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Zhao C, Kong K, Ding X, Zhu Z, Li H, Zhang J. A novel intraoperative acetabular reaming center locating method in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip: a retrospective cohort study. INTERNATIONAL ORTHOPAEDICS 2024; 48:1733-1742. [PMID: 38563992 DOI: 10.1007/s00264-024-06164-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Although the principles of hip reconstruction are consistent, due to lack of reliable anatomical landmarks, how to decide the acetabular cup reaming centre intraoperatively in Crowe IV patients with developmental dysplasia of the hip (DDH) remains unclear. This study aims to address this question. METHODS Fifty-eight Crowe IV patients were enrolled from 2017 to 2019. By examining our previous clinical data, we analyzed the anatomical morphology of Crowe IV acetabulum and proposed a method of locating intraoperative reaming centering for implantation of a standard-sized acetabular cup, which is the upper two thirds of the posterior border of the true acetabulum. All patients included in this study were reamed according to this method. The average postoperative follow-up was 4.1 years (3-5 years). The position of the centre of rotation (COR), cup coverage (CC), and optimal range of joint motion (ROM) were examined by 3D computer simulation measurement. Postoperative complications and hip Harris score were collected and analyzed. RESULTS The morphology of the type IV DDH true acetabulum was mostly triangular. The intraoperative reaming centre were centered on the upper two thirds of the posterior border of the true acetabulum. The postoperative 3D CC was 80.20% ± 7.63% (64.68-90.24%, 44-48-mm cup size). The patients' mean Harris score improved from 39.7 ± 20.4 preoperatively to 91.5 ± 8.12 at the last follow-up. CONCLUSION Our study demonstrated that satisfactory CC and clinical results could be achieved by implanting a standard-sized cup with the reaming centre on the upper two thirds of the posterior border of the true acetabulum.
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Affiliation(s)
- Chen Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Keyu Kong
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Xiaohui Ding
- Joint and Sports Medicine Department, Zhu Cheng People's Hospital, No. 59, South Ring Road, Zhucheng City, Weifang City, Shandong Province, China
| | - Zhenan Zhu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Huiwu Li
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China.
| | - Jingwei Zhang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China.
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Zhang X, Shen X, Zhang R, Chen M, Ma R, Zhang Z, Zhang H, Yang B, Zhu C. Radiographic evaluation of robot-assisted versus manual total hip arthroplasty: a multicenter randomized controlled trial. J Orthop Traumatol 2024; 25:33. [PMID: 38926175 PMCID: PMC11208392 DOI: 10.1186/s10195-024-00773-3] [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: 03/13/2024] [Accepted: 05/25/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The effectiveness of robot-assisted surgery remains contentious due to the lack of high-quality randomized controlled trials (RCTs) to elevate the level of evidence. We aimed to evaluate the postoperative radiographic outcomes of robot-assisted (RAS-THA) versus manual (M-THA) total hip arthroplasty. METHODS This multicenter RCT was performed from March 1, 2021 to December 1, 2021. Patients were randomly assigned to routine M-THA or to RAS-THA that used the TRex-RS orthopedic joint surgical navigation system. The primary outcome was to compare the acetabular component orientation, femoral stem alignment, femoral canal fill ratio, and leg length discrepancy between RAS-THA and M-THA using postoperative radiography. Subgroup analyses of the two groups stratified by surgical approach, gender, and BMI were also conducted. RESULTS Seventy-three participants were randomly allocated to the RAS-THA group, while seventy-two participants were assigned to the M-THA group. Compared to the M-THA group, the RAS-THA group exhibited less variability in the preoperative planning of the vertical center of rotation (VCOR; P < 0.001), demonstrated a significant advantage in femoral stem alignment (P = 0.004), and showed pronounced decreases in inequality and in the variability in leg length discrepancy (P < 0.001). There was no significant difference in the Lewinnek safe-zone ratio (P = 0.081) and the femoral canal fill ratio (P > 0.05) between the two groups. Further subgroup analysis also showed that the RAS-THA group had fewer horizontal center of rotation (HCOR) and leg length differences when stratified by surgical approach, gender, and overweight status. CONCLUSION This RCT found that, regardless of the surgical approach, gender, or body mass index, RAS-THA can effectively improve the postoperative VCOR and significantly reduce the variability of leg length difference. RAS-THA should be considered an effective method to enhance surgical precision by achieving less variability in challenging patients with leg length discrepancies. TRIAL REGISTRATION ChiCTR2100044124.
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Affiliation(s)
- Xianzuo Zhang
- Department of Orthopedics, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Xianyue Shen
- Department of Orthopedics, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Rongwei Zhang
- Department of Orthopedics, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Mo Chen
- Department of Orthopedics, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Ruixiang Ma
- Department of Orthopedics, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Zian Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Haining Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Bo Yang
- Department of Joint Surgery, Weifang People's Hospital, Weifang, Shandong, 261000, People's Republic of China.
| | - Chen Zhu
- Department of Orthopedics, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China.
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Zhang S, Ma M, Kong X, Zhou Y, Chen J, Chai W. Robotic-assisted total hip arthroplasty in patients with developmental dysplasia of the hip. INTERNATIONAL ORTHOPAEDICS 2024; 48:1189-1199. [PMID: 38358516 DOI: 10.1007/s00264-024-06115-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Abstract
PURPOSES Due to the morphological diversity of deformities, technical difficulties, improperly designed components, and so on, THA remains a challenging task in dysplastic hips, especially in highly dislocated hips. The purpose of this study was to comprehensively evaluate the clinical outcomes of robot-assisted THA in patients with DDH through a large cohort study, including the precision of acetabular cup positioning, indicators of inflammatory response, indicators of muscle damage, and complications. METHODS We retrospectively analyzed patients with DDH who underwent THA in our prospectively constructed joint registry between August 2018 and August 2022. Finally, 147 manual THAs and 147 robotic-assisted THAs were included in the final analysis. Patient demographics, indicators of inflammation, indicators of muscle damage, operative time, Harris hip scores (HHS), and forgotten joint score (FJS) were recorded for analysis. The precision of the positioning of the acetabular component was assessed with plain radiographs. RESULTS In the Crowe II/III groups, the reconstructed center of rotation (COR) in the robotic-assisted group was closer to the anatomical COR with less variation than the manual group (absolute horizontal distances of COR 3.5 ± 2.8 vs. 5.4 ± 4.9 mm, p < 0.05; absolute vertical distances of COR 6.4 ± 4.1 vs. 11.7 ± 8.2 mm, p = 0.001). For all Crowe subtypes, the robotic-assisted THA significantly increased the proportion of acetabular cups located in the safety zone within 5° (all p < 0.05). Interleukin-6 and creatine kinase levels were slightly lower and significantly different in the robotic-assisted group at three days postoperatively (all p < 0.05). CONCLUSIONS Compared to the manual technique, the robot-assisted technique improved the precision and reproducibility of acetabular component positioning, particularly in DDH patients with Crowe types II/III. The robotic-assisted technique did not increase operative time, bleeding, complications, or revision rates, and had a slighter early inflammatory response and muscle damage.
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Affiliation(s)
- Shuai Zhang
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China
- Department of Orthopedics, the 969th Hospital of the PLA joint Logisitcs Support Force, No. 51 Aimin street, Xincheng District, Huhehaote, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Mingyang Ma
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
| | - Xiangpeng Kong
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Yonggang Zhou
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
| | - Jiying Chen
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
| | - Wei Chai
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
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Nieschk C, Abelmann-Brockmann J, Lisitano L, Fenwick A, Röttinger H, Ecker M, Mayr E, Röttinger T. Clinical effects of different center of rotation reconstructions in total hip arthroplasty after femoral neck fractures: a cohort study including a follow-up analysis on patient's mobility and daily living ability. J Orthop Traumatol 2023; 24:58. [PMID: 37946089 PMCID: PMC10635998 DOI: 10.1186/s10195-023-00738-y] [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: 07/21/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The aim of this study is a clinical evaluation of the center of rotation (COR) placement towards a patient's recovery with respect to daily living ability and mobility. In past experiments based on three-dimensional (3D) models, medialization of the COR in total hip arthroplasty (THA) showed a negative influence on muscle strength of the abductors and reaction force of the hip joint. This contradicts paradigms, where reduced hip loading forces are claimed to increase functional outcomes. METHODS The plain X-rays of 110 patients who underwent THA after a femoral neck fracture between January 2019 and January 2021 were retrospectively evaluated. A Barthel Index on discharge was obtained in 69 cases. 47 patients were available for a follow-up interview concerning the Barthel Index, Parker mobility score (PMS), and pain levels (NRS) 6 and 12 months after surgery. RESULTS Medialization of the COR had a significantly negative effect on the need for care (Barthel Index) at patient discharge (Spearman correlation 0.357, p = 0.013). The effect on the PMS is still existent at 6 and 12 months (Spearman correlation 0.471, p = 0.009 at 6 months; 0.472, p = 0.008 at 12 months). Mann-Whitney U tests showed that the groups with medialized COR performed significantly worse than the lateralized groups. This was seen for the Barthel Index at discharge and at 6 months after surgery and for the PMS at 6 and 12 months. The accurately reconstructed CORs showed no significant differences from the lateralized rotation centers in need of care and mobility. The superior COR placement group showed significantly reduced mobility at 12 months in contrast to the inferior COR placement group (p = 0.008), and the group of accurately reconstructed rotation centers showed significantly less pain than the inferior COR placement group (p = 0.007 after 6 months, p = 0.026 after 12 months). Especially the combination of both (superomedialization) leads to reduced mobility (Spearman correlation 0.67, p = < 0.001). CONCLUSIONS COR superior displacement, COR medialization, and the combination of both (superomedialization, Spearman p = < 0.001) lead to reduced mobility while inferior displacement showed increased pain. According to our results, we recommend an exact vertical COR restoration, while horizontal medial displacement needs to be avoided. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Christopher Nieschk
- Universitätsklinikum Augsburg, Klinik für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - Johanna Abelmann-Brockmann
- Universitätsklinikum Augsburg, Klinik für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - Leonard Lisitano
- Universitätsklinikum Augsburg, Klinik für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - Annabel Fenwick
- Universitätsklinikum Augsburg, Klinik für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - Heinz Röttinger
- München Klinik Neuperlach, Oskar-Maria-Graf-Ring 51, 81737, München, Deutschland
- Faculty of Medical University of Pleven, Pleven, Bulgaria
| | - Michael Ecker
- Universitätsklinikum Augsburg, Klinik für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - Edgar Mayr
- Universitätsklinikum Augsburg, Klinik für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - Timon Röttinger
- Universitätsklinikum Augsburg, Klinik für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Stenglinstraße 2, 86156, Augsburg, Deutschland.
