, Du Y, Zhang B, Zhang G, Zhou Y. Changes in Distribution of Lower Limb Alignment After Total Hip Arthroplasty for Crowe IV Developmental Dysplasia of the Hip. Ther Clin Risk Manag 2021; 17:389-396. [PMID: 33976547 PMCID: PMC8104987 DOI: 10.2147/tcrm.s302298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/16/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the distribution of lower limb alignment in Crowe IV developmental dysplasia of the hip (DDH) before and after total hip arthroplasty (THA). Patients and Methods We retrospectively included 64 Crowe IV DDH patients (87 hips) who underwent THA between February 2010 and May 2019. Radiographic parameters were measured on full limb length standing anteroposterior radiographs, including hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), anatomical lateral distal femoral angle (aLDFA), and anatomical tibiofemoral angle (aTFA). Results HKA improved from 176.54°±3.52° preoperatively to 179.45°±4.31° at the last followup (P<0.001). According to the preoperative HKA, 40 hips were defined as knee valgus alignment. The majority of them were characteristic of a valgus mLDFA and a valgus or neutral mMPTA (35%, 47.5%). After THA, there were still 22 hips defined as knee valgus alignment. More than 50% of them were characteristic of a valgus mLDFA and a neutral mMPTA. Five hips (22.7%) revealed valgus alignment in both mLDFA and mMPTA. Twenty-one hips (24.1%) remained knee valgus alignment before and after surgery. One hip, defined as neutral alignment, preoperatively turned into valgus alignment after surgery. Conclusion Both preoperative and postoperative sources of valgus alignment were mainly from the femoral side among Crowe IV DDH patients. THA mainly played a positive role in the reconstruction of lower limb alignment in these patients.
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Affiliation(s)
- Jingyang Sun
- Department of Orthopedics, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.,Medical School of Chinese People's Liberation Army, Beijing, People's Republic of China
| | - Lingfei Guo
- Department of Orthopedics, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.,Medical School of Chinese People's Liberation Army, Beijing, People's Republic of China
| | - Ming Ni
- Department of Orthopedics, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Junmin Shen
- Department of Orthopedics, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Yinqiao Du
- Department of Orthopedics, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Bohan Zhang
- Department of Orthopedics, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.,Medical School of Chinese People's Liberation Army, Beijing, People's Republic of China
| | - Guoqiang Zhang
- Department of Orthopedics, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.,Medical School of Chinese People's Liberation Army, Beijing, People's Republic of China
| | - Yonggang Zhou
- Department of Orthopedics, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.,Medical School of Chinese People's Liberation Army, Beijing, People's Republic of China
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Wu K, Zhang X, Chen M, Shang X. Restoration of Proximal Femoral Anatomy during Total Hip Arthroplasty for High Developmental Dysplasia of the Hip: An Original Technique. Orthop Surg 2020; 12:343-350. [PMID: 32077256 PMCID: PMC7031569 DOI: 10.1111/os.12614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 12/07/2019] [Accepted: 12/20/2019] [Indexed: 11/29/2022] Open
Abstract
Objective To introduce a modified osteotomy method for proximal femur reconstruction (PFR) in total hip arthroplasty (THA) for high developmental dysplasia of the hip (DDH). Method A retrospective study was performed in a series of 24 patients (26 hips) with Crowe III/IV DDH who underwent THA and simultaneous PFR. We used an animated video to illustrate and help understand the procedure for this technique. Patients were reviewed clinically and radiographically with an average follow‐up of 31 months. The Harris hip score (HHS) was recorded preoperatively and at 3 and 12 months postoperatively. Results All patients achieved primary bone union. No revision was needed up to the latest follow‐up. One patient had a dislocation due to self‐fall and received manual reduction under general anesthesia. No patient had intraoperative femoral fractures, sciatic nerve injury, or infection. The mean HHS improved from 33.48 ± 9.06 preoperatively to 84.61 ± 4.78 immediately after surgery and 90.84 ± 4.96 at 12 months. Conclusion Proximal femur reconstruction is a simple and practical technique for femoral remolding during THA in patients with high DDH.
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Affiliation(s)
- Kerong Wu
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xianzuo Zhang
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Min Chen
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xifu Shang
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Benjamin B, Haddad FS. Management of limb length problems during total hip arthroplasty for patients with developmental dysplasia of the hip. Br J Hosp Med (Lond) 2020; 81:1-7. [PMID: 32730164 DOI: 10.12968/hmed.2019.0362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The anatomy of the acetabulum and femur is usually significantly altered in people with developmental dysplasia of the hip and this leads to secondary osteoarthritis of the hip joint. Ideal positioning of implants and reduction of the joint is technically demanding during arthroplasty. Lengthening may result in nerve palsies and therefore procedures may have to be undertaken to shorten the femur. Other complications include dislocation and non-union at the shortening osteotomy site. Thorough preoperative planning and templating is required before surgery to assess the need for shortening. Shortening osteotomies can be performed at the proximal femur, diaphysis or distal femoral levels, with subtrochanteric being the most common level. The procedure should be customised for each patient after extensive planning and detailed counselling.
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Affiliation(s)
- Biju Benjamin
- Department of Trauma and Orthopaedics, Forth Valley Royal Hospital, NHS Forth Valley, Larbert, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedics, University College London Hospital, London, UK Conflicts of interest
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Huang ZY, Liu H, Li M, Ling J, Zhang JH, Zeng ZM. Optimal location of subtrochanteric osteotomy in total hip arthroplasty for crowe type IV developmental dysplasia of hip. BMC Musculoskelet Disord 2020; 21:210. [PMID: 32252730 PMCID: PMC7137204 DOI: 10.1186/s12891-020-03248-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 03/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When reconstructing a hip with developmental dysplasia and high dislocation, sub-trochanteric shortening osteotomy is typically needed for placing the acetabular component in the appropriate anatomical position. However, the procedure can result in complications such as non-union of the osteotomy. We evaluated the contact area and the coincidence rate between the proximal and distal fragments at different femoral osteotomy levels and lengths. We then determined the optimal location of subtrochanteric femoral shortening transverse osteotomy in patients with unilateral Crowe type IV developmental dysplasia of the hip (DDH). The consistency between the proximal and distal segments was assessed as a possible predictive indicator of the union at the osteotomy site. METHODS We retrospectively reviewed 57 patients with unilateral Crowe type IV DDH who underwent X-ray imaging of both hip joints. We labelled the inner and outer diameters of the circular ring as N (mm) and M (mm), respectively. We defined the overlapped area between the proximal and distal ring as contact area S (mm2), and the ratio of contact area to distal ring area as coincidence rate R. RESULTS N varied from 9.8-15.2 mm and M varied from 20.7-24 mm, both demonstrated a decreasing trend in the proximal to distal direction. At osteotomy lengths ranging from 0.5-2 cm, there were no differences in S between the different levels of osteotomy in each group. At osteotomy lengths ≤2.5 cm, a significant higher coincidence rate was noted from 2 cm below the lesser trochanter to other positions below the level. At osteotomy lengths from 3 to 5.5 cm, a significantly higher coincidence rate was observed from the level of 1.5 cm below the lesser trochanter to other positions below the level. CONCLUSIONS Our findings suggest that femoral shortening transverse osteotomy at the optimal subtrochanteric level can predictably increase the contact area and coincidence rate, which may contribute to the union at the osteotomy site. Considering the stability of the prostheses, it appears appropriate that osteotomy location should be shifted slightly distally. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Zhe-Yu Huang
- The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, 1059# ZhongShan East Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Hua Liu
- The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, 1059# ZhongShan East Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Ming Li
- The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, 1059# ZhongShan East Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Jing Ling
- The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, 1059# ZhongShan East Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Jun-Hui Zhang
- The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, 1059# ZhongShan East Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Zhi-Min Zeng
- The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, 1059# ZhongShan East Road, Ningbo, Zhejiang, 315040, People's Republic of China.
