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Nishii T. CORR Insights®: Subtrochanteric Shortening Osteotomy Provides Superior Function to Trochanter Slide Osteotomy in THA for Patients With Unilateral Crowe Type IV Dysplasia at a Minimum of 3 Years. Clin Orthop Relat Res 2024; 482:1048-1050. [PMID: 38289712 PMCID: PMC11124589 DOI: 10.1097/corr.0000000000002999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Takashi Nishii
- Department of Orthopaedic Surgery, Osaka General Medical Center, Osaka, Japan
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2
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Meermans G, Fawley D, Zagra L, Ten Broeke RHM, Johnson K, Bernard T, Thomason HC. Accuracy of cup placement compared with preoperative surgeon targets in primary total hip arthroplasty using standard instrumentation and techniques: a global, multicenter study. J Orthop Traumatol 2024; 25:25. [PMID: 38727945 PMCID: PMC11087417 DOI: 10.1186/s10195-024-00766-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Acetabular cup positioning in total hip arthroplasty (THA) is closely related to outcomes. The literature has suggested cup parameters defined by the Lewinnek safe zone; however, the validity of such measures is in question. Several studies have raised concerns about the benefits of using the Lewinnek safe zone as a predictor of success. In this study we elected to use prospective surgeon targets as the basis for comparison to see how successful surgeons are positioning their cup using standard instruments and techniques. METHODS A prospective, global, multicenter study was conducted. Cup positioning success was defined as a composite endpoint. Both cup inclination and version needed to be within 10° of the surgeon target to be considered a success. Radiographic analysis was conducted by a third-party reviewer. RESULTS In 170 subjects, inclination, target versus actual, was 44.8° [standard deviation (SD 0.9°)] and 43.1° (SD 7.6°), respectively (p = 0.0029). Inclination was considered successful in 84.1% of cases. Mean version, target versus actual, was 19.4° (SD 3.9°) and 27.2° (SD 5.6°), respectively (p < 0.0001). Version was considered successful in 63.4% of cases, and combined position (inclination and version) was considered successful in 53.1%. CONCLUSION This study shows that with traditional methods of placing the cup intraoperatively, surgeons are only accurate 53.1% of the time compared with a predicted preoperative plan. This study suggests that the inconsistency in cup positioning based on the surgeon's planned target is potentially another important variable to consider while using a mechanical guide or in freehand techniques for cup placement in THA. TRIAL REGISTRATION This study is registered on ClinicalTrials.gov, NCT03189303.
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Affiliation(s)
- Geert Meermans
- Department of Orthopaedics, Bravis Hospital, Bergen op Zoom, Roosendaal, The Netherlands.
| | - David Fawley
- DePuy Synthes, 700 Orthopaedic Drive, Warsaw, IN, USA
| | - Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - René H M Ten Broeke
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, 6202 AZ, Maastricht, The Netherlands
| | - Kory Johnson
- Orthopaedic Associates of Michigan, 555 Mid Towne St Suite 105, Grand Rapids, MI, USA
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3
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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.
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4
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Gao Y, Chai W, An Z, Chen X, Dong Z, Zhang Z, Jin Z. Effect of Hip Joint Center on Multi-body Dynamics and Contact Mechanics of Hip Arthroplasty for Crowe IV Dysplasia. Orthop Surg 2022; 14:3061-3069. [PMID: 36177845 DOI: 10.1111/os.13272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate the hip joint forces, Von Mises stress, contact pressure and micro-motion of hip prosthesis for developmental dysplasia of the hip (DDH) patients under different hip joint centers using musculoskeletal (MSK) multi-body dynamics and finite element analysis. METHODS Both MSK multi-body dynamics model and finite element (FE) model were based on CT data of a young female DDH patient with total hip replacement and were developed to study the biomechanics of the S-ROM hip prosthesis. The same offset of hip joint center along all six orientations compared with the standard position was set to predict its effects on both MSK multi-body dynamics and contact mechanics during one gait cycle. RESULTS The hip joint forces in the entire walking gait cycle showed two peak values and clear differences between them under different hip joint centers. The hip joint force increased when the hip joint center moved posteriorly (2101 N) and laterally (1969 N) to the anatomical center (1848 N) at the first peak by 13.7% and 6.6%, respectively. The hip joint force increased sharply when the hip center deviated laterally (2115 N) and anteriorly (2407 N), respectively, from the standard position (1742 N) at the second peak. For the sleeve of the S-ROM prosthesis, the maximum Von Mises stress and contact pressure of the sleeve increased if the hip joint center deviated from the anatomical center posteriorly at the first peak. However, the Von Mises stresses and contact pressure increased at anterior and lateral orientations, compared to that of the standard position at the second peak. Small changes were observed for the maximum relative sliding distance along most of the orientations at both peaks except in the lateral and medial orientations, in which an increase of 8.6% and a decrease of 13.6% were observed, respectively. CONCLUSION The hip joint center obviously influenced the hip joint forces, stress, contact pressure and micro-motion of the hip implant for this female patient.