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Yang T, Yang B, Wang P, Qin Y, You G, Shi Y, Zhang A, Shen D, Guo L. The Role of Global Femoral Offset in Total Hip Arthroplasty with High Hip Center Technique. Orthop Surg 2023; 15:2373-2382. [PMID: 37519271 PMCID: PMC10475657 DOI: 10.1111/os.13818] [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: 01/30/2023] [Revised: 05/30/2023] [Accepted: 06/10/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE The high hip center (HHC) technique has been proposed for the treatment of patients with developmental dysplaisa of the hip (DDH) who have an acetabular bone defect. However, the importance of global femoral offset (FO) in the application of this technique has not been sufficiently appreciated. Our goals were to confirm that the HHC technique is feasible in the treatment of patients with DDH and to assess the function of global FO in this procedure. METHODS We retrospectively analyzed 73 patients who underwent total hip arthroplasty using high hip center technique for unilateral DDH at our hospital between January 2014 and June 2019. According to global FO, the patients were split into three groups: increased FO group (increment greater than 5 mm), restored FO group (restoration within 5 mm) and decreased FO group (reduction greater than 5 mm). Patients' medical records and plain radiographs were reviewed. One-way ANOVA was used to compare radiographic outcomes and Harris hip score (HHS). Paired t-test was used to assess preoperative and postoperative HHS and leg length discrepancy. Trochanteric pain syndrome, Trendelenburg sign and postoperative limp was evaluated with Fisher's exact test. RESULTS The average follow-up time was 7.5 ± 1.4 years. The patients' HHS and leg length discrepancy were significantly improved (p < 0.05). In terms of vertical acetabular height, abductor arm, postoperative leg length difference, and acetabular cup inclination, there was no statistically significant difference between the three groups. At the last follow-up, HHS was significantly higher in the restored FO group than in the decreased FO and increased FO groups. Trochanteric pain syndrome occurred in 15.0% and Trendelenburg sign and postoperative limp in 8.2% of all patients, respectively. Trochanteric pain syndrome, Trendelenburg sign and postoperative limp did not differ significantly across the three groups. One patient in increased FO group underwent revision for dislocation 6 years after surgery. CONCLUSION The HHC technique is an alternative technique for total hip arthroplasty in patients with acetabular bone abnormalities, according to the results of the mid-term follow-up. Also, controlling the correction of the global femoral offset to within 5 mm may lead to better clinical outcomes.
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Affiliation(s)
- Tianyu Yang
- Department of Orthopedicsthe First Hospital of China Medical UniversityShenyangChina
| | - Boning Yang
- Department of Orthopedicsthe First Hospital of China Medical UniversityShenyangChina
| | - Penghao Wang
- Department of Orthopedicsthe First Hospital of China Medical UniversityShenyangChina
| | - Yu Qin
- Department of Orthopedicsthe First Hospital of China Medical UniversityShenyangChina
| | - Guanchao You
- Department of Orthopedicsthe First Hospital of China Medical UniversityShenyangChina
| | - Yunyi Shi
- Department of Orthopedicsthe First Hospital of China Medical UniversityShenyangChina
| | - Ao Zhang
- Department of Orthopedicsthe First Hospital of China Medical UniversityShenyangChina
| | - Dianlin Shen
- Department of Orthopedicsthe First Hospital of China Medical UniversityShenyangChina
| | - Lei Guo
- Department of Orthopedicsthe First Hospital of China Medical UniversityShenyangChina
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Femoral Head Autograft to Manage Acetabular Bone Loss Defects in THA for Crowe III Hips by DAA: Retrospective Study and Surgical Technique. J Clin Med 2023; 12:jcm12030751. [PMID: 36769400 PMCID: PMC9918157 DOI: 10.3390/jcm12030751] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Introduction: The pathologic anatomy of Crowe III is characterized by the erosion of the superior rim of acetabulum, with a typical bone defect in its supero-lateral portion. The performance of a total hip arthroplasty requires the management of the acetabular bone defect, and femoral head autograft can be a valid option to optimize implant coverage. Material and Methods: In all, eight Crowe III patients (nine hips), seven of which having unilateral hip affected, and one with bilateral involvement by secondary osteoarthritis in DDH; maximum limb length discrepancy (LLD) of 3.5 cm in unilateral patients. All were operated on by direct anterior approach. Patients were evaluated in terms of clinical, surgical, and radiological (center-edge, horizontal coverage, cup inclination) parameters. Results: Cup placement was implanted with a mean of 39.5 ± 7.5°. Stem alignment showed average 1.5 ± 2.3° in valgus. LLD showed an overall average preoperative of -29.5 ± 10.5 mm at the affected side, with a significant improvement to -2.5 ± 6.4 mm (p = 0.023). The mean initial coverage evaluated like a percentage of the horizontal bone host was 52.1 ± 7.1%, while the mean final coverage at the last post-operative X-ray from femoral autograft bone was 97.0 ± 4.5% with an average improvement of 44.5%. Average CE improved from -9.5 ± 5.2° (CE I) to the immediate post-operative (CE II) of 40.6 ± 8.2°. At the final follow up, CE III showed a mean of 38.6 ± 6.2°, with an average decrease of 2.0°. Discussion: Acetabular bone defect in Crowe III DDH patients undergoing THA by DAA, can be efficiently managed by massive autograft femoral head, which allowed an adequate and long-lasting coverage of the implant, with cup positioning at the native acetabulum.
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Chen F, Stoll T. Segmental Acetabular Defects Managed by Augments in Conjunction with CT During Robotic Total Hip Arthroplasty: A Report of 2 Cases. JBJS Case Connect 2022; 12:01709767-202212000-00039. [PMID: 36821129 DOI: 10.2106/jbjs.cc.22.00185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
CASES We present 2 robotic-assisted hip arthroplasty cases with significant segmental acetabular defects that could compromise cup fixation. We outline an algorithmic planning approach on a computed tomography (CT)-based platform to address these defects by predicting augmentation needs, when component adjustments alone are inadequate, and describe the novel combination of augments in conjunction with robotic-assisted hip arthroplasty. CONCLUSION CT-based robotic-assisted hip arthroplasty is a powerful tool to assess and address acetabular deficiencies. Rudimentary augment planning extracts additional value out of the preoperative CT. However, there remains room for intelligent assessment of hip centers and for deliberate augment planning and execution.
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Affiliation(s)
- Foster Chen
- Washington Permanente Medical Group, Seattle, Washington
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Kaiser D, Ried E, Zingg PO, Rahm S. Acetabular reconstruction with femoral head autograft in primary total hip arthroplasty through a direct anterior approach is a reliable option for patients with secondary osteoarthritis due to developmental dysplasia of the hip. Arch Orthop Trauma Surg 2022; 142:2957-2964. [PMID: 34581861 PMCID: PMC9474438 DOI: 10.1007/s00402-021-04187-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 09/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Developmental dysplasia is challenging to treat with total hip arthroplasty via the direct anterior approach (DAA). Reconstructing the former anatomy while restoring the acetabular bone stock for future revisions in this young patient collective combined with the known advantages of the DAA would be desirable. The purpose of this study was to analyze the feasibility, radiographic outcome and clinical outcome of primary uncemented total hip arthroplasty with bulk femoral head autograft for acetabular augmentation through a DAA with a minimal follow-up of 12 months. METHODS A retrospective, consecutive series from March 2006 to March 2018 of 29 primary total hip arthroplasty with acetabular augmentation with bulk femoral head autograft through a direct anterior approach was identified. All complications, reoperations and failures were analyzed. Radiographic and clinical outcome was measured. RESULTS 24 patients (29 hips) with a mean age of 43 (18-75) years and a mean follow-up of 35 months (12-137) were included. Surgical indication was secondary osteoarthritis for developmental dysplasia of the hip (Hartofilakidis Grade A (n = 19), B (n = 10)) in all cases. We noted no conversion of the approach, no dislocation and no acetabular loosening. The center of rotation was significantly distalized by a mean of 9 mm (0-23) and significantly medialized by a mean of 18 mm (6-29). The bone graft was fully integrated after 12 months in all cases. CONCLUSION Acetabular reconstruction with femoral head autograft in primary THA through a direct anterior approach seems to be a reliable option for the treatment of secondary osteoarthritis in patients with DDH Hartofilakidis grade A and B. Prospective cohort studies with a large sample population and a long-term follow-up are necessary to confirm our findings.
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Affiliation(s)
- Dominik Kaiser
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland.
| | - Emanuel Ried
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
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The application of custom-made 3D-printed titanium augments designed through surgical simulation for severe bone defects in complex revision total hip arthroplasty. J Orthop Traumatol 2022; 23:37. [PMID: 35932367 PMCID: PMC9357241 DOI: 10.1186/s10195-022-00656-5] [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: 03/07/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background With the development of radiology and three-dimensional (3D) printing technology, custom-made 3D-printed titanium augments have been more widely used. However, the radiological and clinical outcomes of custom-made augments lack reports. To better understand the clinical effect of using 3D-printed titanium augments and the significance of accurate placement, the aim of this study was to assess the outcomes when using custom-made 3D-printed titanium augments and to validate the idea that surgical simulation should be done before designing custom-made augments. Methods A retrospective review was conducted on 31 surgical simulations and revision total hip arthroplasties using custom-made 3D-printed titanium augments. The safe zone, cup position, and hip rotation center were measured on anteroposterior radiographs. Clinical outcomes were assessed with a mean 21.1 months of follow-up. Results All patients were positioned within the safe zone, and none of the acetabular cups nor the custom-made augments had any evidence of migration at the latest follow-up. A strong correlation was found between the planned cup position and the postoperative position. The average vertical position of the center of rotation was significantly increased from 3.55 cm to 2.35 cm. The mean Harris Hip Score was increased from 40.81 preoperatively to 65.46 postoperatively. Complications included gait abnormality, groin pain, fracture of the greater trochanter, and partial palsy of the sciatic nerve. However, patient satisfaction reached 92.3%. Conclusion Surgical simulations help to design custom-made augments accurately and improve surgical plans. Acetabular components supported with custom-made 3D-printed augments is a useful method to bridge severe bone deficiencies. In this study, both the radiologic results and clinical outcomes were favorable. Level of evidence Level 4. Supplementary Information The online version contains supplementary material available at 10.1186/s10195-022-00656-5.