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Tahta M, Isik C, Uluyardimci E, Cepni S, Oltulu I. Total hip arthroplasty without subtrochanteric femoral osteotomy is possible in patients with Crowe III/IV developmental dysplasia: total hip arthroplasty without femoral osteotomy. Arch Orthop Trauma Surg 2020; 140:409-413. [PMID: 31813017 DOI: 10.1007/s00402-019-03320-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND We aimed to present our THA technique without femoral shortening osteotomy that we perform for the treatment of coxarthrosis on Crowe type III/IV developmental dysplasia of the hip and to present the early clinical outcomes of our patients. METHODS 77 patients with Crowe type III/IV developmental dysplasia of the hip, who had admitted to our clinic between 2013 and 2017, and had undergone cementless THA without femoral shortening by a single surgeon, were retrospectively evaluated. Patients were called for a final evaluation and assessed by Harris Hip Score. Trendelenburg sign was observed. For radiological evaluation, routine anteroposterior and lateral hip radiography and orthoroentgenogram was used. RESULTS Mean duration of follow-up was 38.2 (22-52) months. Pre-operative mean Harris Hip Score was 53.9 (49-62) and post-operative mean value was 82.7 (76-95). Mean duration of operation was 44.9 (39-57) min. In post-operative final evaluation only three patients (3.8%) had positive Trendelenburg sign. 3 patients (3.8%) had early dislocation. No sciatic palsy was observed in any of the patients. Revision with acetabular cage was performed for one (1.2%) patient due to protrusion development in the acetabular cup. The mean prosthesis survival rate was 98.8%. CONCLUSIONS Total hip arthroplasty without femoral osteotomy can be considered as a successful method in selected patients with Crowe III/IV coxarthrosis. It provides good clinical outcomes in the early period, reduces surgery duration, has acceptable complication rates, has high prosthesis survival rates.
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Affiliation(s)
- Mesut Tahta
- Department of Orthopaedics and Traumatology, Katip Celebi University, Izmir Ataturk Training and Research Hospital, Izmir, Turkey.
| | | | | | - Sahin Cepni
- Department of Orthopaedics and Traumatology, Yildirim Beyazit University, Ataturk Training and Research Hospital, Ankara, Turkey
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Shi XT, Li CF, Han Y, Song Y, Li SX, Liu JG. Total Hip Arthroplasty for Crowe Type IV Hip Dysplasia: Surgical Techniques and Postoperative Complications. Orthop Surg 2019; 11:966-973. [PMID: 31755242 PMCID: PMC6904615 DOI: 10.1111/os.12576] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/11/2019] [Accepted: 10/20/2019] [Indexed: 01/01/2023] Open
Abstract
Total hip arthroplasty (THA) of Crowe type IV developmental dysplasia of the hip (DDH) is challenging. Although traditional (lateral, posterolateral, and posterior) THA approaches have been used with great anatomic success, they damage periarticular muscles, which are already quite weak in type IV DDH. The recently developed direct anterior approach (DAA) can provide an inter‐nerve and inter‐muscle approach for THA of type IV dysplasia hips. However, femur exposure with the DAA could be difficult during surgery and it is hard to apply femoral shortening osteotomy. THA techniques used for type IV DDH include anatomic hip center techniques (true acetabular reconstruction) and high hip center techniques, wherein an acetabulum is reconstructed above the original one. Although anatomic construction of the hip center is considered “the gold standard” treatment, it is impossible if the anatomical acetabular is too small and shallow. Procedures used to support type IV DDH reduction with anatomic hip center techniques include greater trochanter osteotomy, lesser trochanter osteotomy, and subtrochanteric osteotomy. However, these techniques have yet to be standardized, and it is unclear which is best for type IV DDH. One‐state and two‐state non‐osteotomy reduction techniques have also been introduced to treat type IV DDH. Potential complications of THA performed in patients with type IV DDH include leg length discrepancy (LLD), peri‐operative femur fracture, nonunion of the osteotomy site, and nerve injury. It is worth noting that nowadays an increasing number of Crowe type IV DDH patients are more sensitive to postoperative LLD.
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Affiliation(s)
- Xiao-Tong Shi
- Department of Orthopaedics, Jilin University First Hospital, Jilin University First Hospital, Changchun, Jilin Province, China
| | - Chao-Feng Li
- Department of Orthopaedics, Jilin University First Hospital, Jilin University First Hospital, Changchun, Jilin Province, China
| | - Yu Han
- Department of Orthopaedics, Jilin University First Hospital, Jilin University First Hospital, Changchun, Jilin Province, China
| | - Ya Song
- Department of Orthopaedics, Jilin University First Hospital, Jilin University First Hospital, Changchun, Jilin Province, China
| | - Shu-Xuan Li
- Department of Orthopaedics, Jilin University First Hospital, Jilin University First Hospital, Changchun, Jilin Province, China
| | - Jian-Guo Liu
- Department of Orthopaedics, Jilin University First Hospital, Jilin University First Hospital, Changchun, Jilin Province, China
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Wang Y. Current concepts in developmental dysplasia of the hip and Total hip arthroplasty. ARTHROPLASTY 2019; 1:2. [PMID: 35240757 PMCID: PMC8787940 DOI: 10.1186/s42836-019-0004-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/20/2019] [Indexed: 01/06/2023] Open
Abstract
Developmental dysplasia of the hip (DDH) is a spectrum of pathology that involves dysplasia of both the acetabulum and the femur. If left untreated, it can develop to hip pain and osteoarthritis, which eventually require total hip arthroplasty (THA). A broad array of anatomical abnormalities of the acetabulum and femur, plus the younger age of DDH patients make THA a great challenge. Meticulous operation planning with various options is one of the most important prerequisites of a successful THA. This review presents the current concepts of acetabular and femoral reconstruction in THA for DDH, including high hip center, acetabular bone deficiency, highly porous metal, correction of femoral anteversion, femoral shortening osteotomy, stem selection, among others.
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Vreim Holm AG, Terjesen T, Reikerås O. Subtrochanteric shortening and uncemented arthroplasty in hips with high dislocation - a cohort study with 13-30 years follow-up. J Orthop 2019; 16:80-85. [PMID: 30662244 DOI: 10.1016/j.jor.2018.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/02/2018] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION The aim was to evaluate short- and long-term outcomes in patients with high hip dislocation operated with subtrochanteric shortening osteotomy and uncemented total hip arthroplasty. METHODS Sixty-five hips operated in 1986-2001, at mean age 48 years (15-79), were followed for mean 19 years (13-30). RESULTS At last follow up, there were two femoral and 35 acetabular revisions. Harris hip score was mean 86 (81-90) in unrevised, and 87 (82-90) in revised hips. CONCLUSIONS Our study shows favorable long-term results for a fully hydroxyapatite (HA) coated stem. Aseptic cup-loosening may be reduced by using better implants.