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Affiliation(s)
- Yongchang Gao
- National Engineering Laboratory for Highway Maintenance Equipment, Chang'an University, Xi'an, Shaanxi, China
| | - Wei Chai
- Department of Orthopaedics, The Chinese PLA General Hospital, Beijing, China
| | - Zhicheng An
- National Engineering Laboratory for Highway Maintenance Equipment, Chang'an University, Xi'an, Shaanxi, China
| | - Xihui Chen
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhe Dong
- National Engineering Laboratory for Highway Maintenance Equipment, Chang'an University, Xi'an, Shaanxi, China
| | - Zhifeng Zhang
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhongmin Jin
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Meta-analysis of the Efficacy of the Anatomical Center and High Hip Center Techniques in the Treatment of Adult Developmental Dysplasia of the Hip. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7256664. [PMID: 36082152 PMCID: PMC9448599 DOI: 10.1155/2022/7256664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022]
Abstract
Background. In total hip arthroplasty for the treatment of adult developmental dysplasia of the hip, there is considerable controversy regarding the placement of the acetabular cup, anatomic center, and upward in acetabular reconstruction. This article explores the efficacy of the anatomical center technique and high hip center technique in the treatment of adult developmental dysplasia of the hip. Method. By searching for articles in the Cochrane Library, PubMed, CNKI, and Wanfang databases, we collected the literature on the treatment of adult developmental dysplasia of the hip by anatomical center and high hip center technology and screened the literature according to the inclusion and exclusion criteria. The Cochrane risk of bias assessment tool was used to assess the risk of bias of randomized controlled trials, the quality of the literature in retrospective cohort studies was assessed using the Newcastle–Ottawa scale, and the RevMan 5.4 software was used to analyze the extracted outcome indicators. Results. Nine studies were finally included, including one prospective cohort study, eight retrospective cohort studies, two high-quality studies, and six moderate-quality studies. The meta-analysis results showed that the reconstruction of the acetabulum in two positions was significantly different in terms of operation time (
, 95% CI: -45.25-28.74,
), intraoperative blood loss (
, 95% CI: -108.57-75.19,
), postoperative drainage volume (
, 95% CI: -140.56-301.66,
), time to ground (
, 95% CI: -1.37-0.0,
), Harris score (
, 95% CI: -0.91-0.82,
), lower limb length difference (
, 95% CI: -0.22-0.64,
), WOMAC score (
, 95% CI: -4.89-2.41,
), postoperative complications (
, 95% CI: -0.06-0.02,
), Trendelenburg sign (
, 95% CI: -0.02-0.05,
), limb lengthening (
, 95% CI: 0.61-1.09,
), prosthesis wear (
, 95% CI: 0-0.02,
), and prosthesis loosening (
, 95% CI: -0.02-0.04,
). Conclusions. The high hip center technique can reduce operative time, intraoperative blood loss, and downtime. The anatomical center technique is superior to the high hip center technique in terms of limb lengthening. Compared with acetabular anatomical reconstruction, there was no significant difference in postoperative drainage, lower limb length difference, postoperative complications, Trendelenburg sign, and prosthesis survival or wear. For DDH patients who are not severely shortened in the lower limbs and have severe acetabular bone defects, joint surgeons can choose to reconstruct the acetabulum in the upper part to simplify the operation, reduce the trauma of the patient, and accelerate the recovery of the patient, and they can choose to adjust the length of the neck and the angle of the neck shaft to maintain the moment arm of the abductor muscle. A ceramic interface or a highly cross-linked polyethylene interface minimizes the effect of hip response forces. To further evaluate the efficacy of the anatomical center technique and the high hip center technique in the treatment of adult developmental dysplasia of the hip, more large-sample, high-quality, long-term follow-up randomized controlled trials are still needed for verification.
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Negayama T, Iwata K, Shimamura M, Senda T, Mashiba T, Kaji Y, Yamamoto T. Total hip arthroplasty after rotational acetabular osteotomy for developmental dysplasia of the hip: a retrospective observational study. BMC Musculoskelet Disord 2022; 23:646. [PMID: 35794611 PMCID: PMC9258082 DOI: 10.1186/s12891-022-05597-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Total hip arthroplasty after osteotomy is more technically challenging than primary total hip arthroplasty, especially concerning cup placement. This is attributed to bone morphological abnormalities caused by acetabular bone loss and osteophyte formation. This study aimed to investigate the clinical and radiological outcomes of total hip arthroplasty after rotational acetabular osteotomy compared with those of primary total hip arthroplasty, focusing mainly on acetabular deformity and cup position. Methods The study included 22 hips that had undergone rotational acetabular osteotomy and 22 hips in an age- and sex-matched control group of patients who underwent total hip arthroplasties between 2005 and 2020. We analyzed cup abduction and anteversion; lateral, anterior, and posterior cup center–edge angle; hip joint center position; femoral anteversion angle; and presence of acetabular defect using postoperative radiography and computed tomography. Operative results and clinical evaluations were also analyzed. Results The clinical evaluation showed that the postoperative flexion range of motion was lower in total hip arthroplasty after rotational acetabular osteotomy than in primary total hip arthroplasty, although no significant difference was noted in the postoperative total Japanese Orthopedic Association hip score. The operative time was significantly longer in the rotational acetabular osteotomy group than in the control group, but there was no significant difference in blood loss. The lateral cup center–edge angle was significantly higher and the posterior cup center–edge angle was significantly lower in the total hip arthroplasty after rotational acetabular osteotomy, suggesting a posterior bone defect existed in the acetabulum. In total hip arthroplasty after rotational acetabular osteotomy, the hip joint center was located significantly superior and lateral to the primary total hip arthroplasty. Conclusions In total hip arthroplasty after rotational acetabular osteotomy, the cup tended to be placed in the superior and lateral positions, where there was more bone volume. The deformity of the acetabulum and the high hip center should be considered for treatment success because they may cause cup instability, limited range of motion, and impingement.