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Demirkale I, Yaradılmış YU, Uysal Ramadan S, Taşkesen A, Ateş A, Altay M. Periacetabular vascular anatomy in high-riding dysplastic hips: a CT angiographic study. Hip Int 2022; 32:523-529. [PMID: 33131326 DOI: 10.1177/1120700020968157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Developmental hip dysplasia (DDH) is shown to have osseous and neural abnormalities but literature is sparse with investigation of vascular structures. Therefore, we aimed to evaluate periacetabular vascular structures. METHODS By computerised tomography angiography (CTA), 13 highly dislocated hips of 11 patients' iliac bone to external iliac and obturatory artery and vein proximities were measured and compared with the same measurements of 20 healthy hips of 12 patients. Numbering from superior to inferior, a total of 7 axial images were created on the 2D CTA coronal images with 1 cm apart, the 4th being at the level of acetabular dome. RESULTS The mean age of the patients was 53 (18-72) years. Dysplastic hips tended to have curved (53%) and healthy hips tended to have straight iliac arteries (p = 0.037). As compared to healthy hips, external iliac veins were significantly closer to the bone at all levels, but the external iliac arteries were closest at 1st to 4th levels (p < 0.001) in dysplastic hips. The course of the obturatory arteries was similar in both groups (p = 0.147). CONCLUSIONS The external iliac artery and vein is in close proximity to the iliac bone which dangers acetabular screw, acetabular reaming or retractor placement in highly dislocated hips. The surgeon should be aware of this proximity in operations of these hips to avoid vascular complications.
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Affiliation(s)
- Ismail Demirkale
- Departments of Orthopaedics and Traumatology, University of Health Sciences, Keçiören HPRC, Ankara, Turkey
| | - Yüksel Uğur Yaradılmış
- Departments of Orthopaedics and Traumatology, University of Health Sciences, Keçiören HPRC, Ankara, Turkey
| | - Selma Uysal Ramadan
- Department of Radiology, University of Health Sciences, Kecioren HPRC, Ankara, Turkey
| | | | - Ahmet Ateş
- Departments of Orthopaedics and Traumatology, University of Health Sciences, Keçiören HPRC, Ankara, Turkey
| | - Murat Altay
- Departments of Orthopaedics and Traumatology, University of Health Sciences, Keçiören HPRC, Ankara, Turkey
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11
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Wang Y, Wang M, Li C, Nakamura Y, Deng L, Yamako G, Chosa E, Pan C. Biomechanical effect of metal augment and bone graft on cup stability for acetabular reconstruction of total hip arthroplasty in hip dysplasia: a finite element analysis. BMC Musculoskelet Disord 2022; 23:277. [PMID: 35321681 PMCID: PMC8943934 DOI: 10.1186/s12891-022-05168-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Different methods of acetabular reconstruction with total hip arthroplasty (THA) for Crowe II and III of adult developmental dysplasia of the hip (DDH) acetabular bone defect have been implemented clinically. However, the biomechanical effect of different augmented materials for acetabular reconstruction in THA on shell stability has never been discussed. Methods In the present study, autologous bone graft (BG)and metal (Ti6Al4V) augment (MA) were simulated with several acetabular bone defect models of DDH in THA. The contact pressure and micromotion between the shell and host bone were measured for evaluating the shell stability using a finite element method. Results The peak contact stress between shell and host bone was higher in the MA situation (12.45 vs 8.71 MPa). And the load transfer path was different, for BG models, the high local contact stresses were found at the junction of bone graft and host bone while for MA models the concentrated contact stresses were at the surface of MA. The peak relative micromotion between shell and host bone was higher in the MA situation (12.61 vs 11.13 µm). However, the peak micromotion decreased in the contact interface of MA and cup compared to the BG models. Conclusions The higher micromotion was found in MA models, however, enough for bone ingrowth, and direct stronger fixation was achieved in the MA-cup interface. Thus, we recommended the MA can be used as an option, even for Crowe III, however, the decision should be made from clinical follow-up results.
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Affiliation(s)
- Yuzhu Wang
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Mincong Wang
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Chengguo Li
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yoshihiro Nakamura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Liwei Deng
- Department of Radiology, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Go Yamako
- Department of Mechanical Engineering, Faculty of Engineering, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Etsuo Chosa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Chenglong Pan
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China.
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12
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Loppini M, Temporiti F, Furone R, Galli M, Grappiolo G, Gatti R. Static and dynamic pelvic kinematics after one-stage bilateral or unilateral total hip arthroplasty. Hip Int 2021; 31:729-734. [PMID: 32363933 DOI: 10.1177/1120700020921120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The pelvis rotates simultaneously around both hips along sagittal, frontal and transversal planes and its kinematics change in patients after total hip arthroplasty (THA). Consequently, it is reasonable to expect different pelvic kinematic profiles in bilateral or unilateral THA. Therefore, the aim of this study was to compare pelvic kinematics in patients with bilateral or unilateral THA. METHODS 40 patients undergoing bilateral (n = 20) or unilateral (n = 20) THA were evaluated for pelvic kinematics during standing and walking tasks using an optoelectronic system. Mean pelvic orientation was assessed during standing, whereas the Gait Variable Score (GVS), maximum and minimum peaks, range and values of pelvic tilt, obliquity and rotation during Heel-Strike and Toe-Off phases of gait cycle were calculated during walking. Data were collected the day before and at seven days after surgery. RESULTS At baseline, no between-group differences were found. At 7 days, GVS for pelvic tilt (p = 0.029) and rotation (p = 0.046) were closer to normative data in bilateral patients, who also revealed lower maximum peak of anterior tilt (p = 0.013) and lower range of pelvic tilt during gait (p = 0.031) with respect to unilateral cases. No between-group differences were found for pelvic orientation during standing at any time-point. CONCLUSIONS Bilateral patients revealed more physiological pelvic kinematics than unilateral cases. These findings underline the advantage of patients undergoing 1-stage bilateral THA and may be helpful in selecting personalised rehabilitative approaches.
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Affiliation(s)
- Mattia Loppini
- Hip and Knee Orthopaedic Surgery Department, Humanitas Clinical and Research Centre, Milan, Italy.,Humanitas University, Milan, Italy
| | - Federico Temporiti
- Humanitas University, Milan, Italy.,Physiotherapy Unit, Humanitas Clinical and Research Centre, Milan, Italy
| | - Roberta Furone
- Physiotherapy Unit, Humanitas Clinical and Research Centre, Milan, Italy.,BTS S.p.A., Milan, Italy
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Guido Grappiolo
- Hip and Knee Orthopaedic Surgery Department, Humanitas Clinical and Research Centre, Milan, Italy
| | - Roberto Gatti
- Humanitas University, Milan, Italy.,Physiotherapy Unit, Humanitas Clinical and Research Centre, Milan, Italy
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13
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van Duren BH, Royeca JM, Cunningham CM, Lamb JN, Brew CJ, Pandit H. Can the use of an inclinometer improve acetabular cup inclination in total hip arthroplasty? A review of the literature. Hip Int 2021; 31:609-617. [PMID: 32750263 PMCID: PMC8488637 DOI: 10.1177/1120700020946716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The angle of acetabular (cup) radiographic inclination is an important measurement in total hip arthroplasty (THA) procedures. Abnormal radiographic inclination is associated with dislocation, edge loading and higher failure rates. Consistently achieving a satisfactory radiographic inclination remains a challenge. Inclinometers have been increasingly used over the last decade. This paper reviews the literature to determine whether using an inclinometer improves the accuracy of acetabular cup inclination in THA. METHODS A systematic literature search was performed. The following search terms were used: ('hip' OR 'hip replacement' OR 'hip arthroplasty' OR 'primary hip replacement' OR 'THR' OR 'THA' OR 'Acetabular cup Inclination') AND ('Inclinometer'). Titles and abstracts were screened for relevance. Both radiographic and operative inclination comparisons were included. RESULTS 7 studies met the inclusion criteria. 2 were randomised control trials with level I evidence, and the remaining studies were cohort studies with level III/IV evidence. 5 were clinical and 2 experimental. In total there were 16 cohorts: 7 using an inclinometer, 6 freehand, and 3 using MAG techniques. All studies comparing radiographic inclination and 1 of 2 studies comparing operative inclination showed an improvement in the attainment of the optimal inclination. Similarly, the use of an inclinometer showed a reduction in the number of outliers when compared to MAG and freehand techniques. DISCUSSION This review demonstrates that using an inclinometer improved the surgeon's ability to achieve their intended inclination (both operative and radiographic) and reduced the incidence of positioning outside the safe-zone. However, only 2 of the studies were randomised control trials and these resulted in opposing conclusions. Therefore, further studies looking at the use of inclinometers would prove useful in understanding their true benefit.
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Affiliation(s)
- Bernard H van Duren
- Leeds Orthopaedic and Trauma Sciences, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK,Bernard H van Duren, Leeds Institute of Rheumatic and Musculoskeletal Medicine, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.