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Affiliation(s)
- Anne Guro Vreim Holm
- Oslo University Hospital, Department of Orthopaedics, Oslo, Norway and the University of Oslo, Norway
| | - Terje Terjesen
- Oslo University Hospital, Department of Orthopaedics, Oslo, Norway and the University of Oslo, Norway
| | - Olav Reikerås
- Oslo University Hospital, Department of Orthopaedics, Oslo, Norway and the University of Oslo, Norway
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11
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Puliero B, Blakeney WG, Beaulieu Y, Roy A, Vendittoli PA. Distal femoral shortening osteotomy for treatment of sciatic nerve palsy after total hip arthroplasty - a report of 3 cases. Acta Orthop 2018; 89:696-698. [PMID: 30273084 PMCID: PMC6300719 DOI: 10.1080/17453674.2018.1520679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Benjamin Puliero
- Department of Surgery, CIUSSS-de-L’Est-de-L’Ile-de-Montréal, Hôpital Maisonneuve Rosemont. Montréal, Québec;;
| | - William G Blakeney
- Department of Surgery, CIUSSS-de-L’Est-de-L’Ile-de-Montréal, Hôpital Maisonneuve Rosemont. Montréal, Québec;;
| | - Yann Beaulieu
- Department of Surgery, CIUSSS-de-L’Est-de-L’Ile-de-Montréal, Hôpital Maisonneuve Rosemont. Montréal, Québec;;
| | - Alain Roy
- Department of Surgery, CIUSSS-de-L’Est-de-L’Ile-de-Montréal, Hôpital Maisonneuve Rosemont. Montréal, Québec;;
| | - Pascal-André Vendittoli
- Department of Surgery, CIUSSS-de-L’Est-de-L’Ile-de-Montréal, Hôpital Maisonneuve Rosemont. Montréal, Québec;; ,Department of Surgery, Université de Montréal, Québec, Canada,Correspondence:
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12
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Atilla B. Reconstruction of neglected developmental dysplasia by total hip arthroplasty with subtrochanteric shortening osteotomy. EFORT Open Rev 2017; 1:65-71. [PMID: 28461930 PMCID: PMC5367593 DOI: 10.1302/2058-5241.1.000026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Patients with neglected developmental dysplasia (DDH) face with early osteoarthritis of the hip, limb length inequality and marked disability while total hip reconstruction is the only available choice. DDH has severe morphologic consequences, with distorted bony anatomy and soft tissue contractures around the hip. It is critical to evaluate patients thoroughly before surgery. Anatomic reconstruction at the level of true acetabulum with uncemented implant is the mainstay of treatment. This requires a subtrochanteric shortening osteotomy, which can be realised using different osteotomy and fixation options. Although a demanding technique with a high rate of related complications, once anatomic reconstruction of the hip is achieved, patients have a remarkably good functional capacity and implant survival during long follow-up periods.
Cite this article: Atilla B. Reconstruction of neglected developmental dysplasia by total hip arthroplasty with subtrochanteric shortening osteotomy. EFORT Open Rev 2016;1:65–71. DOI: 10.1302/2058-5241.1.000026.
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Affiliation(s)
- Bülent Atilla
- Hacettepe University Faculty of Medicine, Ankara, Turkey
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Femoral shortening osteotomy in total hip arthroplasty for severe dysplasia: a comparison of two fixation techniques. INTERNATIONAL ORTHOPAEDICS 2016; 40:2271-2276. [PMID: 26935203 DOI: 10.1007/s00264-016-3144-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/16/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to compare two distinct fixation methods for a total hip replacement performed via transverse femoral shortening osteotomy for patients with severe hip dysplasia. METHODS In this retrospective study we compared two fixation methods for total hip replacement of 78 hips in 76 patients exhibiting Crowe type IV developmental hip dysplasia (DDH). The hip replacements were performed via a transverse femoral shortening osteotomy and carried out between September 2009 and December 2013. Group I patients underwent fixation of the shortened femoral segment via a cable attached to the osteotomied segment, and group II patients underwent fixation with a plate and screw. We compared the two techniques based on operating time, osteotomy site union time, Harris hip score, hip loosening signs, and overall clinical outcomes. RESULTS The mean operating time for groups I and II was determined to be 116.5 ± 12.8 min and 137.7 ± 14 min, respectively (p < 0.05), while the average union time was 113 ± 51 days for group I and 152 ± 37 days for group II (p < 0.05). Fixation of the femur with a cable (group I) is therefore faster and results in more rapid union time when compared to plate osteosynthesis at the osteotomy site (group II). We observed only one non-union in group I compared with three in group II (p = 0.49). Harris hip scores at the final patient follow-up were 82.8 ± 7.8 and 80.8 ± 6.7 for groups I and II, respectively (p = 0.23). Thus, notably no significant differences were observed between the groups with regard to clinical outcomes such as the Harris hip score or loosening of the replacement components. CONCLUSION Fixation of the removed femoral segment with a cable provided adequate rotational stability and decreased the operating time, leading to early union at the osteotomy site.
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Cementless total hip arthroplasty in developmental dysplasia of the hip with end stage osteoarthritis: 2-7 years' clinical results. Hip Int 2016; 25:442-6. [PMID: 25907395 DOI: 10.5301/hipint.5000240] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 02/04/2023]
Abstract
Between 2006 and 2011, 102 hips of 78 patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip (DDH) underwent cementless total hip arthroplasty (THA). According to the Crowe's classification, 22 hips (21%) were type 1, 19 hips (18%) were type 2, 22 hips (21%) were type 3 and 39 hips (38%) were type 4 respectively. Functional and clinical analyses were performed by Harris Hip Scores (HHS). There were 73 (71%) excellent or good results according to HHS. The postoperative HHS was significantly lower in patients who underwent femoral shortening (p<0.01). We observed 25 (24.5%) complications in total, 15 (14.7%) of which required revision surgery. The authors concluded that THA for DDH is a safe and a reliable procedure with good clinical outcomes.
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15
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Total hip arthroplasty in the developmental dysplasia of the hip using transverse subtrochanteric osteotomy. J Orthop 2016; 13:259-63. [PMID: 27408499 DOI: 10.1016/j.jor.2016.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 06/08/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We assessed the results of the transverse subtrochanteric femoral shortening osteotomy technique and the cementless THA process applied to Crowe type III and IV patients with developmental dysplasia of the hips. METHODS We retrospectively evaluated 25 patients (32 hips) between 2006 and 2014. RESULTS The mean follow-up time was 5.1 years. The mean preoperative Harris hip score was 49.5, which increased to 87.1 postoperatively. The mean preoperative leg-length discrepancy was 3.6 cm; the mean postoperative discrepancy was 0.5 cm. CONCLUSION THA with subtrochanteric femoral shortening osteotomy technique is an effective technique for treating developmental dysplasia of the hip.