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Association between Hip Center Position and Isokinetic Hip Muscle Performance after Anterolateral Muscle-Sparing Total Hip Arthroplasty. Medicina (B Aires) 2022; 58:medicina58040538. [PMID: 35454377 PMCID: PMC9029787 DOI: 10.3390/medicina58040538] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/04/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background and objectives: The superior placement of the acetabular cup induced the delayed recovery of abductor muscle moment after total hip arthroplasty (THA) with a conventional posterior approach. The anterior-based muscle-sparing (ABMS) THA effectively reduces soft tissue damage, including muscles. The influence of hip center position on anterior-based muscle-sparing (ABMS) total hip arthroplasty (THA) for post-operative hip muscle strength was unclear. We evaluate whether the hip center position affects the recovery of hip muscle strength after ABMS THA. Materials and Methods: The study was performed as a retrospective cohort study, and included 38 hips in 38 patients that underwent primary ABMS THA. Muscle strength was measured using isokinetic dynamometry before the operation, and at 6 and 12 months after surgery. The horizontal and vertical centers of rotation (H-COR and V-COR), vertical shift (V-shift), leg length, and global femoral offset were determined radiographically in reference to a previous report. Results: A weak negative correlation was observed between abduction muscle strength at 6 months and V-shift; a V-shift more than 15 mm demonstrated significantly decreased abductor muscle strength at 6 months. Conclusions: The superior placement of the hip center caused delayed recovery of abductor muscle strength in hips with anterolateral minimally invasive THA. There seems to exist no biomechanical reason why the same should not also be the case for the muscle-sparing approach.
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Makida K, Seki T, Osawa Y, Takegami Y, Higuchi Y, Kusano T, Ishiguro N. Effects of additional neck cut of the femur on the range of motion in total hip arthroplasty for hip dislocation: a computer simulation study. Hip Int 2022; 32:39-44. [PMID: 32594771 DOI: 10.1177/1120700020938657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Subtrochanteric shortening osteotomy (SSO) is commonly performed in total hip arthroplasty (THA) for high hip dislocation. However, this procedure is technically difficult and includes complications. Additional neck cut (ANC) of the femur is a procedure that involves femoral shortening by possibly eliminating the need for SSO in THA for high hip dislocation. Herein, we evaluated the effect and the depth limit of ANC of the femur on the range of motion (ROM) in THA for high hip dislocation. METHODS ROM was measured in 26 patients with high hip dislocation using computer software. The stem was deeply positioned at 5-mm intervals from 0 mm to 30 mm (7 groups). The ROM before impingement was measured during flexion, internal rotation (IR) at 90° flexion, external rotation (ER) and abduction. Receiver operator coefficient (ROC) curves for abduction were generated. The cut-off value of ANC where the required ROM was achieved was also determined. RESULTS Deeper ANCs increased the ROM values during flexion and IR, but they decreased the ROM values during ER and abduction. The ROM values during ER were also limited in 0-mm ANCs. According to the result of the ROC curve for abduction, 15 mm was considered as the permissible range of ANC. CONCLUSIONS In THA for high hip dislocation additional neck cut should be taken into consideration for hips requiring less than 15-mm shortening. For more extended corrections a subtrochanteric shortening osteotomy should be performed.
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Affiliation(s)
- Kazuya Makida
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Osawa
- 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
| | - Yoshitoshi Higuchi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taiki Kusano
- 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
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Singh G, Khurana A, Gupta S. Evaluation of Direct Anterior Approach for Revision Total Hip Arthroplasty: A Systematic Review. Hip Pelvis 2021; 33:109-119. [PMID: 34552888 PMCID: PMC8440135 DOI: 10.5371/hp.2021.33.3.109] [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: 01/17/2021] [Revised: 03/21/2021] [Accepted: 04/03/2021] [Indexed: 12/03/2022] Open
Abstract
The direct anterior approach (DAA) is an established approach for total hip arthroplasty (THA) but has been sparingly tried for revisions. The purpose of this study was to examine the available literature in order to consolidate information available on revision THA using the DAA. A PubMed, Embase, and Scopus search was performed using relevant keywords. Studies reporting on patients undergoing revision THA using DAA were included for analysis. In a review of the literature, nine studies matched the pre-decided inclusion criteria with 319 hip joints undergoing revision THA. Mean follow-up of all included studies was 34 months. The indications of revision after primary THA in decreasing order were aseptic loosening (53%), prosthetic joint infection (20.7%), peri-prosthetic fracture (16.9%), dislocation (7.2%), psoas impingement (1.9%), polyethylene wear (1.2%), pain (0.6%), and instability (0.3%). Of the 319 revisions evaluated, 107 underwent a stem revision, 142 underwent cup revision, 49 underwent a combined revision, and 21 underwent isolated liner/head change. A statistically significant improvement in functional score (P<0.05) was observed for all studies reporting on functional outcomes. A low complication rate (51/319, 16.0%), which includes dislocation (12), infection (12), loosening of the acetabular shell (5), peri-prosthetic fractures (6), haematoma (4), and transient nerve palsy (6), was reported. Based on available level III-IV evidence, DAA appears to be a reliable alternative for revision of the failed hip arthroplasty with acceptable complication rates. Evidence of a higher quality is needed to further characterize its role in revision scenarios.
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Affiliation(s)
- Gurvinder Singh
- Department of Orthopaedics, Dr. Baba Saheb Ambedkar Medical College and Hospital (BSAMCH), Rohini, Delhi, India
| | - Ankit Khurana
- Department of Orthopaedics, ESI Hospital, Rohini, Delhi, India
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Tran DH, Hoshino H, Togawa D, Matsuyama Y. Characteristics of radiographic morphometries of the lower leg in subjects with progression of knee osteoarthritis in the TOEI cohort. Aging Clin Exp Res 2020; 32:67-76. [PMID: 30840205 DOI: 10.1007/s40520-019-01164-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Knee osteoarthritis is one of the most common orthopedic diseases. However, few studies have reported the morphometric characteristics of the lower leg related to the progression of knee osteoarthritis in regional populations. This study aimed to determine the radiographic morphometries of the lower leg in subjects who showed progression of osteoarthritis of the knee in the TOEI cohort. METHODS Data were collected from the TOEI study cohort, during the period from 2014 to 2016, to assess osteoarthritis of the knee and radiographic morphometries of the lower leg. The joints were divided into three groups according to osteoarthritis progression over 2 years. There were 323 legs of females and 163 legs of males. Knees which did not exhibit osteoarthritis were in group 1; knees with osteoarthritis that remained stable for 2 years were in group 2; knees that worsened osteoarthritis over 2 years were in group 3. Morphometric parameters in the lower leg were measured by radiographs taken in 2014. RESULTS In female subjects, group 2 had higher age, lower lever arm ratio and lower hip-knee-ankle angle, and higher height of the hip center compared with group (1). Group 3 had higher age compared with group 1 and lower height of the hip center compared with group (2). In male subjects, group 2 had lower height of the hip center and lower hip-knee-ankle angle compared with group 1. Group 3 had higher patellar shift index compared with group 1, higher height of the hip center and higher femoral neck length compared with group 2. CONCLUSIONS Higher age was the risk of osteoarthritis progression of the knee in female subjects but not significant risk in male subjects. Hip morphometries such as height of the hip center and femoral neck length in which showed a sex difference might be associated with the progression of knee osteoarthritis.