| | | | | | - Jonathan N Lamb
- Leeds Orthopaedic and Trauma Sciences, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Hemant Pandit
- Leeds Orthopaedic and Trauma Sciences, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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14
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Fowler LM, Nepple JJ, Devries C, Harris MD, Clohisy JC. Medialization of the Hip's Center with Periacetabular Osteotomy: Validation of Assessment with Plain Radiographs. Clin Orthop Relat Res 2021; 479:1040-1049. [PMID: 33861214 PMCID: PMC8052006 DOI: 10.1097/corr.0000000000001572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/19/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Periacetabular osteotomy (PAO) increases acetabular coverage of the femoral head and medializes the hip's center, restoring normal joint biomechanics. Past studies have reported data regarding the degree of medialization achieved by PAO, but measurement of medialization has never been validated through a comparison of imaging modalities or measurement techniques. The ilioischial line appears to be altered by PAO and may be better visualized at the level of the inferior one-third of the femoral head, thus, an alternative method of measuring medialization that begins at the inferior one-third of the femoral head may be beneficial. QUESTIONS/PURPOSES (1) What is the true amount and variability of medialization of the hip's center that is achieved with PAO? (2) Which radiographic factors (such as lateral center-edge angle [LCEA] and acetabular inclination [AI]) correlate with the degree of medialization achieved? (3) Does measurement of medialization on plain radiographs at the center of the femoral head (traditional method) or inferior one-third of the femoral head (alternative method) better correlate with true medialization? (4) Are intraoperative fluoroscopy images different than postoperative radiographs for measuring hip medialization? METHODS We performed a retrospective study using a previously established cohort of patients who underwent low-dose CT after PAO. Inclusion criteria for this study included PAO as indicated for symptomatic acetabular dysplasia, preoperative CT scan, and follow-up between 9 months and 5 years. A total of 333 patients who underwent PAO from February 2009 to July 2018 met these criteria. Additionally, only patients who were between 16 and 50 years old at the time of surgery were included. Exclusion criteria included prior ipsilateral surgery, femoroacetabular impingement (FAI), pregnancy, neuromuscular disorder, Perthes-like deformity, inadequate preoperative CT, and inability to participate. Thirty-nine hips in 39 patients were included in the final study group; 87% (34 of 39) were in female patients and 13% (5 of 39 hips) were in male patients. The median (range) age at the time of surgery was 27 years (16 to 49). Low-dose CT images were obtained preoperatively and at the time of enrollment postoperatively; we also obtained preoperative and postoperative radiographs and intraoperative fluoroscopic images. The LCEA and AI were assessed on plain radiographs. Hip medialization was assessed on all imaging modalities by an independent, blinded assessor. On plain radiographs, the traditional and alternative methods of measuring hip medialization were used. Subgroups of good and fair radiographs, which were determined by the amount of pelvic rotation that was visible, were used for subgroup analyses. To answer our first question, medialization of all hips was assessed via measurements made on three-dimensional (3-D) CT hip reconstruction models. For our second question, Pearson correlation coefficients, one-way ANOVA, and the Student t-test were calculated to assess the correlation between radiographic parameters (such as LCEA and AI) and the amount of medialization achieved. For our third question, statistical analyses were performed that included a linear regression analysis to determine the correlation between the two radiographic methods of measuring medialization and the true medialization on CT using Pearson correlation coefficients, as well as 95% confidence intervals and standard error of the estimate. For our fourth question, Pearson correlation coefficients were calculated to determine whether using intraoperative fluoroscopy to make medialization measurements differs from measurements made on radiographs. RESULTS The true amount of medialization of the hip center achieved by PAO in our study as assessed by reference-standard CT measurements was 4 ± 3 mm; 46% (18 of 39 hips) were medialized 0 to 5 mm, 36% (14 hips) were medialized 5 to 10 mm, and 5% (2 hips) were medialized greater than 10 mm. Thirteen percent (5 hips) were lateralized (medialized < 0 mm). There were small differences in medialization between LCEA subgroups (6 ± 3 mm for an LCEA of ≤ 15°, 4 ± 4 mm for an LCEA between 15° and 20°, and 2 ± 3 mm for an LCEA of 20° to 25° [p = 0.04]). Hips with AI ≥ 15° (6 ± 3 mm) achieved greater amounts of medialization than did hips with AI of < 15° (2 ± 3 mm; p < 0.001). Measurement of medialization on plain radiographs at the center of the femoral head (traditional method) had a weaker correlation than using the inferior one-third of the femoral head (alternative method) when compared with CT scan measurements, which were used as the reference standard. The traditional method was not correlated across all radiographs or only good radiographs (r = 0.16 [95% CI -0.17 to 0.45]; p = 0.34 and r = 0.26 [95% CI -0.06 to 0.53]; p = 0.30), whereas the alternative method had strong and very strong correlations when assessed across all radiographs and only good radiographs, respectively (r = 0.71 [95% CI 0.51 to 0.84]; p < 0.001 and r = 0.80 [95% CI 0.64 to 0.89]; p < 0.001). Measurements of hip medialization made on intraoperative fluoroscopic images were not found to be different than measurements made on postoperative radiographs (r = 0.85; p < 0.001 across all hips and r = 0.90; p < 0.001 across only good radiographs). CONCLUSION Using measurements made on preoperative and postoperative CT, the current study demonstrates a mean true medialization achieved by PAO of 4 mm but with substantial variability. The traditional method of measuring medialization at the center of the femoral head may not be accurate; the alternate method of measuring medialization at the lower one-third of the femoral head is a superior way of assessing the hip center's location. We suggest transitioning to using this alternative method to obtain the best clinical and research data, with the realization that both methods using plain radiography appear to underestimate the true amount of medialization achieved with PAO. Lastly, this study provides evidence that the hip center's location and medialization can be accurately assessed intraoperatively using fluoroscopy. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Lucas M Fowler
- L. M. Fowler, J. J. Nepple, C. Devries, J. C. Clohisy, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
- M. D. Harris, Department of Physical Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - Jeffrey J Nepple
- L. M. Fowler, J. J. Nepple, C. Devries, J. C. Clohisy, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
- M. D. Harris, Department of Physical Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - Clarabelle Devries
- L. M. Fowler, J. J. Nepple, C. Devries, J. C. Clohisy, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
- M. D. Harris, Department of Physical Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael D Harris
- L. M. Fowler, J. J. Nepple, C. Devries, J. C. Clohisy, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
- M. D. Harris, Department of Physical Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - John C Clohisy
- L. M. Fowler, J. J. Nepple, C. Devries, J. C. Clohisy, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
- M. D. Harris, Department of Physical Therapy, Washington University in St. Louis, St. Louis, MO, USA
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15
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Developmental Hip Dysplasia Treated with Cementless Total Hip Arthroplasty Using a Straight Stem and a Threaded Cup-A Concise Follow-Up, At a Mean of Twenty-Three Years. J Clin Med 2021; 10:jcm10091912. [PMID: 33924980 PMCID: PMC8124514 DOI: 10.3390/jcm10091912] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/24/2022] Open
Abstract
We previously reported the 9-year follow-up results of 121 cementless total hip arthroplasties (THAs) from 1990 to 1994 in 93 patients with developmental dysplasia of the hip (DDH). The present study reports the updated long-term results after a mean follow-up of 23 years. Fifty-seven patients (72 hips) were alive and available for follow-up. Since our previous report, nine THAs had been revised. The cumulative implant survivorship of any component was 87% (95% CI, 78–92%). The cumulative probability of not having aseptic cup loosening was 87% (95% CI, 77–93%) and there was no revision surgery for aseptic stem loosening. In three hips (5%), an exchange of the ball and liner due to polyethylene wear was performed after a mean of 12 years. This study demonstrates that cementless THA for DDH with restoration of the hip joint center provides excellent long-term durability.
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16
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Restoration of the hip geometry after two-stage exchange with intermediate resection arthroplasty for periprosthetic joint infection. Sci Rep 2021; 11:5221. [PMID: 33664369 PMCID: PMC7933341 DOI: 10.1038/s41598-021-84692-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/11/2021] [Indexed: 11/13/2022] Open
Abstract
Two-stage exchange with intermediate resection arthroplasty (RA) is a well-established surgical procedure in the treatment of chronic periprosthetic joint infection (PJI), whereby a higher failure rate of final hip geometry restoration due to tissue contraction is controversially discussed. The aim was to evaluate radiographic changes of hip geometry parameters during PJI treatment and to determine the impact of the intermediate RA on the final joint restoration after reimplantation of a total hip arthroplasty (reTHA). Radiographic parameters (leg length (LL), femoral offset (FO), horizontal/vertical acetabular center of rotation distance (h/vCORD)) of 47 patients (mean age: 64.1 years) were measured on standard radiographs of the pelvis and compared between four different stages during PJI treatment (pre-replacement status (preTHA), primary total hip arthroplasty (pTHA), RA and reTHA). The RA duration (mean: 10.9 months) and the number of reoperations during this period (mean: n = 2.0) as well as their impact on hip geometry restoration were evaluated. Between preTHA and pTHA/reTHA an equivalent restoration was measured regarding the FO (p < 0.001/p < 0.001) and hCORD (p = 0.016/p < 0.001), but not regarding the LL and vCORD. In contrast, analysis revealed no influence of RA and an equivalent reconstruction of LL (p = 0.003), FO (p < 0.001), v/hCORD (p = 0.039/p = 0.035) at reTHA compared to pTHA. Furthermore, RA duration (p = 0.053) and the number of reoperations after RA (p = 0.134) had no impact on radiographic hip geometry restoration. The two-stage exchange with intermediate RA does not alter the preexisting hip joint parameters, whereby a good restoration of the final hip geometry, independent of the duration or the number of reoperations, can be achieved.
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17
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Goto E, Umeda H, Otsubo M, Teranishi T. Cemented acetabular component with femoral neck autograft for acetabular reconstruction in Crowe type III dislocated hips. Bone Joint J 2021; 103-B:299-304. [PMID: 33517728 PMCID: PMC7954189 DOI: 10.1302/0301-620x.103b2.bjj-2020-1214.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIMS Various surgical techniques have been described for total hip arthroplasty (THA) in patients with Crowe type III dislocated hips, who have a large acetabular bone defect. The aim of this study was to evaluate the long-term clinical results of patients in whom anatomical reconstruction of the acetabulum was performed using a cemented acetabular component and autologous bone graft from the femoral neck. METHODS A total of 22 patients with Crowe type III dislocated hips underwent 28 THAs using bone graft from the femoral neck between 1979 and 2000. A Charnley cemented acetabular component was placed at the level of the true acetabulum after preparation with bone grafting. All patients were female with a mean age at the time of surgery of 54 years (35 to 68). A total of 18 patients (21 THAs) were followed for a mean of 27.2 years (20 to 33) after the operation. RESULTS Radiographs immediately after surgery showed a mean vertical distance from the centre of the hip to the teardrop line of 21.5 mm (SD 3.3; 14.5 to 30.7) and a mean cover of the acetabular component by bone graft of 46% (SD 6%; 32% to 60%). All bone grafts united without collapse, and only three acetabular components loosened. The rate of survival of the acetabular component with mechanical loosening or revision as the endpoint was 86.4% at 25 years after surgery. CONCLUSION The technique of using autologous bone graft from the femoral neck and placing a cemented acetabular component in the true acetabulum can provide good long-term outcomes in patients with Crowe type III dislocated hips. Cite this article: Bone Joint J 2021;103-B(2):299-304.
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Affiliation(s)
- Eiji Goto
- Department of Orthopaedic Surgery, Toyooka Chuou Hospital, Asahikawa, Japan
| | - Hirotsugu Umeda
- Department of Orthopaedic Surgery, Toyooka Chuou Hospital, Asahikawa, Japan
| | - Makoto Otsubo
- Department of Orthopaedic Surgery, Toyooka Chuou Hospital, Asahikawa, Japan
| | - Tadashi Teranishi
- Department of Orthopaedic Surgery, Toyooka Chuou Hospital, Asahikawa, Japan
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18
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Deep K, Prabhakara A, Mohan D, Mahajan V, Sameer M. Orientation of Transverse Acetabular Ligament With Reference to Anterior Pelvic Plane. Arthroplast Today 2021; 7:1-6. [PMID: 33521189 PMCID: PMC7818603 DOI: 10.1016/j.artd.2020.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/22/2020] [Accepted: 11/22/2020] [Indexed: 11/21/2022] Open
Abstract
Background Transverse acetabular ligament (TAL) is a 3-dimensional structure which cannot be defined by a single plane. Therefore, we aimed at describing the orientation of different parts of TAL with respect to anterior pelvic plane (APP) and correlate it with gender, body mass index (BMI), and Lewinnek’s safe zone. Methods A total of 109 consecutive patients undergoing imageless navigated THA were prospectively studied. Computer navigation was used as the measurement tool. APP was registered for navigation. After excision of osteophytes, a trial component matching the size of unreamed acetabular cavity was aligned with acetabular rim, outer and inner margins, and middle of TAL to record cup orientation with computer tracker. Results Ninety-nine patients (41 males and 58 females, mean BMI of 28.8kg/m2) were studied after applying exclusion criteria. Mean acetabular inclination was 55.15°, 53.00°, 47.70°, and 42.60° respectively, for acetabular rim, outer, middle, and inner margins of the TAL. Corresponding mean acetabular anteversion was 6.63°, 7.41°, 11.23° and 14.90°respectively. Overall, 17.17%, 28.28%, 47.47% and 71.71% of cup orientation corresponding to acetabular rim, outer, middle, and inner margin of TAL respectively, were within Lewinnek’s safe zone. No association was established between BMI and acetabular orientation. Males had overall lesser anteversion than females. Conclusion We describe orientation of outer, middle, and inner margins of TAL, as reference planes for TAL, in relation to APP. The anteversion differs significantly with gender. A knowledge about these will assist surgeon in component placement during THA, with inner margin of TAL providing the best chance of orientation out of the studied landmarks.