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16
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Tuncay I, Yıldız F, Bilsel K, Uzer G, Elmadağ M, Erden T, Bozdağ E. Biomechanical Comparison of 2 Different Femoral Stems in the Shortening Osteotomy of the High-Riding Hip. J Arthroplasty 2016; 31:1346-1351. [PMID: 26795256 DOI: 10.1016/j.arth.2015.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We hypothesized that a rectangular cross-sectional femoral stem may produce more initial stability of the transverse subtrochanteric femoral shortening osteotomy rather than a circular cross-sectional stem. METHODS Twenty, fourth-generation, synthetic femur models were inserted with either circular or rectangular cross-sectional femoral stems after 3 cm of transverse subtrochanteric shortening. Half of the models were tested with axial bending and the other half with torsional loads. After the femora underwent cyclic loading, they were loaded until failure. Outcome parameters were stiffness values before and after cyclical loading, failure loads/torques, and displacements at the osteotomy sites. RESULTS In axial bending tests, the results were not significantly different between the groups. Under rotational forces, the mean stiffness value before cyclical loading and failure torque of the cylindrical stems was significantly higher than that of rectangular cross-sectional stems (11.8 ± 1.2 vs 7.1 ± 2.8 Nm/degree; P = .009 and 136.9 ± 60.2 vs 27.1 ± 17.5 Nm; P = .027 Nm, respectively). The mean amounts of displacements at the osteotomy sites were not significantly different between the groups in any direction in both axial and rotational tests. CONCLUSIONS According to the results of the study, using straight, cylindrical femoral stems can increase rotational stability of the transverse osteotomy more than the rectangular cross-sectional stems although the latter one has the advantages of rectangular geometrical design.
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Affiliation(s)
- Ibrahim Tuncay
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Fatih Yıldız
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Gökçer Uzer
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Elmadağ
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Tunay Erden
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ergun Bozdağ
- Department of Biomechanics, Faculty of Mechanical Engineering, İstanbul Technical University, İstanbul, Turkey
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Hua WB, Yang SH, Xu WH, Ye SN, Liu XZ, Wang J, Feng Y. Total hip arthroplasty with subtrochanteric femoral shortening osteotomy for high hip dislocation. Orthop Surg 2016; 7:112-8. [PMID: 26033991 DOI: 10.1111/os.12176] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 04/07/2015] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluate the outcomes of total hip arthroplasty (THA) with subtrochanteric femoral shortening osteotomy for high hip dislocation. METHODS In this retrospective study, the results of 24 primary THAs with acetabular reconstruction and subtrochanteric femoral shortening osteotomy in 21 patients with high hip dislocation were evaluated. The acetabula were reconstructed with cemented or uncemented cups and bone grafting. Transverse subtrochanteric femoral shortening osteotomies were applied and the osteotomy sites treated by bone grafting and cable fixation. Assessment was by Hip Harris scores and radiographic evaluation. RESULTS The mean follow-up time was 42 months (18-108 months), three cases being lost to follow-up 18-27 months postoperatively. The HHS improved from 47.5 ± 8.7 to 88.5 ± 3.1. The mean length of femoral segments removed was 2.5 ± 0.8 cm (range, 1.0-4.5 cm) and mean acetabular inclination 43° ± 5° (range, 31°-54°). Caudalization of the femoral head center was 3.2 ± 3.0 mm (range, -3 to 12 mm) and lateralization 4.0 ± 4.0 mm (range, -9 to 11 mm). Mean greater trochanter height relative to theoretical hip center was 5.2 ± 1.0 cm (range, 3.5-7.1 cm) preoperatively and 0.2 ± 0.6 cm (range, -0.9 to 1.2 cm) postoperatively. Intraoperative trochanteric fractures occurred in three cases and sciatic nerve palsy in one. CONCLUSION THA with subtrochanteric femoral shortening osteotomy is an effective technique for treating high hip dislocation. Its advantages include improvement in limb imbalance and decreased risk of sciatic nerve injury.
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Affiliation(s)
- Wen-bin Hua
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shu-hua Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei-hua Xu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shu-nan Ye
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xian-zhe Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Feng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Chu YM, Zhou YX, Han N, Yang DJ. Two Different Total Hip Arthroplasties for Hartofilakidis Type C1 Developmental Dysplasia of Hip in Adults. Chin Med J (Engl) 2016; 129:289-94. [PMID: 26831230 PMCID: PMC4799572 DOI: 10.4103/0366-6999.174507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) is more complex than the normal hip, with large replacement risks and many complications. Although nonosteotomy THA is convenient to perform, femoral osteotomy shortening can avoid blood vessel and nerve traction injuries. This study aimed to compare osteotomy THA with nonosteotomy to determine reasonable options for operative management of DDH. Methods: Data on 48 DDH patients who underwent THA were analyzed retrospectively. The patients were divided into two groups: Group A 29 cases (nonosteotomy), and group B 19 cases (osteotomy). Harris and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, limb length discrepancy (LLD), radiological data on the hip, and claudication were evaluated. Data were analyzed by using paired-sample Student's t-test, independent-sample Student's t-test, and Pearson's Chi-square test; the test level was α =0.05. Results: Postoperative Harris (90.7 ± 5.1) and WOMAC scores (88.0 ± 10.6) were significantly improved compared with preoperative Harris (44.8 ± 5.7) and WOMAC scores (42.0 ± 5.3) in group A (P < 0.05). Postoperative Harris (90.4 ± 2.8) and WOMAC scores (88.2 ± 5.9) were significantly improved compared with preoperative Harris (44.4 ± 4.2) and WOMAC scores (43.2 ± 4.3) in group B (P < 0.05). One case of dislocation occurred in group A; after closed reduction, dislocation did not recur. In group A, 2 patients developed cutaneous branch injury of the femoral nerve, which spontaneously recovered without treatment. Postoperative LLD >2 cm was seen in one case in group A and five cases in group B. Postoperative claudication showed no significant difference between the two groups (P > 0.05). No patients developed infection; postoperative X-rays showed that the location of the prosthesis was satisfactory, and the surrounding bone was not dissolved. Conclusions: THA is effective and safe for DDH. For unilateral high dislocation DDH patients with limb lengthening ≤4 cm and good tissue conditions, THA without femoral osteotomy may be considered.
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Affiliation(s)
| | - Yi-Xin Zhou
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
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19
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Oblique femoral shortening osteotomy in total hip arthroplasty for high dislocation in patients with hip dysplasia. INTERNATIONAL ORTHOPAEDICS 2015; 39:1797-802. [PMID: 26150335 DOI: 10.1007/s00264-015-2865-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/23/2015] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim of this study was to evaluate outcomes after implantation of total hip arthroplasty for developmental dysplasia with high dislocation of the hip using conical stems combined with oblique subtrochanteric shortening osteotomy. METHODS We retrospectively reviewed the functional scores, radiographic results, and complications in a consecutive series of 16 hips (12 patients) with Crowe IV developmental dysplasia of the hip. The average age at surgery was 53.2 years and the patients were operated on between 1999 and 2008. RESULTS The average Harris Hip Score improved from 37.2 to 83.7 at a mean follow-up of 8.7 years. All acetabular cups were inserted into the true acetabulum and all prosthetic components were stable at the last follow-up visit. No neurovascular damage was recorded. Complications arose in six hips (37.5%): intra-operative fracture of proximal femur requiring fixation (n = 2); dislocation (n = 3); and asymptomatic non-union of the osteotomy (n = 1). The osteotomy healed within less than six months in all the remaining cases. CONCLUSIONS With the numbers given the oblique femur shortening osteotomy led to an increased rotational stability and proved to be a simple and effective method. Compared with transverse osteotomy and as related to our experience, this technique may be a method of choice in selected cases.