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Affiliation(s)
- Dung Huu Tran
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Hironobu Hoshino
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Daisuke Togawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
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The minimalinvasive direct anterior approach in aseptic cup revision hip arthroplasty: a mid-term follow-up. Arch Orthop Trauma Surg 2019; 139:121-126. [PMID: 30415415 DOI: 10.1007/s00402-018-3062-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The minimally invasive direct anterior approach (DAA) is an established approach for primary total hip arthroplasty (THA). The complication rates in hip revision arthroplasty are much higher in comparison with primary THA. A right positioning of the implants and a soft tissue, especially the abductors spearing approach, is important to get good functional results and low complication rates. The aim of this study was to show the clinical and radiological outcome of isolated revision hip arthroplasty of the cup by using the DAA. MATERIALS AND METHODS Aseptic cup revisions were carried out in 48 patients using the DAA. A decision to exchange the stem was made intraoperatively in seven cases. Complications, radiological and functional outcome were assessed. All of the data were collected retrospectively. The mean follow-up period was 65 months. RESULTS In most of the cases the standard DAA was used. A proximal extension was nescessary in 15 patients (31%). The mean cup inclination angle after revision was 44° (min. 25°, max. 62°). Six implants (12.5%) were located outside of the Lewinnek safe zone. The centers of rotation of the revision implants were a mean of 0.6 cm superior (min. 0, max. 2.2 cm) and 0.5 cm lateral (min. 0.2 cm, max 1.2 cm) in comparison with the center of rotation in the healthy hip on the contralateral side. Harris Hip Score improved significantly from 50 to 91 (P = 0.03). Complications noted consisted of two periprosthetic infections (4.2%), one aseptic cup loosening (2.1%), two hematomas requiring revision (4.2%), and one case each of femoral nerve injury, lower-leg venous thrombosis, and pneumonia. No dislocations were observed and there were no cases of heterotopic ossification based on the Brooker classification. No persistent damage of the nervus cutaneus femoris lateralis was found at the follow-up examinations. CONCLUSIONS The DAA represents a feasible option in hip revision arthroplasty. Anatomic reconstruction of the cup is reproducibly possible. Good medium-term results can also be achieved. Particularly in relation to dislocation, the complication rates are low. Due to the learning curve, the DAA should only be used in hip revision arthroplasty by those with sufficient experience in primary THA. Adequate data regarding stem revisions through the DAA are not available at the moment.
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Does hip center location affect the recovery of abductor moment after total hip arthroplasty? Orthop Traumatol Surg Res 2018; 104:1149-1153. [PMID: 30292598 DOI: 10.1016/j.otsr.2018.06.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 06/06/2018] [Accepted: 06/17/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND In total hip arthroplasty (THA), placing the cup in an anatomic position is not always possible in case of deformities related to developmental dysplasia of the hip (DDH). Thus far, the influence of a hip center on the abductor moment after THA has not been clearly elucidated. Therefore, we performed a retrospective study to assess (1) how abductor muscle moment recovers postoperatively in THA and (2) whether acetabular cup position affects the recovery of abductor moment. HYPOTHESIS A high hip center affects the recovery of abductor moment of a dysplastic hip after THA. PATIENTS AND METHODS We evaluated 100 patients, who underwent unilateral primary THA, at 12 months postoperatively. The study included 86 women and 14 men, with a mean age of 65.5±9.9 years (range, 40 to 86 years). Patients with secondary osteoarthritis due to DDH were included (Crowe 1: 76; Crowe 2: 15, Crowe 3:9, and Crowe 4: none). A cementless straight stem was implanted in all hips. Hip abductor moment was measured using a belt-stabilized hand-held dynamometer. The ratio of moment of the affected side to that of the contralateral side was calculated as moment ratio. The horizontal and vertical centers of rotation (H-COR and V-COR) (with respect to the inter teardrop line) and vertical shift (V-shift) (difference in V-COR between the affected hip and the contralateral normal hip) were determined. RESULTS At 6 and 12 months postoperatively, the abductor moment ratios were 95.1 and 94.7%, respectively. Significant negative correlation was observed between the postoperative abductor moment ratio and V-COR at 6 months postoperatively (r=-0.2436, p=0.0238). Significant delay in the recovery of abductor moment ratio was observed in the groups with higher hip center (V-shift>15mm) (odds ratio=12.7; 95% CI: 2.11-232.1, p=0.0034) at 6 months postoperatively, which was fully recovered at 12 months postoperatively. DISCUSSION Superior placement of a hip center, more than 15mm above the true hip center, delayed the recovery of abductor muscle moment after THA. LEVEL OF EVIDENCE III, retrospective comparative study.