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Affiliation(s)
- Kamal Deep
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Glasgow, UK
| | - Anjan Prabhakara
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Glasgow, UK
- Corresponding author. Golden Jubilee National Hospital, Agamemnon Street, G81 4DY, Glasgow, UK. Tel.: +44 7311195584.
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vivek Mahajan
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Glasgow, UK
| | - Mohamed Sameer
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Glasgow, UK
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19
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van Duren BH, Al Ashqar M, Lamb JN, Pandit HG, Brew C. A novel mechanical inclinometer device to measure acetabular cup inclination in total hip arthroplasty. J Med Eng Technol 2020; 44:481-488. [PMID: 33118407 DOI: 10.1080/03091902.2020.1825846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
It is well recognised that acetabular cup orientation influences patient function and implant survival post-THR. Reliable intra-operative determination of cup orientation remains a challenge. We describe the design and testing of a novel mechanical inclinometer to measure intra-operative acetabular cup inclination. The aim was to design a generic inclinometer to measure acetabular inclination to within + 5° without requiring modification to existing instrumentation while remaining easy to handle, robust/reusable, and sterilizable. The device was drafted using CAD software, prototyped using a 3D printer and constructed using stainless steel. Two experiments were undertaken to test accuracy: (1) the absolute accuracy was tested; (2) placement of an acetabular component using the device was compared to a freehand technique using a sawbone pelvis. 18 surgeons were asked to place an uncemented acetabular cup in a saw bone pelvis to a target of 40°. The average root-mean-square error was 1.1° (SD: 0.9°). Comparison showed that with the freehand component placement 50% of the surgeons were outside the specified range (35°-45°) where all participants achieved placement within range when using the inclinometer. This work demonstrates that the design and initial testing of a mechanical inclinometer which is suitable for use in determining the acetabular cup inclination in THR.
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Affiliation(s)
- B H van Duren
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - J N Lamb
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - H G Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - C Brew
- Bradford Royal Infirmary, Bradford, UK
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Liu T, Yang Y, Shen X, Xiao J, Zuo J, Gao Z. Comparison of two different on-shelf femoral stems for Crowe type IV developmental dysplasia of the hip. J Int Med Res 2020; 48:300060520947888. [PMID: 32808568 PMCID: PMC7436795 DOI: 10.1177/0300060520947888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study was performed to evaluate the proximal anatomical compatibility of stems for treatment of Crowe IV developmental dysplasia of the hip (DDH) using a previously developed three-dimensional comparison technique. Methods Patients with Crowe IV DDH who underwent computed tomography were retrospectively analyzed. The femoral medullary canals were three-dimensionally reconstructed, and models of cementless modular (S-ROM; DePuy Synthes) and conical (Wagner Cone; Zimmer Biomet) implants were used for virtual implantation. The negative point percentages (NPPs) were applied to verify fitting. The average distance (deviation) and the root mean square of the distance (RMSd) were used to quantify geometric compatibilities. Results Four (16.7%) and 12 (50.0%) femoral medullary canals could not be fitted properly with either the modular or conical implant. The NPPs in the distal comparison region were significantly greater in the conical than modular group. The deviation was significantly smaller in the modular than conical group. The RMSd was also significantly smaller in the modular than conical group. Conclusions Compared with conical implants, modular implants might be more effectively used in patients with Crowe type IV DDH. However, some Crowe IV DDH femurs with severe deformity cannot be fitted with either of these two on-shelf implants.
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Affiliation(s)
- Tong Liu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Yuhui Yang
- Department of Orthopaedics, Guangdong General Hospital (Guangdong Academy of Medical Sciences), Guangzhou, Guangdong, China
| | - Xianyue Shen
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Jianlin Xiao
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Jianlin Zuo
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Zhongli Gao
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
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Shen J, Sun J, Ma H, Du Y, Li T, Zhou Y. High Hip Center Technique in Total Hip Arthroplasty for Crowe Type II-III Developmental Dysplasia: Results of Midterm Follow-up. Orthop Surg 2020; 12:1245-1252. [PMID: 32776482 PMCID: PMC7454156 DOI: 10.1111/os.12756] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/13/2020] [Accepted: 06/21/2020] [Indexed: 12/19/2022] Open
Abstract
Objectives We aimed to show the utility of high hip center technique used in patients with Crowe II–III developmental dysplasia of the hip at the midterm follow‐up and evaluated the clinical and radiographic results between different heights of hip center. Methods From December 2003 to November 2013, we retrospectively evaluated 69 patients (85 hips) with Crowe II–III dysplasia who underwent a high hip center cementless total hip arthroplasty. The patients were divided into two groups according to the height of hip center, respectively group A (≥ 22 mm and < 28 mm) and group B (≥28 mm). The survivorship outcomes and radiographic and clinical results, including the vertical and horizontal distances of hip center, femoral offset, abductor lever arm, cup inclination, leg length discrepancy, Trendelenburg sign, and limp were evaluated. Results The mean follow‐up time was 8.9 ± 1.8 years. The mean location of the hip center from the inter‐teardrop was 25.1 ± 1.6 mm vertically and 30.0 ± 3.8 mm horizontally in group A, and 33.1 ± 4.8 mm vertically and 31.4 ± 6.1 mm horizontally in group B. Eleven hips of group B showed a lateralization over 10 mm, and the same was shown in one hip in group A (P = 0.012). There were no statistically significant differences between two groups in postoperative femoral offset, abductor lever arm, leg length discrepancy and cup inclination. At the final follow up, the mean WOMAC and Harris hip score were significantly improved in both groups. Of the 85 hips, four hips in group A and three hips in group B showed a positive Trendelenburg sign. Additionally, four patients in group A and two patients in group B presented with a limp. No significant differences were shown regarding the Harris hip score, WOMAC score, Trendelenburg sign, and limp between two groups. One hip of group A was revised by reason of dislocation at 8.3 years after surgery. One hip of group B was diagnosed with osteolysis and underwent a revision at 8.1 years after surgery. The Kaplan–Meier implants survivorship rates at the final follow‐up for all‐causes revisions in group A and group B were similar (96.7% [95% confidence interval, 90.5%–100%] and 96.2% [95% confidence interval, 89.0%–100%], respectively). Conclusions The high hip center technique is a valuable alternative to achieve excellent midterm results for Crowe II–III developmental dysplasia of the hip. Further, between the groups with differing degrees of HHC, there were no significant differences in outcomes or survivorship in our study.
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Affiliation(s)
- Junmin Shen
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jingyang Sun
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Haiyang Ma
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yinqiao Du
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Tiejian Li
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yonggang Zhou
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
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Implant positioning among the surgical approaches for total hip arthroplasty: a Bayesian network meta-analysis. Arch Orthop Trauma Surg 2020; 140:1115-1124. [PMID: 32361952 DOI: 10.1007/s00402-020-03448-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Although there is anatomical individuality among patients, some standardized requirements for component orientation for total hip arthroplasty (THA) exist. To date, no study has compared implant positioning using a network meta-analysis (NMA). Hence, the purpose of this study was to perform a NMA comparing implant positioning among the various approaches for THA. METHODS This study was conducted according to the PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions. All randomized (RCT) and non-randomized (nRCT) clinical trials comparing two or more different approaches for THA were considered for inclusion. For the statistical analysis, the STATA Software/ MP, Version 14.1 (Stata Corporation, College Station, Texas, USA) was used. The NMA was performed through a Stata routine for Bayesian hierarchical random-effects model analysis. RESULTS We enrolled in the present study, a total of 4060 patients, with a mean of 17.84 ± 16.41 months follow-up. The patient baseline data were very homogeneous across the groups concerning age (P = 0.91), sex (P = 0.52), and BMI (P = 0.83). Concerning the cup anteversion, the anterolateral approach reported the value closest to the reference value. The test for overall inconsistency, however, was not statistically significant (P = 0.30). Concerning cup inclination, the lateral approach reported the value closest to the reference value. The test for overall inconsistency was statistically significant (P = 0.01). CONCLUSION The anterolateral approach for total hip arthroplasty detected the best femoral stem alignment and cup anteversion. Data concerning cup inclination detected no sufficient transitivity to draw consistent conclusions.
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23
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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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Trevisan C, Klumpp R, Piscitello S, Compagnoni R, Grattieri R, Cazzaniga C. Biomechanical reconstruction parameters obtained after direct anterior approach total hip arthroplasty do not compromise clinical outcome. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1463-1470. [PMID: 32613469 DOI: 10.1007/s00590-020-02727-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/25/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Accurate reconstruction of biomechanical parameters following total hip arthroplasty (THA) is crucial for good joint function. We investigated how reconstruction parameters achieved by minimally invasive anterior (MIS) THA may influence function and patient-related outcomes. METHODS A consecutive series of 95 patients treated by MIS THA for primary osteoarthritis were retrospectively reviewed. Primary outcome measures were Harris Hip Score (HHS), hip disability and osteoarthritis outcome score (HOOS) and EQ-5D. Femoral offset (FO), abductor lever arm (ALA), centre of rotation (CoR), leg length discrepancy (LLD), cup version and stem alignment were measured pre- and post-operatively. Obtained reconstruction parameters compared to the contralateral hip were used as independent variables in a multivariate regression with each primary outcome measure as dependent variable. RESULTS Mean age at surgery was 69 years. HHS rated 94.7% of patients as good/excellent and mean EQ-5D was 0.82. Post-operative HOOS subscales showed no statistical difference compared to the Italian benchmark population. Stem alignment averaged 0.2° valgus, mean cup inclination was 37.8° and mean anteversion was 12.8°. When compared to the contralateral side, CoR was post-operatively elevated by 2.6 mm and medialized by 2.4 mm averagely. An average FO reduction of -0.5 mm was observed while FO ratio increased by 1.9% averagely. ALA decreased by -3.3 mm while LLD was 2.3 mm averagely. Multivariate regression analysis revealed a significant contribution of ALA to HHS only. CONCLUSIONS Biomechanical parameters achieved by MIS THA are satisfactory with negligible impact on functional results and no impact on patient-related outcomes certifying the high quality achieved in THA.