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20
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Chae MP, Rozen WM, McMenamin PG, Findlay MW, Spychal RT, Hunter-Smith DJ. Emerging Applications of Bedside 3D Printing in Plastic Surgery. Front Surg 2015; 2:25. [PMID: 26137465 PMCID: PMC4468745 DOI: 10.3389/fsurg.2015.00025] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/02/2015] [Indexed: 12/16/2022] Open
Abstract
Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D) reconstructions, are limited by their representation on 2D workstations. 3D printing, also known as rapid prototyping or additive manufacturing, was once the province of industry to fabricate models from a computer-aided design (CAD) in a layer-by-layer manner. The early adopters in clinical practice have embraced the medical imaging-guided 3D-printed biomodels for their ability to provide tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. With increasing accessibility, investigators are able to convert standard imaging data into a CAD file using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography, multijet modeling, selective laser sintering, binder jet technique, and fused deposition modeling. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without outsourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. In this review, existing uses of 3D printing in plastic surgery practice spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative esthetics are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, developing intraoperative guidance tools, teaching patients and surgical trainees, and producing patient-specific prosthetics in everyday surgical practice.
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Affiliation(s)
- Michael P Chae
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia ; Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health , Frankston, VIC , Australia
| | - Warren M Rozen
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia ; Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health , Frankston, VIC , Australia
| | - Paul G McMenamin
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, School of Biomedical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University , Clayton, VIC , Australia
| | - Michael W Findlay
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia ; Department of Surgery, Stanford University , Stanford, CA , USA
| | - Robert T Spychal
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia
| | - David J Hunter-Smith
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia ; Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health , Frankston, VIC , Australia
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21
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Sofu H, Kockara N, Gursu S, Issin A, Oner A, Sahin V. Transverse Subtrochanteric Shortening Osteotomy During Cementless Total Hip Arthroplasty in Crowe Type-III or IV Developmental Dysplasia. J Arthroplasty 2015; 30:1019-23. [PMID: 25707993 DOI: 10.1016/j.arth.2015.01.045] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to review the outcomes of transverse subtrochanteric shortening osteotomy during cementless total hip arthroplasty in Crowe Type-III or IV developmental dysplasia. Seventy-three osteotomies were included in our study. Mean follow-up was 61 months. Harris hip score, leg length discrepancy, neurological status, union status of the osteotomy, and femoral component stability were the criteria for evaluation. All complications were noted. The mean Harris hip score improved from 38.6 points to 83.7 points. The mean leg length discrepancy decreased from 56.5 mm to 10.7 at the latest follow-up. The mean union time was 5.2 months. We observed 4 non-unions. Transverse subtrochanteric shortening osteotomy is an effective and reliable method in restoration of a more normal limb.
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Affiliation(s)
- Hakan Sofu
- Erzincan University Faculty of Medicine, Erzincan, Turkey
| | | | - Sarper Gursu
- Baltalimani Bone and Joint Diseases Hospital, Istanbul, Turkey
| | - Ahmet Issin
- Erzincan University Faculty of Medicine, Erzincan, Turkey
| | - Ali Oner
- Mengucekgazi Education and Research Hospital, Erzincan, Turkey
| | - Vedat Sahin
- Erzincan University Faculty of Medicine, Erzincan, Turkey
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22
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Zhu J, Shen C, Chen X, Cui Y, Peng J, Cai G. Total hip arthroplasty with a non-modular conical stem and transverse subtrochanteric osteotomy in treatment of high dislocated hips. J Arthroplasty 2015; 30:611-4. [PMID: 25499677 DOI: 10.1016/j.arth.2014.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/24/2014] [Accepted: 11/04/2014] [Indexed: 02/01/2023] Open
Abstract
Conventional stems may be unsuitable for hypoplastic femurs associated with severe dysplasia, meanwhile, custom-made or modular stems in total hip arthroplasty are often complex and expensive. This series included 21 Crowe type IV dysplastic hips in which a non-modular cementless conical stem was implanted with transverse subtrochanteric femoral osteotomy. Follow up averaged 40months. Twenty hips survived with mean Harris hip score improved from 52 to 90. One hip failed for stem loosening. The average leg lengthening was 3.8cm with transient sciatic nerve palsy occurring in three hips. Femoral offset averaged 3.3cm postoperatively. The non-modular conical stem not only obviated the complexities, high medical cost and potential risk at the neck-stem interface associated with stem modularity, but also simplified surgical technique.
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Affiliation(s)
- Junfeng Zhu
- Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University Medical School, Shanghai China
| | - Chao Shen
- Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University Medical School, Shanghai China
| | - Xiaodong Chen
- Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University Medical School, Shanghai China
| | - Yiming Cui
- Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University Medical School, Shanghai China
| | - Jianping Peng
- Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University Medical School, Shanghai China
| | - Guiquan Cai
- Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University Medical School, Shanghai China
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23
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Guo CY, Liang BW, Sha M, Kang LQ, Wang JZ, Ding ZQ. Cementless arthroplasty with a distal femoral shortening for the treatment of Crowe type IV developmental hip dysplasia. Indian J Orthop 2015; 49:442-6. [PMID: 26229166 PMCID: PMC4510799 DOI: 10.4103/0019-5413.159652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Severe developmental dysplasia of the hip is a surgical challenge. The purpose of this study is to describe the cementless arthroplasty with a distal femoral shortening osteotomy for Crowe type IV developmental hip dysplasia and to report the results of this technique. MATERIALS AND METHODS 12 patients (2 male and 10 female) of Crowe type IV developmental hip dysplasia operated between January 2005 and December 2010 were included in the study. All had undergone cementless arthroplasty with a distal femoral shortening osteotomy. Acetabular cup was placed at the level of the anatomical position in all the hips. The clinical outcomes were assessed and radiographs were reviewed to evaluate treatment effects. RESULTS The mean followup for the 12 hips was 52 months (range 36-82 months). The mean Harris hip score improved from 41 points (range 28-54) preoperatively to 85 points (range 79-92) at the final followup. The mean length of bone removed was 30 mm (range 25-40 mm). All the osteotomies healed in a mean time of 13 weeks (range 10-16 weeks). There were no neurovascular injuries, pulmonary embolism or no infections. CONCLUSION Our study suggests that cementless arthroplasty with a distal femoral shortening is a safe and effective procedure for severe developmental dysplasia of the hip.