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Yi LH, Li R, Zhu ZY, Bai CW, Tang JL, Zhao FC, Zheng X, Guo KJ. Anatomical study based on 3D-CT image reconstruction of the hip rotation center and femoral offset in a Chinese population: preoperative implications in total hip arthroplasty. Surg Radiol Anat 2018; 41:117-124. [PMID: 30488299 DOI: 10.1007/s00276-018-2143-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Several anatomical studies regarding the value of hip rotation center (HRC) and femoral offset (FO) have been performed in Western populations. However, there are a few data on hip morphological values in the Chinese population based on CT scans. This study measured the values of the hip and pelvis, especially HRC and FO, in a Chinese population and compared them with the published values obtained from Western populations. PATIENTS AND METHODS One hundred patients (50 females and 50 males) were included in the present study, and 3D-CT reconstructions of the hip and pelvis were generated. The mean age was 51.4 ± 8.9 years and mean body mass index (BMI) was 23.5 ± 2.6 kg/m2. All the morphologic measurements were compared between genders and sides, and the relationships between different parameters were analyzed. RESULTS The mean FO values were 38.4 ± 4.7 mm and 35.6 ± 4.4 mm for the males and females, respectively. A significant negative correlation was noted between FO and neck shaft angle (NSA) in both genders (r = - 0.262, P = 0.009 for the males, r = - 0.350, P ≤ 0.001 for the females). A significant positive correlation was found between horizontal distance (HD) and diameter of the femoral head (DFH) in both genders (r = 0.734, P ≤ 0.001 for the males, r = 0.658, P ≤ 0.001 for the females). A significant positive correlation was noted between HD and pelvic width (PW) in males (r = 0.455, P ≤ 0.001). A significant positive correlation was also noted between HD and pelvic height (PH) in males (r = 0.318, P ≤ 0.001). A significant positive correlation was observed between FO and pelvic cavity height (PCH) in males (r = 0.411, P ≤ 0.001), and a significant positive correlation was observed between VD and PCH in females (r = 0.497, P ≤ 0.001). The tip of the greater trochanter was, on average, 7.0 mm higher than the femoral head center. Relationships between DFH and pelvic morphometric parameters were also observed. CONCLUSION The present morphological data and the relationships between them can be applied to design better ethnic-specific THA prostheses and preoperative plans.
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Affiliation(s)
- Lin-Hong Yi
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Rui Li
- Department of Medical Imaging, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zheng-Ya Zhu
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chao-Wen Bai
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jin-Long Tang
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Feng-Chao Zhao
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xin Zheng
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
| | - Kai-Jin Guo
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
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Abstract
Biomechanics of the hip joint describes how the complex combination of osseous, ligamentous, and muscular structures transfers the weight of the body from the axial skeleton into the appendicular skeleton of the lower limbs. Throughout history, several biomechanical studies based on theoretical mathematics, in vitro, in vivo as well as in silico models have been successfully performed. The insights gained from these studies have improved our understanding of the development of mechanical hip pathologies such as osteoarthritis, hip fractures, and developmental dysplasia of the hip. The main treatment of end-stage degeneration of the hip is total hip arthroplasty (THA). The increasing number of patients undergoing this surgical procedure, as well as their demand for more than just pain relief and leading an active lifestyle, has challenged surgeons and implant manufacturers to deliver higher function as well as longevity with the prosthesis. The science of biomechanics has played and will continue to play a crucial and integral role in achieving these goals. The aim of this article, therefore, is to present to the readers the key concepts in biomechanics of the hip and their application to THA.
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Affiliation(s)
- Jan Van Houcke
- Department of Orthopaedics Surgery and Traumatology, Ghent University Hospital, Ghent 9000, Belgium
| | - Vikas Khanduja
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Christophe Pattyn
- Department of Orthopaedics Surgery and Traumatology, Ghent University Hospital, Ghent 9000, Belgium
| | - Emmanuel Audenaert
- Department of Orthopaedics Surgery and Traumatology, Ghent University Hospital, Ghent 9000, Belgium
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
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Ozden VE, Dikmen G, Beksac B, Tozun IR. Total hip arthroplasty with step-cut subtrochanteric femoral shortening osteotomy in high riding hip dislocated patients with previous femoral osteotomy. J Orthop Sci 2017; 22:517-523. [PMID: 28254154 DOI: 10.1016/j.jos.2017.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/11/2016] [Accepted: 01/30/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND To evaluate the long-term clinical and radiological outcomes of cementless total hip arthroplasty (THA) in high riding hip dislocated patients with previous proximal femoral osteotomy. METHODS Twenty-one consecutive patients with a mean age forty-two years were treated with cementless THA Step-cut subtrochanteric femoral osteotomy was performed in all twenty-eight hips. Metal on polyethylene (MoP) and ceramic on ceramic (CoC) bearings were used in two different consecutive time periods. The mean follow-up time was twelve years. Harris hip score, limb length discrepancy, complications, union status of the osteotomy, survivorship of constructs were the criteria for evaluation. RESULTS The mean Harris hip score improved from 39.5 to 88.7 points. The mean limb length discrepancy in unilateral cases decreased from 54.5 mm to 12.3 mm. The mean amount of femoral shortening was 37 mm. The mean union time was 3.5 months and there were no delayed union and non-union. There were three cup and two femoral revisions due to osteolysis in patients who had MoP. There was only one femoral revision in patients who had CoC. The Kaplan Meier survivorship with an end point of any revision of the stem and the acetabular component was 94% (95% CI, 75%-98%) and 92% (95% CI, 74%-99%) at ten years respectively. CONCLUSIONS Total hip arthroplasty with subtrochanteric step-cut femoral shortening is a successful technique to improve the hip functions and reconstruct limb length discrepancy in young patients with proximal femoral deformities.