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Affiliation(s)
- Carlo Trevisan
- Orthopaedics and Traumatology of the University of Milano-Bicocca, Milano, Italy
- Orthopaedics and Traumatology of the Hospital ASST Bergamo Est, Via Paderno 21, 24068, Seriate (Bergamo), Italy
| | - Raymond Klumpp
- Orthopaedics and Traumatology of the Hospital ASST Bergamo Est, Via Paderno 21, 24068, Seriate (Bergamo), Italy.
| | - Stefano Piscitello
- Orthopaedics and Traumatology of the Hospital ASST Bergamo Est, Via Paderno 21, 24068, Seriate (Bergamo), Italy
| | - Riccardo Compagnoni
- Orthopaedics and Traumatology of the University of Milano, ASST "Gaetano Pini"-CTO, Piazza Ferrari 1, 20122, Milano, Italy
| | | | - Carlo Cazzaniga
- Orthopaedics and Traumatology, ASST Rhodense Ospedale Guido Salvini, Viale Forlanini, 95, 20024, Garbagnate Milanese (MI), Italy
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Kazarian GS, Schloemann DT, Barrack TN, Lawrie CM, Barrack RL. Pelvic rotation after total hip arthroplasty is dynamic and variable. Bone Joint J 2020; 102-B:47-51. [PMID: 32600205 DOI: 10.1302/0301-620x.102b7.bjj-2019-1614.r2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS The aims of this study were to determine the change in the sagittal alignment of the pelvis and the associated impact on acetabular component position at one-year follow-up after total hip arthroplasty (THA). METHODS This study represents the one-year follow-up of a previous short-term study at our institution. Using the patient population from our prior study, the radiological pelvic ratio was assessed in 91 patients undergoing THA, of whom 50 were available for follow-up of at least one year (median 1.5; interquartile range (IQR) 1.1 to 2.0). Anteroposterior radiographs of the pelvis were obtained in the standing position preoperatively and at one year postoperatively. Pelvic ratio was defined as the ratio between the vertical distance from the inferior sacroiliac (SI) joints to the superior pubic symphysis and the horizontal distance between the inferior SI joints. Apparent acetabular component position changes were determined from the change in pelvic ratio. A change of at least 5° was considered clinically meaningful. RESULTS Pelvic ratio decreased (posterior tilt) in 54.0% (27) of cases, did not change significantly in 34.0% (17) of cases, and increased (anterior tilt) in 12.0% (6) of cases when comparing preoperative to one-year postoperative radiographs. This would correspond with 5° to 10° of abduction error in 22.0% of cases and > 10° of error in 6.0%. Likewise, this would correspond with 5° to 10° of version error in 22.0% of cases and > 10° of error in 44.0%. CONCLUSION Pelvic sagittal alignment is dynamic and variable after THA, and these changes persist to the one-year postoperative period, altering the orientation of the acetabular component. Surgeons who individualize the acetabular component placement based on preoperative functional radiographs should consider that the rotation of the pelvis (and thus the component version and inclination) changes one year postoperatively. Cite this article: Bone Joint J 2020;102-B(7 Supple B):47-51.
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Affiliation(s)
- Gregory S Kazarian
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri, USA
| | - Derek T Schloemann
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri, USA
| | - Toby N Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri, USA
| | - Charles M Lawrie
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri, USA
| | - Robert L Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri, USA
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Kobayashi H, Cech A, Kase M, Pagenstart G, Carrillon Y, O'Loughlin PF, Bothorel H, Aït-Si-Selmi T, Bonnin MP. Pre-operative templating in THA. Part II: a CT-based strategy to correct architectural hip deformities. Arch Orthop Trauma Surg 2020; 140:551-562. [PMID: 31974697 DOI: 10.1007/s00402-020-03341-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Pre-operative templating for total hip arthroplasty (THA) remains inaccurate due to improper magnification and alignment. We aimed to describe an improved templating strategy using computed tomography (CT) to predict component sizes and offsets with greater accuracy. MATERIALS AND METHODS We analysed 184 CT images acquired for pre-operative templating of primary THA. We aimed to restore native (pre-arthritic) femoral offset and limb length, by raising the head center to the level of the templated cup center cranio-caudally, but maintaining the pathologic (pre-operative) head center medio-laterally (except in medialized hips). Acetabular offset (AO) and femoral offset (FO) were measured on pre-operative CT scans, during acetate templating, and on post-operative true antero-posterior radiographs. RESULTS The post-operative offsets were within ± 5 mm from templated estimates in 174 hips (91%) for AO, in 116 hips (61%) for FO, in 111 hips (58%) for GO, and in 134 hips (70%) for neck cut level. The post-operative hip architecture reproduced the templated hip architecture within ±5 mm in 77 hips (40%). The agreement between planned and post-operative parameters was moderate for stem size (0.57), cup size (0.62), AO (0.50), but fair for FO (0.45). The AO decreased in most arthritic types, notably in lateralized hips (6.6 mm), but remained unchanged in medialized hips. The FO increased in most arthritic types (1.8-3.1 mm) but remained unchanged in medialized and lateralized hips. CONCLUSIONS We described a strategy for pre-operative templating in THA. Despite the accuracy of CT, the authors found significant variations between planned and post-operative reconstructions, which suggest that pre-operative templating should only be used as an approximate guide.
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Affiliation(s)
- Hideo Kobayashi
- Department of Orthopaedic Surgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Alexandre Cech
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Masanori Kase
- Department of Orthopaedic Surgery, Nissan Tamagawa Hospital, Setagayaku, Tokyo, Japan
| | - Geert Pagenstart
- Department of Clinical Research, University of Basel, Basel, Switzerland.,Clarahof Clinic of Orthopaedic Surgery, Merian-Iselin-Hospital Swiss Olympic Medical Center, Basel, Switzerland.,Knee Institute Basel, Basel, Switzerland
| | - Yannick Carrillon
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Padhraig F O'Loughlin
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.,Cork University Hospital, South Infirmary, Victoria University Hospital, Mater Private Cork, Cork, Ireland
| | - Hugo Bothorel
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Tarik Aït-Si-Selmi
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.,Artro Institute, Lyon, France
| | - Michel P Bonnin
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.,Artro Institute, Lyon, France
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27
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Cheng R, Zhang H, Kernkamp WA, Zheng J, Dai K, Yao Y, Wang L, Tsai TY. Relations between the Crowe classification and the 3D femoral head displacement in patients with developmental dysplasia of the hip. BMC Musculoskelet Disord 2019; 20:530. [PMID: 31711458 PMCID: PMC6849202 DOI: 10.1186/s12891-019-2838-z] [Citation(s) in RCA: 5] [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] [Received: 06/25/2019] [Accepted: 09/20/2019] [Indexed: 11/19/2022] Open
Abstract
Background The purpose of this study was to investigate the relationship between the three dimensional (3D) femoral head displacement in patients with developmental dysplasia of the hip (DDH) and Crowe classification. Methods Retrospectively, CT scans of 60 DDH patients and 55 healthy demography-matched healthy control subjects were analyzed. Using the anterior pelvic plane a pelvic anatomic coordinate system was established. The center coordinates of the femoral heads of both the DDH patients and control subjects were quantified relative to the pelvic coordinate system and were mapped proportionally to a representative normal pelvis for comparison. Results In the anteroposterior (AP) direction, the center of the femoral head was significantly more anterior in the DDH patients (type I, II, and III, respectively45.0 ± 5.5, 42.9 ± 7.1, and 43.9 ± 4.6 mm) when compared to the controls (50.0 ± 5.2 mm) (p < 0.001 for all). In the medial-lateral (ML) direction, the center of the femoral head was significantly more lateral in the DDH patients (type I, II, and III =103.5 ± 8.6, 101.5 ± 6.6, 102.1 ± 11.2 mm) when compared to the controls (87.5 ± 5.1 mm) (p < 0.001 for all). In the superior-inferior (SI) direction, the center of the femoral head was significantly more proximal in the DDH patients (type I, II, and III =62.4 ± 7.3, 50.0 ± 6.3, and 43.2 ± 6.6 mm) when compared to the controls (66.0 ± 6.2 mm) (p < 0.001 for all). Conclusions The severity of DDH using the Crowe classification was related to the degree of the femoral head displacement in the SI direction, but not in the ML or AP directions. By assessing the 3D femoral head displacement in DDH patients, individualized component positioning might benefit surgical outcome.
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Affiliation(s)
- Rongshan Cheng
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Henghui Zhang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Willem Alexander Kernkamp
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Jingmao Zheng
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China.,Guangxi Clinical Research Center for Digital Medicine and 3D Printing, Guigang City People's Hospital, Guangxi, 537100, China
| | - Kerong Dai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China.,Engineering Research Center of Clinical Translational Digital Medicine, Ministry of Education of P.R. China, Shanghai, 200030, China
| | - Yifei Yao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China.,Engineering Research Center of Clinical Translational Digital Medicine, Ministry of Education of P.R. China, Shanghai, 200030, China
| | - Liao Wang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China.
| | - Tsung-Yuan Tsai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China. .,Engineering Research Center of Clinical Translational Digital Medicine, Ministry of Education of P.R. China, Shanghai, 200030, China.
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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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Shoji T, Yamasaki T, Izumi S, Kenji M, Sawa M, Yasunaga Y, Adachi N. The effect of cup medialization and lateralization on hip range of motion in total hip arthroplasty. Clin Biomech (Bristol, Avon) 2018; 57:121-128. [PMID: 29986274 DOI: 10.1016/j.clinbiomech.2018.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 06/18/2018] [Accepted: 06/22/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is little description of the effect of cup position on the hip range of motion in total hip arthroplasty. The purpose is to evaluate the effect of cup medialization/lateralization with a compensatory increase/decrease in femoral offset on the hip range of motion, and whether the bone morphology of the anterior inferior iliac spine affects hip range of motion in total hip arthroplasty. METHODS Using the CT data of 100 patients (male; 30, female; 70), 3D-dynamic motion analysis was performed in four scenarios with cup medialization/lateralization with the same/decreased global offset. We calculated the range of motion before component impingement and bony impingement in flexion, internal rotation and external rotation using the software. Furthermore, we measured bony morphological features of anterior inferior iliac spine, and we analyzed the correlations among them. FINDINGS We found that the cup medialization with the same stem offset had negative effects on hip range of motion in flexion and internal rotation due to bony impingement, whereas cup medialization caused external rotation to significantly decrease with the same global offset. On the other hand, cup lateralization with the same global offset had negative effects on flexion and internal rotation, whereas external rotation increased. Furthermore, there were negative correlations among flexion and laterally large and steep anterior inferior iliac spine. INTERPRETATION Our results demonstrated that the advantage of cup medialization can depend on the individual anatomy such as bony morphology of anterior inferior iliac spine in flexion.