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Affiliation(s)
- Chang-Yong Guo
- Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of the People's Liberation Army, Zhangzhou 363000, China
| | - Bo-Wei Liang
- Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of the People's Liberation Army, Zhangzhou 363000, China
| | - Mo Sha
- Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of the People's Liberation Army, Zhangzhou 363000, China
| | - Liang-Qi Kang
- Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of the People's Liberation Army, Zhangzhou 363000, China
| | - Jiang-Ze Wang
- Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of the People's Liberation Army, Zhangzhou 363000, China
| | - Zhen-Qi Ding
- Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of the People's Liberation Army, Zhangzhou 363000, China,Address for correspondence: Dr. Zhen-Qi Ding, Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou 363000, China. E-mail:
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Total hip arthroplasty with subtrochanteric osteotomy in neglected dysplastic hip. INTERNATIONAL ORTHOPAEDICS 2014; 39:27-33. [PMID: 25305138 DOI: 10.1007/s00264-014-2554-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 09/23/2014] [Indexed: 01/14/2023]
Abstract
PURPOSE Total hip arthroplasty (THA) in the presence of developmental dysplasia of the hip (DDH) presents many challenges to the reconstructive surgeon. The complexity of femoral and acetabular anatomy in these cases makes standard reconstruction technically challenging. Restoring the anatomic centre of hip rotation may require femoral osteotomy. The aim of this study was to determine the rate of union, complications and functional results in a series of patients with Crowe IV dysplastic hips who underwent cementless THA and simultaneous subtrochanteric oblique osteotomy. METHODS A retrospective study was designed in a series of 13 patients (14 hips) with Crowe IV DDH who underwent cementless THA and simultaneous subtrochanteric oblique osteotomy at a mean age of 37 years. Patients were reviewed clinically and radiographically with a minimum follow-up of two years. Complications were noted. Harris Hip Score (HHS) was recorded pre-operatively and at six and 12 months postoperatively. RESULTS Union occurred in 14 of 14 femora (100%). The overall revision rate was 14% (7% femoral, 7% acetabular). No dislocations necessitated further surgery. No patient had intraoperative femoral fracture, sciatic nerve injury, infection or deep venous thrombosis. Mean HHS improved from 42 preoperatively to 79 at 6 months and 86 at 12 months. CONCLUSION Combined subtrochanteric femoral osteotomy and cementless THA is technically demanding and proved to be safe and effective in femoral shortening for treatment of Crowe IV DDH.
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25
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THA following deformities due to congenital dislocation of the hip joint. Hip Int 2014; 24 Suppl 10:S29-32. [PMID: 24970032 DOI: 10.5301/hipint.5000168] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2014] [Indexed: 02/04/2023]
Abstract
Total hip replacement is the treatment of choice for the patient suffering from end-stage hip osteoarthritis. Excellent long-term results have been published. In the presence of deformities due to congenital hip dislocation, total hip replacement is, in most of the cases, a difficult task, since the technique of performing such an operation is demanding and the results could vary. This paper presents our experience and preferred strategies focusing on challenges and surgical techniques associated with reconstructing the dysplastic hip.
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26
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Bicanic G, Barbaric K, Bohacek I, Aljinovic A, Delimar D. Current concept in dysplastic hip arthroplasty: Techniques for acetabular and femoral reconstruction. World J Orthop 2014; 5:412-424. [PMID: 25232518 PMCID: PMC4133448 DOI: 10.5312/wjo.v5.i4.412] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 03/23/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
Adult patients with developmental dysplasia of the hip develop secondary osteoarthritis and eventually end up with total hip arthroplasty (THA) at younger age. Because of altered anatomy of dysplastic hips, THA in these patients represents technically demanding procedure. Distorted anatomy of the acetabulum and proximal femur together with conjoined leg length discrepancy present major challenges during performing THA in patients with developmental dysplasia of the hip. In addition, most patients are at younger age, therefore, soft tissue balance is of great importance (especially the need to preserve the continuity of abductors) to maximise postoperative functional result. In this paper we present a variety of surgical techniques available for THA in dysplastic hips, their advantages and disadvantages. For acetabular reconstruction following techniques are described: Standard metal augments (prefabricated), Custom made acetabular augments (3D printing), Roof reconstruction with vascularized fibula, Roof reconstruction with pedicled iliac graft, Roof reconstruction with autologous bone graft, Roof reconstruction with homologous bone graft, Roof reconstruction with auto/homologous spongious bone, Reinforcement ring with the hook in combination with autologous graft augmentation, Cranial positioning of the acetabulum, Medial protrusion technique (cotyloplasty) with chisel, Medial protrusion technique (cotyloplasty) with reaming, Cotyloplasty without spongioplasty. For femoral reconstruction following techniques were described: Distraction with external fixator, Femoral shortening through a modified lateral approach, Transtrochanteric osteotomies, Paavilainen osteotomy, Lesser trochanter osteotomy, Double-chevron osteotomy, Subtrochanteric osteotomies, Diaphyseal osteotomies, Distal femoral osteotomies. At the end we present author’s treatment method of choice: for acetabulum we perform cotyloplasty leaving only paper-thin medial wall, which we break during acetabular cup impacting. For femoral side first we peel of all rotators and posterior part of gluteus medius and vastus lateralis from greater trochanter on the very thin flake of bone. This method allows us to adequately shorten proximal femoral stump, with possibility of additional resection of proximal femur. Furthermore, several advantages and disadvantages of this procedure are also discussed.
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Muratli KS, Karatosun V, Uzun B, Celik S. Subtrochanteric shortening in total hip arthroplasty: biomechanical comparison of four techniques. J Arthroplasty 2014; 29:836-42. [PMID: 24095585 DOI: 10.1016/j.arth.2013.09.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/31/2013] [Accepted: 09/02/2013] [Indexed: 02/01/2023] Open
Abstract
Safe reduction of the femoral head into the true acetabulum requires a certain amount of femoral shortening in patients with high dislocation of the hip. In subtrochanteric shortening applications, to reduce complications it is necessary to maintain a stable fixation at the osteotomy line. The purpose of this study is to investigate frequently used methods from a biomechanical point of view. Four osteotomy groups were created with composite femurs to investigate subtrochanteric osteotomies; transverse, oblique, z-subtrochanteric and double Chevron. All loading tests were carried out with two implant types both with and without strut graft and cable fixation. No single inherent feature increasing the stability of the investigated osteotomy types was found. Additionally graft application did not have a significant contribution to stability.