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Affiliation(s)
- Vahit Emre Ozden
- Acıbadem University, Faculty of Medicine, Department of Orthopedics and Traumatology, Acıbadem Maslak Hospital, Maslak 34457 Istanbul, Turkey.
| | - Goksel Dikmen
- Acıbadem University, Faculty of Medicine, Department of Orthopedics and Traumatology, Acıbadem Maslak Hospital, Maslak 34457 Istanbul, Turkey
| | - Burak Beksac
- Acıbadem University, Faculty of Medicine, Department of Orthopedics and Traumatology, Acıbadem Maslak Hospital, Maslak 34457 Istanbul, Turkey
| | - Ismail Remzi Tozun
- Acıbadem University, Faculty of Medicine, Department of Orthopedics and Traumatology, Acıbadem Maslak Hospital, Maslak 34457 Istanbul, Turkey
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Ikeda T, Jinno T, Aizawa J, Masuda T, Hirakawa K, Ninomiya K, Suzuki K, Morita S. Effects of perioperative factors and hip geometry on hip abductor muscle strength during the first 6 months after anterolateral total hip arthroplasty. J Phys Ther Sci 2017; 29:295-300. [PMID: 28265161 PMCID: PMC5332992 DOI: 10.1589/jpts.29.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/07/2016] [Indexed: 12/16/2022] Open
Abstract
[Purpose] The importance and effect of hip joint geometry on hip abductor muscle strength
are well known. In addition, other perioperative factors are also known to affect hip
abductor muscle strength. This study examined the relative importance of factors affecting
hip abductor muscle strength after total hip arthroplasty. [Subjects and Methods] The
subjects were 97 females with osteoarthritis scheduled for primary unilateral THA. The
following variables were assessed preoperatively and 2 and 6 months after surgery:
isometric hip abductor strength, radiographic analysis (Crowe class, postoperative femoral
offset (FO)), Frenchay Activities Index, compliance rate with home exercise, Japanese
Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), and demographic data.
Factors related to isometric hip abductor muscle strength 2 and 6 months after surgery
were examined. [Results] Significant factors related to isometric hip abductor muscle
strength at 2 and 6 months after surgery were, in extraction order: 1. isometric hip
abductor muscle strength in the preoperative period; 2. BMI; and 3. the JHEQ mental score
at 2 and 6 months after surgery. [Conclusion] Preoperative factors and postoperative
mental status were related to postoperative isometric hip abductor strength. FO was not
extracted as a significant factor related to postoperative isomeric hip abductor
strength.
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Affiliation(s)
- Takashi Ikeda
- Department of Rehabilitation Medicine, Tokyo Medical and Dental University Graduate School, Japan; Showa University School of Nursing and Rehabilitation Sciences, Japan
| | - Tetsuya Jinno
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University Graduate School, Japan
| | - Junya Aizawa
- Clinical Center for Sports Medicine & Sports Dentistry, Tokyo Medical and Dental University, Japan
| | - Tadashi Masuda
- Faculty of Symbiotic Systems Science, Fukushima University, Japan
| | | | | | - Kouji Suzuki
- Shonan Kamakura Joint Reconstruction Center, Japan
| | - Sadao Morita
- Department of Rehabilitation Medicine, Tokyo Medical and Dental University Graduate School, Japan
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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.
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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
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Iwase T, Morita D, Ito T, Takemoto G, Makida K. Favorable Results of Primary Total Hip Arthroplasty With Acetabular Impaction Bone Grafting for Large Segmental Bone Defects in Dysplastic Hips. J Arthroplasty 2016; 31:2221-6. [PMID: 27133930 DOI: 10.1016/j.arth.2016.03.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/22/2016] [Accepted: 03/24/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of the present study was to assess midterm results after acetabular impaction bone grafting (IBG) in primary total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) with large acetabular segmental defect. METHODS Primary THA with IBG for DDH with large acetabular segmental defect was performed in 40 hips of 38 patients. The average age was 61.6 years (range: 33-82 years), and the average follow-up period was 7.5 years (range: 3-10.3 years). The Merle d'Aubigné and Postel hip score and complications were assessed. For radiological assessment, postoperative location of the hip rotation center, the socket inclination angle, and the socket center-edge angle were assessed. Kaplan-Meier survival analysis was performed with the end points of any type of reoperation and aseptic acetabular loosening. RESULTS The mean Merle d'Aubigné and Postel hip score improved from 10.4 points to 16.2 points at the final follow-up. Reoperation was performed in 1 case for acute infection without loosening. In 39 out of 40 hips (97.5%), the center of hip rotation was located beneath the "high hip center." The average socket inclination angle was 39.3° (range: 30°-54°), and the average socket center-edge angle was -11.8° (range: -23° to 9°). Survival rate of acetabular component at 8 years with the end point of any reoperation and of aseptic loosening was 96.6% (95% confidence interval: 89.9%-100%) and 100%, respectively. CONCLUSION Acetabular IBG represents one of the useful options for restoring a normal hip center and acetabular bone stock in primary THA for DDH with large acetabular defect.
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Affiliation(s)
- Toshiki Iwase
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| | - Daigo Morita
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| | - Tadashi Ito
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| | - Genta Takemoto
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| | - Kazuya Makida
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
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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.
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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
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20
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A radiological study of the true anatomical position of the acetabulum in Japanese women. Hip Int 2016; 21:311-6. [PMID: 21698580 DOI: 10.5301/hip.2011.8395] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2011] [Indexed: 02/04/2023]
Abstract
There is sometimes uncertainty concerning the correct socket position prior to total hip arthroplasty (THA). We conducted a study to determine the hip centre in Japanese women in order to define the true anatomical position of the acetabulum. The study involved 200 consecutive female patients in whom the contralateral hip joint was normal or was prearthritic and who underwent unilateral THA. The 'normal' group comprised 100 hip joints with no acetabular hip dysplasia, and the prearthritis group comprised 100 hip joints with Crowe type I dysplasia. The length of a perpendicular line drawn under the teardrop (interteardrop line) connecting both inferior edges of the teardrop with the centre of the femoral head was recorded as the vertical distance, and the distance from the intersection of the perpendicular line and interteardrop line up to the teardrop was recorded as the horizontal distance. We measured these distances on the femoral head of the side that did not undergo THA. The mean vertical distances in the 'normal' and prearthritis groups were 14.6 ± 2.8 mm and 16.8 ± 2.7 mm, respectively, and the mean horizontal distances were 30.2 ± 2.8 mm and 32.5 ± 2.7 mm, respectively. We therefore determined the mean centre of the hips to lie at a vertical distance of 11 to 22 mm and a horizontal distance of 27 to 38 mm. These values can serve as a useful index for socket positioning in THA.