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Affiliation(s)
- Takeshi Shoji
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Soutarou Izumi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Mifuji Kenji
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Mikiya Sawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-town, Higashi-hiroshima 739-0036, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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Ozden VE, Dikmen G, Beksac B, Tozun IR. Long-term retrospective study on the placement of the cementless acetabular cup and clinical outcomes in patients undergoing femoral head autografting for hip dysplasia and total hip arthroplasty. J Orthop Sci 2018; 23:525-531. [PMID: 29503037 DOI: 10.1016/j.jos.2018.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 01/02/2018] [Accepted: 02/12/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Placement of acetabular cup in the dysplastic hip is a challenging procedure. Using bulk femoral head autograft to increase the bony coverage of the cup is one of the techniques, which have been described. The impact of cup position on cup and autograft survival is a controversial issue. We aimed to determine whether the position of cementless acetabular cup used in conjunction with femoral head autograft in dysplastic hips affected the autograft-host incorporation with its final radiographic appearance and the cup survivorship into the second decade. METHODS Thirty-eight dysplastic hips with varying Crowe types in 31 patients (30 women and one man) were included. The mean age was 47 years (range, 29-64 years) and the mean follow-up was 20.3 years (range, 14.8-25.9 years). The initial postoperative and final radiographs were evaluated. The survival rate of the cups was analysed using Kaplan-Meier statistics and the log-rank test. Multivariate analysis was used to evaluate the effect of variables (Crowe type, radiographic initial host bone coverage over the cup and position of the cup) on survivorship. RESULTS The acetabular cups were positioned anatomical in 27/38 hips according to Ranawat measurement technique. Trabecular bridging at graft-host interface was seen in all cases at an average 22.1 months. Neither acetabular cup position nor initial host bone coverage over acetabular cup less than 50% had any significant effect on either cup survival or final radiographic appearance of the graft. The 20-year cup survival rate without aseptic revision was 66% (95 CI, 52%-84%). No revision was performed due to graft resorption. CONCLUSION Twenty-year survival rate of the cementless cup combination with femoral head autograft showed no significant differences whether it was placed at high or anatomic hip centre. The final radiographic appearance of the autograft was not affected from either the cup location or the initial radiographic horizontal host bone coverage.
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Affiliation(s)
- Vahit Emre Ozden
- Acibadem University, Faculty of Medicine, Acibadem Maslak Hospital, Department of Orthopedics and Traumatology, Maslak, 34457, Istanbul, Turkey.
| | - Goksel Dikmen
- Acibadem University, Faculty of Medicine, Acibadem Maslak Hospital, Department of Orthopedics and Traumatology, Maslak, 34457, Istanbul, Turkey
| | - Burak Beksac
- Acibadem University, Faculty of Medicine, Acibadem Maslak Hospital, Department of Orthopedics and Traumatology, Maslak, 34457, Istanbul, Turkey
| | - Ismail Remzi Tozun
- Acibadem University, Faculty of Medicine, Acibadem Maslak Hospital, Department of Orthopedics and Traumatology, Maslak, 34457, Istanbul, Turkey
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Kim SC, Lim YW, Kwon SY, Jo WL, Ju SH, Park CJ, Lee CW, Kim YS. Level of surgical experience is associated with change in hip center of rotation following cementless total hip arthroplasty: A radiographic assessment. PLoS One 2017; 12:e0178300. [PMID: 28542504 PMCID: PMC5443567 DOI: 10.1371/journal.pone.0178300] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 05/10/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives After total hip arthroplasty (THA), restoration of hip center of rotation (COR) is essential to ensure stability of the prosthetic hip and longevity of the prosthesis. Our aim was to determine whether, and how, the COR changed postoperatively compared to the native COR following implantation of a cementless acetabular component in anatomical position and to compare the accuracy of cup placement between two surgeons with different levels of surgical experience. Materials and methods We evaluated 145 patients (145 hips) who underwent unilateral primary THA, who had no distorted acetabulum on the affected hip and a normal contralateral hip. Hip reconstruction was radiologically and clinically assessed at a minimum 2-year follow-up. Perioperative change in COR, initial cup position, offset, leg-length discrepancy (LLD), radiographic cup orientation, Harris Hip Score (HHS), component loosening, and dislocations were compared between the highly experienced surgeon and less-experienced surgeon groups. Results The COR was significantly displaced in the superior and medial directions postoperatively. Significant differences were identified in the vertical COR change, initial cup position, LLD, cup inclination, and cups within safe zones, but not in the horizontal COR change, offset parameters, cup anteversion, or HHS. There were no radiographic evidence of component loosening in both groups, but three dislocations (7%) only in the group operated on by the less-experienced surgeon (p = 0.027). Conclusions We found that the postoperative COR tended to be displaced in the superior and medial directions, and that the level of surgical experience strongly affected the accuracy and consistency of cup placement, particularly in COR position and cup inclination.
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Affiliation(s)
- Seung-Chan Kim
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young-Wook Lim
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Soon-Yong Kwon
- Department of Orthopaedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Woo-Lam Jo
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Hun Ju
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chan-Joo Park
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Choong-Woo Lee
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yong-Sik Kim
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- * E-mail:
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Abstract
Being one of the most successful surgeries in the history of medicine, the indications for total hip arthroplasty have widened and are increasingly being offered to younger and fitter patients. This has also led to high expectations for longevity and outcomes. Acetabular cup position has a significant impact on the results of hip arthroplasty as it affects dislocation, abductor muscle strength, gait, limb lengths, impingement, noise generation, range of motion (ROM), wear, loosening, and cup failure. The variables in cup position are depth, height, and angular position (anteversion and inclination). The implications of change in depth of center of rotation (COR) are medialized versus anatomical positioning. As opposed to traditional medialization with beneficial effects on joint reaction force, the advantages of an anatomical position are increasingly recognized. The maintained acetabular offset offers advantages in terms of ROM, impingement, cortical rim press fit, and maintaining medial bone stock. The height of COR influences muscle activity and limb lengths and available bone stock for cup support. On the other hand, ideal angular position remains a matter of much debate and reliably achieving a target angular position remains elusive. This is not helped by variations in the way we describe angular position, with operative, radiologic, or anatomic definitions being used variably to describe anteversion and inclination. Furthermore, pelvic tilt plays a major role in functional positions of the acetabulum. In addition, commonly used techniques of positioning often do not inform us of the real orientation of the pelvis on operating table, with possibility of significant adduction, flexion, and external rotation of the pelvis being possibilities. This review article brings together the evidence on cup positioning and aims to provide a systematic and pragmatic approach in achieving the best position in individual cases.
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Affiliation(s)
- Deepu Bhaskar
- Department of Trauma and Orthopaedics, Centre for Hip Surgery, Wrightington Hospital, Hall Lane, Appley Bridge, Lancashire WN6 9EP, UK
| | - Asim Rajpura
- Department of Trauma and Orthopaedics, Centre for Hip Surgery, Wrightington Hospital, Hall Lane, Appley Bridge, Lancashire WN6 9EP, UK
| | - Tim Board
- Department of Trauma and Orthopaedics, Centre for Hip Surgery, Wrightington Hospital, Hall Lane, Appley Bridge, Lancashire WN6 9EP, UK,Address for correspondence: Prof. Tim Board, Centre for Hip Surgery, Wrightington Hospital, Hall Lane, Appley Bridge, Lancashire WN6 9EP, UK. E-mail:
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Kim SC, Lim YW, Kwon SY, Lee JK, Park IK, Kim YS. Comparative Analysis of Radiographic Hip Joint Geometry Using Measurement Tools on Picture Archiving and Communication System: A Prospective Study of 100 Pelvic Radiographs of Koreans. J Arthroplasty 2016; 31:2597-2602. [PMID: 27267227 DOI: 10.1016/j.arth.2016.04.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/10/2016] [Accepted: 04/29/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A contralateral normal hip joint has been often used as a reference standard in preoperative planning and intraoperative assessment of hip arthroplasty, with the assumption that bilateral hip joint geometries have no significant differences. However, one previous study using analog measurements on hardcopy films reported significant bilateral variation in hip joint geometry. We therefore investigated the level of agreement between the right and left hips for each measurement and determined index values and the range of normal bilateral variations. METHODS We assessed 100 standard anteroposterior radiographs of the pelvis in this study. Two independent observers measured the actual value of femoral head diameter, location of the femoral head center, acetabular offset, femoral offset, hip offset, greater trochanteric height, neck-shaft angle, medullary canal diameter, and proximal femoral diameter. Intraclass correlation coefficients (ICCs) and values of mean difference were calculated for each measurement. RESULTS The results demonstrated perfect agreement (ICC >0.8) between the right and left hips for most parameters and substantial agreement for greater trochanteric height (ICC = 0.735) and femoral offset (ICC = 0.773). The mean difference and standard deviation in the measurement between the right and left hips for the location of the femoral head center and the acetabular offset were 0.60 ± 0.48 mm and 0.42 ± 0.30 mm, respectively. CONCLUSION Hip joint geometry is not influenced by side. In hip arthroplasty, a contralateral normal hip can be reliably used as a guide for preoperative planning using measurement tools on a picture archiving and communication system.
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Affiliation(s)
- Seung-Chan Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young-Wook Lim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Soon-Yong Kwon
- Department of Orthopaedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jun-Ku Lee
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Il-Kyu Park
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yong-Sik Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Bjarnason JA, Reikeras O. Changes of center of rotation and femoral offset in total hip arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2016; 3:355. [PMID: 26807410 DOI: 10.3978/j.issn.2305-5839.2015.12.37] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND It is a challenge to reconstruct the center of rotation (COR) and femoroacetabular offset anatomically in total hip arthroplasty (THA). We addressed the controversy how we manage to preserve the COR and femoroacetabular offset with an uncemented total hip prosthesis implanted with free hand technique. METHODS We analyzed a prospective series of 73 patients who underwent primary THA. The series was composed of 40 females and 33 males, mean age 64 years (range, 35-90 years). The reasons for THA were primary osteoarthritis (n=63) and developmental dysplasia of the hip (n=10). Pre- and postoperative X-rays were done in a standardized format for anterior-posterior (AP) radiographs of the pelvis, and digitalized measurements were done using SectraTM. We compared preoperative measurements with the final outcome to determine changes in COR and femoral offset. RESULTS We found that 40 patients had their COR and 34 patients had their femoral offset preserved within preoperative 5.0 mm limits. Twenty-three patients had both their values of COR and femoral offset preserved within 5.0 mm limits. While a significant correlation was found between changes of femoral and global offset (r=0.786, P<0.001), there were no correlation between changes of acetabular and femoral offset (r=-0.027, P=0.822). CONCLUSIONS Using an uncemented THA and free hand technique, there is a fair reproducibility of anatomy. The variations were mostly minor, but our results indicate a potential for better restoring the location of COR and femoral offset when planning and implanting an uncemented THA.