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Affiliation(s)
- Kivanc S Muratli
- Department of Orthopaedics and Traumatology Baskent University School of Medicine, Zubeyde Hanim Research and Medical Center, Izmir, Turkey
| | - Vasfi Karatosun
- Department of Orthopaedics and Traumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Bora Uzun
- Department of Biomechanics, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Salih Celik
- Department of Biomechanics, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Hartofilakidis G, Babis GC, Lampropoulou-Adamidou K, Vlamis J. Results of total hip arthroplasty differ in subtypes of high dislocation. Clin Orthop Relat Res 2013; 471:2972-9. [PMID: 23572352 PMCID: PMC3734426 DOI: 10.1007/s11999-013-2983-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 04/03/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND In a previous study, we described two subtypes of high dislocation of the hip depending on the presence (C1) or absence (C2) of a false acetabulum, yet we have already presented the concise followup of total hip arthroplasty (THA) in these patients as a group at a minimum of 15 years. QUESTIONS/PURPOSES In this retrospective study, we investigated differences in the results of THA in the C1 and C2 subtypes of high dislocation such as (1) survivorship of the reconstructions; (2) Merle d'Aubigné-Postel clinical scores; (3) leg lengthening and femoral shortening; and (4) site of reattachment and union rate of the greater trochanter. METHODS We included 49 hips of the C1 subtype and 30 hips of the C2 subtype operated on from 1976 to 1994. We evaluated survivorship (using reoperation for any reason as the end point) and performed chart and radiographic reviews. RESULTS The 15-year survival was 84% (± 10% [95% CI]) for the C1 subtype and 60% (± 17% [95% CI]) for the C2 subtype (p = 0.001). Cox regression analysis, after adjustment for confounding factors, showed also statistically significantly worse survivorship in the C2 subtype (p = 0.021) and, after adjustment for possible predictive factors, found a statistically significant relationship of high dislocation subtype (p = 0.018) and trochanteric union (p = 0.005) with survival of THAs. Pain, function, and mobility scores improved from preoperative to last followup in C1 and C2 groups but they did not differ between C1 and C2 hips. C2 hips were lengthened more (p < 0.001) despite greater amounts of femoral shortening (p = 0.006). Site of reattachment and the risk of greater trochanter nonunion were not different between the groups. CONCLUSIONS We found important differences in fundamental parameters after THA in the high-dislocation subtypes, including the risk of revision, which was higher in patients whose hips did not have a false acetabulum. These findings indicate that while reporting THA results in patients with high dislocation, mixing results of the two subtypes may lead to statistical bias.
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Affiliation(s)
- George Hartofilakidis
- />Orthopaedic Department, National and Kapodistrian University of Athens, KAT Hospital, 21 Fotiou Patriarchou Street, 11471 Athens, Greece
| | - George C. Babis
- />First Orthopaedic Department, University of Athens Medical School, Athens, Greece
| | | | - John Vlamis
- />Third Orthopaedic Department, University of Athens, KAT Hospital, Athens, Greece
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Versatile application of short stem during total hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 23 Suppl 2:S229-32. [PMID: 23412253 DOI: 10.1007/s00590-012-1128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 11/01/2012] [Indexed: 10/27/2022]
Abstract
Total hip arthroplasty (THA) is one of the most commonly performed orthopedic surgery worldwide. Current research and development had improved the designs of modern total hip prosthesis. Although long femoral stems are widely used, short stems are thought to preserve more native host bone and optimize proximal load transfer utilized with the advent of less invasive surgery. Modular short femoral stems in THA may have versatile applicability by virtue of their unique geometry, mechanism of fixation, and modularity. In this report, we present two unique case scenarios where the use of short stems has given successful results.
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Lesser trochanteric osteotomy in total hip arthroplasty for treating CROWE type IV developmental dysplasia of hip. INTERNATIONAL ORTHOPAEDICS 2013; 37:385-90. [PMID: 23291907 DOI: 10.1007/s00264-012-1758-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 12/13/2012] [Indexed: 12/17/2022]
Abstract
PURPOSE The study was designed to evaluate the efficacy and safety of lesser trochanteric osteotomy for femoral shortening in total hip arthroplasty in treatment of 28 cases of CROWE IV developmental dysplasia of the hip (DDH). METHODS Patients underwent progressive femoral shortening at the level of lesser trochanteric to make reduction possible into the anatomical acetabulum in all hips. The results were collected and evaluated clinically and radiographically. RESULTS The mean follow-up period was 55.3 months. The average postoperative leg length discrepancy was eight millimetres for unilateral THA patients. A modified Merle d'Aubigné scale was improved from 9.3 preoperatively to 15.9 postoperatively. Sciatic nerve palsy was confirmed in two hips which resolved completely in six months. The Trendelenburg sign was positive in two hips at the final follow-up. No revision surgery was required by the final follow-up. CONCLUSION Lesser trochanteric osteotomy proved to be safe and effective in femoral shortening for treatment of CROWE IV DDH without the problem of nonunion at the site of osteotomy.
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Kiliçoğlu Oİ, Türker M, Akgül T, Yazicioğlu O. Cementless total hip arthroplasty with modified oblique femoral shortening osteotomy in Crowe type IV congenital hip dislocation. J Arthroplasty 2013; 28:117-25. [PMID: 22868069 DOI: 10.1016/j.arth.2012.06.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 11/16/2011] [Accepted: 06/15/2012] [Indexed: 02/01/2023] Open
Abstract
Midterm results of cementless total hip arthroplasty in patients with Crowe type IV congenital dislocation of the hip were evaluated. A modified oblique subtrochanteric shortening osteotomy was used in all patients. A cylindrical femoral stem was used in all patients to stabilize the osteotomy. Mean follow-up was 82 months in 20 hips of 16 patients. Mean Merle D'Aubigné pain score increased from 2.52 to 5.65 points, function score improved from 4.0 to 5.3 points, and mobility score improved from 3.95 to 5.35. Mean greater trochanter height relative to the estimated hip center was 6.8 ± 2.0 cm preoperatively and -1 ± 0.2 cm postoperatively. Complications were dislocations in 3 patients, which were successfully managed without redislocation and fracture of greater trochanter in 3 patients, which healed uneventfully in 2 but with residual Trendelenburg gait in one. Total hip arthroplasty with modified oblique subtrochanteric shortening osteotomy is an effective technique for the treatment for Crowe type IV hip dislocation.
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Affiliation(s)
- Onder İ Kiliçoğlu
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul,Turkey
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Hartofilakidis G, Babis GC, Georgiades G, Kourlaba G. Trochanteric osteotomy in total hip replacement for congenital hip disease. ACTA ACUST UNITED AC 2011; 93:601-7. [PMID: 21511924 DOI: 10.1302/0301-620x.93b5.24780] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We studied the effect of trochanteric osteotomy in 192 total hip replacements in 140 patients with congenital hip disease. There was bony union in 158 hips (82%), fibrous union in 29 (15%) and nonunion in five (3%). The rate of union had a statistically significant relationship with the position of reattachment of the trochanter, which depended greatly on the pre-operative diagnosis. The pre-operative Trendelenburg gait substantially improved in all three disease types (dysplasia, low and high dislocation) and all four categories of reattachment position. A persistent Trendelenburg gait post-operatively was noticed mostly in patients with defective union (fibrous or nonunion). Acetabular and femoral loosening had a statistically significant relationship with defective union and the position of reattachment of the trochanter. These results suggest that the complications of trochanteric osteotomy in total hip replacement for patients with congenital hip disease are less important than the benefits of this surgical approach.
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Affiliation(s)
- G Hartofilakidis
- University of Athens Medical School, 21 Fotiou Patriarchou Street, Athens 11471, Greece.