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Kamada T, Mashima N, Nakashima Y, Imai H, Takeba J, Miura H. Mid-term clinical and radiographic outcomes of porous tantalum modular acetabular components for hip dysplasia. J Arthroplasty 2015; 30:607-10. [PMID: 25443360 DOI: 10.1016/j.arth.2014.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 10/15/2014] [Accepted: 11/01/2014] [Indexed: 02/01/2023] Open
Abstract
It is still challenging to perform successful cementless cup fixation during total hip arthroplasty for hip dysplasia. In this multicenter study we evaluated the clinical results of porous tantalum modular acetabular cups (TM cups) in 45 dysplastic hips with a mean follow-up period of 9.8 years. The mean Japanese Orthopaedic Association hip score improved from 48.2 preoperatively to 92.1 at the most recent follow-up. All of the cups were radiographically stable with no evidence of progressive radiolucencies or osteolysis regardless of bone grafting. Sixteen hips with bone grafts showed the integration of grafted bone without any radiolucencies. There were no revisions of TM cups. The use of TM cups for dysplastic hips provided satisfactory 10-year clinical and radiographic results.
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Affiliation(s)
- Tomomi Kamada
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Naohiko Mashima
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Kyushu University School of Medicine, 1-3-3 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Hiroshi Imai
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Jun Takeba
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Hiromasa Miura
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
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Tezuka T, Inaba Y, Kobayashi N, Ike H, Kubota S, Kawamura M, Saito T. Effects of hip joint center location and femoral offset on abductor muscle strength after total hip arthroplasty. Mod Rheumatol 2014; 25:630-6. [DOI: 10.3109/14397595.2014.988863] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Effect of preoperative limb-length discrepancy on abductor strength after total hip arthroplasty in patients with developmental dysplasia of the hip. Arch Orthop Trauma Surg 2014; 134:113-9. [PMID: 24297213 DOI: 10.1007/s00402-013-1899-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Indexed: 02/09/2023]
Abstract
BACKGROUND Limb-length discrepancy (LLD) arising from hip subluxation or dislocation and accompanied by insufficiency of hip abductor in patients with developmental dysplasia of the hip (DDH) can be corrected partially or completely with total hip arthroplasty (THA). However, information about post-THA changes in abductor strength related to preoperative LLD in patients with DDH is lacking. We aimed to explore the post-THA recovery course of abductor muscle strength and its related factors in patients with DDH. METHODS A cohort of 45 patients with unilateral DDH was divided into two groups according to their Crowe classification: patients with class I or II DDH formed Group M, and patients in class III and IV DDH formed Group S. The following parameters were measured on standardized antero-posterior hip radiographs taken in the supine position pre- and post-THA: abductor muscle length, abductor lever arm, LLD, and femoral offset (FO). Abductor strength was evaluated quantitatively with the Isomed 2000 isokinetic test system (1 week before the operation and 1, 3, 6, and 12 months after the operation). The contralateral normal hip joint served as a within-patient control. The affected side:healthy side ratios of the parameters above were calculated. RESULTS Abductor strength ratio evaluated at the five follow-up time points was larger in Group M than that in Group S (p < 0.001). The average abductor strength ratio reached 78.5, 85.4, and 89.2% at the 3, 6, and 12 months postoperative exams, respectively, in Group M, and reached 50.3, 63.2, and 72.9% in Group S. The abductor muscle length ratio, the abductor muscle level arm ratio, and the FO ratio were significantly increased postoperatively, relative to preoperative assessment, in the two groups. LLD was reduced significantly postoperatively, relative to preoperative values, in both groups. Both preoperative LLD (r = -0.791, p < 0.001) and the change in abductor muscle length ratio (r = -0.659, p < 0.001) correlated with abductor strength recovery. CONCLUSION Patients showed the greatest improvement in abductor strength within the first 6 months after THA, especially during the first 3 months. Abductor strength was consistently greater in patients with mild dysplasia than in patients with severe dysplasia. The extent of preoperative LLD and the increase in abductor length were related with post-THA abductor strength recovery in patients with DDH.
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Tikhilov RM, Shubnyakov II, Kovalenko AN, Totoyev ZA, Lyu B, Bilyk SS. THE STRUCTURE OF EARLY REVISIONS AFTER HIP REPLACEMENT. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2014. [DOI: 10.21823/2311-2905-2014-0-2-5-13] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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How far above the true anatomic position can the acetabular cup be placed in total hip arthroplasty? Hip Int 2013; 23:129-34. [PMID: 23543468 DOI: 10.5301/hipint.5000010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2012] [Indexed: 02/04/2023]
Abstract
INTRODUCTION There is controversy about which is more suitable for determining correct socket position in patients with severe bone deficiency of the acetabular roof because of developmental dysplasia of the hip (DDH): the anatomic centre of hip rotation or a high centre.
METHOD We evaluated the relationship, in 200 hips, between the centre of rotation and presence of the Trendelenburg sign to determine the upper limit of cup position from the standpoint of hip-abductor strength.
RESULTS Of the 200 hips, 20 (10%) showed a positive Trendelenburg sign. There were no statistically significant differences between parameters (the centre of rotation, femoral offset, abductor lever arm) regarding the presence of the Trendelenburg sign except for age at surgery. Patients with a positive Trendelenburg sign were significantly older (64.1 ± 9.4 years) than those with a negative Trendelenburg sign (58.8 ± 7.7 years) (P = 0.01).