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Affiliation(s)
- Jon A Bjarnason
- Department of Orthopedics, Rikshospitalet, Oslo University Hospital, N-0027 Oslo, Norway
| | - Olav Reikeras
- Department of Orthopedics, Rikshospitalet, Oslo University Hospital, N-0027 Oslo, Norway
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Nie Y, Pei F, Shen B, Kang P, Li Z. Importance of maintaining the basic stress pathway above the acetabular dome during acetabular reconstruction. Comput Methods Biomech Biomed Engin 2015; 19:977-84. [PMID: 26469561 DOI: 10.1080/10255842.2015.1085025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The basic stress pathway above the acetabular dome is important for the maintenance of implant stability in press-fit acetabular reconstruction of total hip arthroplasty. However, information on the basic stress pathway and its impact factors remains unclear. The objective of this study was to investigate the effects of the orientations and positions of the acetabular component on the basic stress pathway. The basic stress pathway above the acetabular dome was defined as two parts: 3D basic trabecular bone stress distribution and quantified basic cortical bone stress level, using two subject-specific finite element normal hip models. The effects were then analysed by generating 32 reconstructed acetabular cases with different cup abduction and anteversion angles within a range of 35-50° and 10-25°, respectively, and 12 cases with different hip centre heights within a range of 0-15 mm above the acetabular dome. The 3D trabecular stress distribution decreased remarkably in all cases, while the 80% of the basic cortical bone stress level was maintained in cases when the acetabular component was positioned at 10° or 15° anteversion and 40° or 45° abduction angles. The basic stress pathway above the acetabular dome was disturbed when the superior displacement of the hip centre exceeded 5 mm above the anatomical hip centre. Positioning the acetabular component correctly contributes to maintain the stress balance between the acetabular cup and the bone during acetabular reconstruction, thus helping restore the normal hip biomechanics and preserve the stability of the implants.
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Affiliation(s)
- Yong Nie
- a Department of Orthopedics , West China Hospital, Sichuan University , Chengdu , China
| | - Fuxing Pei
- a Department of Orthopedics , West China Hospital, Sichuan University , Chengdu , China
| | - Bin Shen
- a Department of Orthopedics , West China Hospital, Sichuan University , Chengdu , China
| | - Pengde Kang
- a Department of Orthopedics , West China Hospital, Sichuan University , Chengdu , China
| | - Zongming Li
- b Department of Biomedical Engineering , Cleveland Clinic Lerner Research Institute , Cleveland , OH , USA
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Seufert CR, McGrory BJ. Treatment of Arthritis Associated With Legg-Calve-Perthes Disease With Modular Total Hip Arthroplasty. J Arthroplasty 2015; 30:1743-6. [PMID: 25979188 DOI: 10.1016/j.arth.2015.04.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/07/2015] [Accepted: 04/07/2015] [Indexed: 02/01/2023] Open
Abstract
Legg-Calve-Perthes (LCP) disease can result in morphological deformities and associated adult hip arthritis. Thirty-five consecutive total hip arthroplasties (THA) were performed in 28 patients with a history of LCP using a non-cemented modular femoral component. There was one revision for late hematogenous infection and no evidence of prosthesis failure. Harris hip scores, on average, improved from 49.8 (26-73) to 93.9 (82-100) (P<0.05) after a minimum of 2 years follow-up (average, 8.2 years, range 2-14 years). Clinically, patients demonstrated diminished or no limping (94%, 33/35) and improved leg length equality post-operatively (100%, 35/35). This style of stem accommodated metaphyseal/diaphyseal size mismatch in 80% (28/35), allowed for abnormal anteversion in 71% (25/35), and resulted in radiographic improvements in trochanteric height (P<0.05), body weight lever arm (P<0.05), and leg length (P<0.05).
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Affiliation(s)
| | - Brian J McGrory
- Tufts University School of Medicine, Maine Medical Partners Orthopedics, Division of Joint Replacements, Falmouth, Maine
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Günther KP, Stiehler M, Goronzy J, Schneiders W, Hartmann A. [Arthroplasty for osteoarthritis secondary to hip dysplasia: Problem-oriented treatment strategies]. DER ORTHOPADE 2015; 44:497-8, 500-9. [PMID: 25860120 DOI: 10.1007/s00132-015-3106-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Because of anatomical variations total hip arthroplasty (THA) can be demanding in patients with osteoarthritis secondary to hip dysplasia. OBJECTIVES Depending on the degree of bony deformation, hip dislocation and soft tissue alteration numerous treatment strategies are available. This review describes current approaches that address frequent deformities. MATERIALS AND METHODS Review of relevant clinical studies, meta-analyses, and presentation of our own approach. RESULTS Pre-operative planning (based on a thorough clinical and radiographic examination) is essential. Acetabular reconstruction close to the primary acetabulum should always be intended. Roof augmentation and/or cup medialization can support stable bony implant fixation. Subtrochanteric shortening osteotomy of the femur is a demanding but reliable technique that avoids nerve damage in cases where inappropriate lengthening would be necessary (i.e., high riding dislocation). CONCLUSIONS Although the post-operative complication rate is elevated after THA for dysplastic hips compared with primary osteoarthritis, the overall functional results and implant survival are comparable.
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Affiliation(s)
- K P Günther
- UniversitätsCentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Deutschland,
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Zeng Y, Lai OJ, Shen B, Yang J, Zhou ZK, Kang PD, Pei FX, Zhou X. Three-dimensional computerized preoperative planning of total hip arthroplasty with high-riding dislocation developmental dysplasia of the hip. Orthop Surg 2015; 6:95-102. [PMID: 24890290 DOI: 10.1111/os.12099] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 02/28/2014] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To assess whether computed tomography (CT)-based 3-dimensional (3D) computerized pre-operative planning is accurate and reliable in patients with high-riding dislocation developmental dysplasia of the hip (DDH) undergoing total hip arthroplasty (THA). METHODS Between September 2009 and February 2011, a prospective study with an inbuilt means of comparing predictive techniques in 20 patients (20 hips) with high-riding dislocation DDH was undertaken. All patients had pre- and post-operative CT scans, data from which were transferred digitally to Mimics software. 3D pre-operative planning to predict the acetabular component size, hip rotation center position and acetabular component coverage was performed using Mimics software. The results and post-operative course were compared with those of the traditional acetate templating technique. RESULTS Using 3D computerized planning, 14/20 components (70%) were predicted exactly and 6/20 (30%) within one size, whereas with the conventional acetate templating technique, 5/20 components (25%) were predicted exactly, 9/20 (45%) within one size and 6/20 (30%) within two or more sizes. There was a strong correlation between the 3D computerized planned acetabular component size, hip rotation center distance, acetabular component host coverage and that found postoperatively. Five patients were considered to need structural bone graft on the basis of 3D computerized planning; this was highly coincident with the intraoperative findings in all five cases. CONCLUSION CT-based 3D computerized pre-operative planning using Mimics software is an accurate and reliable technique for patients with high-riding dislocation DDH undergoing THA.
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Affiliation(s)
- Yi Zeng
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
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Nie Y, Pei F, Li Z. Effect of high hip center on stress for dysplastic hip. Orthopedics 2014; 37:e637-43. [PMID: 24992059 DOI: 10.3928/01477447-20140626-55] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 12/20/2013] [Indexed: 02/03/2023]
Abstract
High hip center reconstruction has been advocated in treating deficient acetabulum. However, there is no consensus on the clinical outcome of this technique. In addition, it remains unclear to what extend this technique restores the normal hip biomechanics. The goal of this study was to investigate stress above the acetabular dome in response to a range of high hip center positioning for Crowe type I and II hip dysplasia. This study consisted of 2 main parts, radiologic and biomechanical. Pelvic radiographs of 18 patients were studied to determine the amount of displacement of the hip center in the superior direction compared with the normal side. Second, qualitative and quantitative changes in stress on cortical and trabecular bone in the region of the acetabular dome as a result of superior displacement of the hip center were analyzed with subject-specific finite element models. The results showed that the range of the hip center position in the superior direction for Crowe type I and II hip dysplasia was 0 to 15 mm above the contralateral femoral head center. When superior displacement of the hip center exceeded 5 mm above the anatomic hip center, cortical bone mass on the 2 thickest cross-sections above the acetabular dome decreased quickly and the stress value on posterolateral cortical bone was obviously lower than the normal level. This study showed that to restore the normal load above the acetabular dome, there is a limit of 5 mm above the anatomic hip center for high hip center acetabular reconstruction for Crowe type I and II hip dysplasia.
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Abolghasemian M, Drexler M, Abdelbary H, Sayedi H, Backstein D, Kuzyk P, Safir O, Gross AE. Revision of the acetabular component in dysplastic hips previously reconstructed with a shelf autograft: study of the outcome with special assessment of bone-stock changes. Bone Joint J 2013; 95-B:777-81. [PMID: 23723271 DOI: 10.1302/0301-620x.95b6.31346] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this retrospective study we evaluated the proficiency of shelf autograft in the restoration of bone stock as part of primary total hip replacement (THR) for hip dysplasia, and in the results of revision arthroplasty after failure of the primary arthroplasty. Of 146 dysplastic hips treated by THR and a shelf graft, 43 were revised at an average of 156 months, 34 of which were suitable for this study (seven hips were excluded because of insufficient bone-stock data and two hips were excluded because allograft was used in the primary THR). The acetabular bone stock of the hips was assessed during revision surgery. The mean implant-bone contact was 58% (50% to 70%) at primary THR and 78% (40% to 100%) at the time of the revision, which was a significant improvement (p < 0.001). At primary THR all hips had had a segmental acetabular defect > 30%, whereas only five (15%) had significant segmental bone defects requiring structural support at the time of revision. In 15 hips (44%) no bone graft or metal augments were used during revision. A total of 30 hips were eligible for the survival study. At a mean follow-up of 103 months (27 to 228), two aseptic and two septic failures had occurred. Kaplan-Meier survival analysis of the revision procedures demonstrated a ten-year survival rate of 93.3% (95% confidence interval (CI) 78 to 107) with clinical or radiological failure as the endpoint. The mean Oxford hip score was 38.7 (26 to 46) for non-revised cases at final follow-up. Our results indicate that the use of shelf autografts during THR for dysplastic hips restores bone stock, contributing to the favourable survival of the revision arthroplasty should the primary procedure fail.
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Affiliation(s)
- M Abolghasemian
- Mount Sinai Hospital, University of Toronto, 600 University Street, Suite 476, Toronto, Ontario M5G 1X5, Canada.
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