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Clinical outcome of Zweymüller total hip arthroplasty for patients with high congenital hip dislocation. Hip Int 2011; 21:71-5. [PMID: 21279967 DOI: 10.5301/hip.2011.6279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2010] [Indexed: 02/04/2023]
Abstract
Treatment of high congenital dislocation of the hip (CDH) remains controversial. We report the outcome of hip arthroplasty using a cementless threaded cup and a cementless straight stem in patients with high congenital hip dislocation. Between January 2001 and August 2004, 17 patients with high congenital hip dislocation were treated. During surgery, at least 25% of the cup was anchored in bone. By monitoring somatosensory-evoked potentials (SEPs) of the common peroneal nerve we were able to reduce the femoral head into position in the true acetabulum by releasing soft tissues. A bulk autogenous femoral head bone graft was implanted in 5 patients to achieve at least 75% bony coverage of the acertabular component. Follow-up ranged from 48 months to 91 months with an average of 69.7 months. The mean Harris hip score increased from 43 points preoperatively to 89 points at the time of final follow-up (P<0.001). Radiographic analysis showed bony union of the bone graft in all cases.
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Howie CR, Ohly NE, Miller B. Cemented total hip arthroplasty with subtrochanteric osteotomy in dysplastic hips. Clin Orthop Relat Res 2010; 468:3240-7. [PMID: 20461484 PMCID: PMC2974863 DOI: 10.1007/s11999-010-1367-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) in the presence of developmental dysplasia of the hip (DDH) can be technically challenging. Restoring the anatomic center of hip rotation may require femoral osteotomy. Techniques using cementless components are widely reported but less is known about using cemented components that may be more appropriate with osteopenic bone. QUESTIONS/PURPOSES We therefore determined the rate of union, complications, and early functional score in a series of patients with DDH who underwent cemented THA and simultaneous subtrochanteric osteotomy. METHODS We retrospectively reviewed 28 patients (35 hips) who underwent a cemented THA for DDH at a mean age of 47.3 years. Two patients (two hips) died within 12 months of surgery of unrelated conditions. The clinical notes and radiographs were reviewed with a minimum followup of 2 years (mean, 5.6 years; range, 2-14 years). Complications were noted. SF-12 and Oxford hip scores (OHS) were recorded for 18 patients preoperatively and after 6 and 12 months. RESULTS Union occurred in 32 of 33 femora (97%); one patient had an infected nonunion. The overall revision rate was 20% (9% femoral revision rate). There were three dislocations, two of which had further surgery. Two patients had a transient neuropraxia. The mean SF-12 physical component score increased from 32 to 52 and mean SF-12 mental component score increased from 48 to 51. The mean OHS decreased from 40 to 27. CONCLUSION Combined subtrochanteric osteotomy and cemented THA is technically demanding with a higher complication rate than routine THA. The rate of union, complications, implant survival, and early OHS were comparable to those for similar techniques using cementless components.
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Affiliation(s)
- Colin R. Howie
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK
| | - Nicholas E. Ohly
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK
| | - Ben Miller
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK
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Karachalios T, Hartofilakidis G. Congenital hip disease in adults: terminology, classification, pre-operative planning and management. ACTA ACUST UNITED AC 2010; 92:914-21. [PMID: 20595107 DOI: 10.1302/0301-620x.92b7.24114] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This paper reviews the current knowledge relating to the management of adult patients with congenital hip disease. Orthopaedic surgeons who treat these patients with a total hip replacement should be familiar with the arguments concerning its terminology, be able to recognise the different anatomical abnormalities and to undertake thorough pre-operative planning in order to replace the hip using an appropriate surgical technique and the correct implants and be able to anticipate the clinical outcome and the complications.
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Affiliation(s)
- T Karachalios
- Orthopaedic Department Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa 41110, Greece.
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Femoral shortening in total hip arthroplasty for high developmental dysplasia of the hip. Clin Orthop Relat Res 2010; 468:1949-55. [PMID: 20077043 PMCID: PMC2881990 DOI: 10.1007/s11999-009-1218-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 12/21/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND When reconstructing a hip with developmental dysplasia with a high dislocation, placing the acetabular component in the anatomic position can result in a prosthetic hip that is difficult to reduce. Subtrochanteric femoral osteotomy and shortening makes reduction easier but can be associated with complications (eg, limp, sciatic nerve injury, nonunion of the osteotomy) or compromise long-term stem survival. QUESTIONS/PURPOSES We therefore evaluated (1) the short-term complication rate, (2) functional scores, and (3) survivorship of prostheses in patients with high developmental dysplasia of the hip reconstructed with femoral shortening. PATIENTS AND METHODS We prospectively followed 46 patients (65 hips) operated on from 1990 to 2000. There were 34 females and 12 males with a mean age of 48 years (range, 16-79 years). Before surgery, all patients had a positive Trendelenburg test. The minimum followup was 8 years (mean, 13 years; range, 8-18 years). RESULTS One patient experienced recurrent dislocation and two peroneal nerve palsies, one of which partially recovered and one of which was permanent. In one patient, the stem subsided and after 8 months was replaced by a larger stem that stabilized. One patient had a nonunion but was functioning well and did not have additional surgery. At followup, 12 of the 65 hips (18%) had a positive Trendelenburg test. The mean muscle strength of the abductors was 4 (range, 3-5). The mean Harris hip score was 87 (range, 59-100) and the mean visual analog scale pain score 81 (range, 35-100). At followup, all stems were well fixed with no obvious signs of radiographic loosening. Ten cups were revised because of aseptic loosening. CONCLUSIONS Our data suggest femoral osteotomy and shortening at the subtrochanteric level predictably allows a stable reduction in patients with high developmental dysplasia of the hip and does not lead to any reduction in long-term survival. LEVEL OF EVIDENCE Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Macheras GA, Kateros K, Koutsostathis SD, Tsakotos G, Galanakos S, Papadakis SA. The Trabecular Metal Monoblock acetabular component in patients with high congenital hip dislocation: a prospective study. ACTA ACUST UNITED AC 2010; 92:624-8. [PMID: 20435996 DOI: 10.1302/0301-620x.92b5.23256] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Between November 1997 and December 2000 we performed 27 total hip replacements in 22 patients with high congenital dislocation of the hip using porous tantalum monoblock acetabular components implanted in the true acetabular bed. Clinical and radiological evaluation was performed at regular intervals for a mean of 10.2 years (8.5 to 12). The mean Harris Hip Score improved from 48.3 (15 to 65) pre-operatively to 89.5 (56 to 100) at the final follow-up. The mean Oxford Hip Score was 49.5 (35 to 59) pre-operatively and decreased to 21.2 (12 to 48) at one year and 15.2 (10 to 28) at final follow-up. Migration of the acetabular component was assessed with the EBRA software system. There was a mean migration of 0.68 mm (0.49 to 0.8) in the first year and a mean 0.89 mm (0.6 to 0.98) in the second year, after excluding one initial excessive migration. No revision was necessary for any reason, no acetabular component became loose, and no radiolucent lines were observed at the final follow-up. The porous tantalum monoblock acetabular component is an implant offering adequate initial stability in conjunction with a modulus of elasticity and porosity close to that of cancellous bone. It favours bone ingrowth, leading to good mid-term results.
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Affiliation(s)
- G A Macheras
- Department of Orthopaedics, KAT General Hospital, Athens, Greece.
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