CONCLUSIONS Our findings indicate that a high centre of hip rotation of up to approximately 30 mm from the inter-teardrop line is a feasible option for patients with DDH from the standpoint of hip-abductor strength if stems are used that allow the restoration of femoral offset and the abductor lever arm.
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Abolghasemian M, Samiezadeh S, Jafari D, Bougherara H, Gross AE, Ghazavi MT. Displacement of the hip center of rotation after arthroplasty of Crowe III and IV dysplasia: a radiological and biomechanical study. J Arthroplasty 2013; 28:1031-5. [PMID: 23541865 DOI: 10.1016/j.arth.2012.07.042] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 07/10/2012] [Accepted: 07/20/2012] [Indexed: 02/01/2023] Open
Abstract
To study the direction and biomechanical consequences of hip center of rotation (HCOR) migration in Crowe type III and VI hips after total hip arthroplasty, post-operative radiographs and CT scans of several unilaterally affected hips were evaluated. Using a three-dimensional model of the human hip, the HCOR was moved in all directions, and joint reaction force (JRF) and abductor muscle force (AMF) were calculated for single-leg stance configuration. Comparing to the normal side, HCOR had displaced medially and inferiorly by an average of 23.4% and 20.8%, respectively, of the normal femoral head diameter. Significant decreases in JRF (13%) and AMF (46.13%) were observed in a presumptive case with that amount of displacement. Isolated inferior displacement had a small, increasing effect on these forces. In Crowe type III and IV hips, the HCOR migrates inferiorly and medially after THA, resulting in a decrease in JRF, AMF, and abductor muscle contraction force.
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Affiliation(s)
- Mansour Abolghasemian
- Department of Orthopedic Surgery, Shafa Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Changes of gluteus medius muscle in the adult patients with unilateral developmental dysplasia of the hip. BMC Musculoskelet Disord 2012; 13:101. [PMID: 22703548 PMCID: PMC3461455 DOI: 10.1186/1471-2474-13-101] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 05/29/2012] [Indexed: 11/10/2022] Open
Abstract
Background The gluteus medius muscle is essential for gait and hip stability. Changes that occur in the gluteus medius muscles in patients with developmental dysplasia of the hip (DDH) are not well understood. A better understanding of DDH related changes will have positive repercussions toward hip soft tissue reconstruction. Methods 19 adult patients with unilateral DDH scheduled for total hip arthroplasty were assessed for: cross-sectional area (CSA), radiological density (RD) and the length of gluteus medius using computed tomograhpy(CT) (scanned before THA). Hip abductor moment arm and gluteus medius activation angle were also measured via hip anteroposterior radiographs. Results Both CSA and RD of gluteus medius muscle were significantly reduced (p < 0.05) in the affected hip compared to the control. In the affected hip, the length of the gluteus medius muscle was reduced by 8-11 % (p < 0.05) while the gluteus medius activation angle was significantly increased (p < 0.05) and the hip abductor moment arm was decreased (p < 0.05). Conclusions The gluteus medius showed substantial loss of CSA, RD as well as decreased length in patients with DDH in the affected hip. These changes should be considered in both hip reconstruction and postoperative rehabilitation training in patients with DDH.
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Bulk femoral head autograft without decortication in uncemented total hip arthroplasty: seven- to ten-year results. J Arthroplasty 2012; 27:437-444.e1. [PMID: 21831577 DOI: 10.1016/j.arth.2011.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Accepted: 06/02/2011] [Indexed: 02/01/2023] Open
Abstract
Superolateral acetabular bone defect is a serious challenge in uncemented total hip arthroplasty for acetabular dysplasia. We report a bulk bone autografting technique without decortication of the acetabulum and femoral head contact surfaces in 22 joints. Mean follow-up time was 8.3 years, and survival rates were 100% for loosening and revision end points. The preoperative Japanese orthopedic association hip score increased from 49.5 to 94.0. Although trabecular bridging and graft remodeling occurred in all cases, complete trabecular reorientation was observed in only 15 joints. Eccentric polyethylene wear was observed in 8 of 22 joints, and osteolysis, in 1 joint. Our technique is easy to perform, and midterm results were favorable; thus, we conclude that it may be an effective option for bulk bone autografting.
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Kamada S, Naito M, Nakamura Y, Kiyama T. Hip abductor muscle strength after total hip arthroplasty with short stems. Arch Orthop Trauma Surg 2011; 131:1723-9. [PMID: 21739114 DOI: 10.1007/s00402-011-1350-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Indexed: 11/26/2022]
Abstract
Excellent clinical results have been reported for total hip arthroplasty (THA) using a short stem. However, the range of variance in positioning of the stem has been reported to be wide. The authors hypothesized that the short stem position influences the femoral offset (FO) and hip abductor muscle strength (AMS) after surgery. The AMS was evaluated in 64 limbs in 32 patients who underwent unilateral THA using a short stem with a normal contralateral hip. The average time of AMS evaluation was 46.3 months postoperatively. The Harris Hip Score (HHS) was used for clinical evaluation. The ratio of the AMS on the reconstructed side to that on the contralateral side was calculated (strength ratio). The valgus angle (VA) of each stem and FO was measured on an anteroposterior hip radiograph. The FO ratio, as the normalized FO, was calculated. Linear regression analyses were performed to investigate the relationships among the VA, FO ratio and strength ratio. The average HHS improved from 57.7 points preoperatively to 94.6 points postoperatively. The VA negatively correlated with the FO ratio (r = -0.511, P = 0.028). The strength ratio negatively correlated with the VA (r = -0.505, P = 0.032) and positively correlated with the FO ratio (r = 0.479, P = 0.0056). The average postoperative HHS was generally satisfactory after THA using a short stem. A more valgus postoperative position of the short stem leads to reduced FO, which causes decreasing postoperative AMS after THA with a short stem.
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Affiliation(s)
- Satoshi Kamada
- Department of Orthopaedic Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
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