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Otaka K, Osawa Y, Takegami Y, Iida H, Ozawa Y, Funahashi H, Imagama S. Computer simulation study of cementless cup placement for dysplastic hip osteoarthritis using subluxation percentage of Crowe classification. J Orthop Res 2024; 42:1801-1809. [PMID: 38409822 DOI: 10.1002/jor.25819] [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] [Received: 12/04/2023] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 02/28/2024]
Abstract
It is often difficult to achieve adequate bone coverage of the cup in total hip arthroplasty in cases of severe developmental dysplasia of the hip (DDH). This study aimed to evaluate the relationship between subluxation percentage of Crowe classification and cup center-edge (cup-CE) angle to investigate whether subluxation percentage according to the Crowe classification is a useful indicator for cementless cup placement. Cementless cup placement was simulated in 77 women with DDH in 91 hips (Crowe I, 35 hips; Crowe II, 35 hips; and Crowe III, 21 hips) using computed tomography-based computer simulation software. The cups were placed at the anatomic hip center (AHC) and 10-mm high hip center (HHC). The relationship between the subluxation percentage and cup-CE angle was evaluated using Spearman's rank correlation coefficient. In addition, the cutoff values for the subluxation percentage that satisfied a cup-CE angle ≥0° were determined using the receiving operating characteristic curve. The cup-CE angle was negatively correlated with the subluxation percentage in both AHC and 10-mm HHC (correlation coefficient ρ = -0.542 [p < 0.01] and -0.704 [p < 0.01], respectively). The cutoff values for subluxation percentage that satisfied a cup-CE angle ≥0° were 56.1% and 73.6% for AHC and 10-mm HHC, respectively. Cementless cup placement in AHC is difficult in cases with the subluxation percentage ≥56.1%, and HHC reconstruction or femoral structural autograft technique should be considered as an alternative. Moreover, placement at 10 mm above AHC is difficult in cases with subluxation percentage ≥73.6%.
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Affiliation(s)
- Keiji Otaka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Iida
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuto Ozawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroto Funahashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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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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Shimizu T, Takahashi D, Ishizu H, Yokota S, Hasebe Y, Uetsuki K, Iwasaki N. Anatomical and Simulation Studies Based on Three-Dimensional-Computed Tomography Image Reconstruction of Femoral Offset. Diagnostics (Basel) 2023; 13:diagnostics13081434. [PMID: 37189535 DOI: 10.3390/diagnostics13081434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/12/2023] [Accepted: 03/28/2023] [Indexed: 05/17/2023] Open
Abstract
Although the hip joint morphology varies by race, few studies have investigated the associations between two-dimensional (2D) and three-dimensional (3D) morphologies. This study aimed to use computed tomography simulation data and radiographic (2D) data to clarify the 3D length of offset, 3D changes in the hip center of rotation, and femoral offset as well as investigate the anatomical parameters associated with the 3D length and changes. Sixty-six Japanese patients with a normal femoral head shape on the contralateral side were selected. In addition to radiographic femoral, acetabular, and global offsets, 3D femoral and cup offsets were investigated using commercial software. Our findings revealed that the mean 3D femoral and cup offsets were 40.0 mm and 45.5 mm, respectively; both were distributed around the mean values. The difference between the 3D femoral and cup offsets (i.e., 5 mm) was associated with the 2D acetabular offset. The 3D femoral offset was associated with the body length. In conclusion, these findings can be applied to the design of better ethnic-specific stem designs and can help physicians achieve more accurate preoperative diagnoses.
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Affiliation(s)
- Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Daisuke Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Hotaka Ishizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Shunichi Yokota
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Yoshihiro Hasebe
- R&D Center, Teijin Nakashima Medical Co., Ltd., Okayama 701-1221, Japan
| | - Keita Uetsuki
- R&D Center, Teijin Nakashima Medical Co., Ltd., Okayama 701-1221, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
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Funahashi H, Osawa Y, Seki T, Takegami Y, Nishida K, Imagama S. Pelvic morphologies of developmental dysplasia and primary osteoarthritis on range of motion after total hip arthroplasty. J Orthop Res 2023. [PMID: 36866827 DOI: 10.1002/jor.25544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/29/2023] [Accepted: 03/01/2023] [Indexed: 03/04/2023]
Abstract
Bony impingement, especially in the anterior inferior iliac spine (AIIS) after total hip arthroplasty (THA), may cause dislocation. However, the influence of AIIS characteristics on bony impingement after THA is not fully understood. Thus, we aimed to determine the morphological characteristics of AIIS with developmental dysplasia of the hip (DDH) and primary osteoarthritis (pOA) and to evaluate its effect on range of motion (ROM) after THA. Hips from 130 patients who underwent THA, including pOA were analyzed. In total, we had 27 male and 27 female participants with pOA, and 38 male and 38 female participants with DDH. The horizontal distances of AIIS from teardrop (TD) were compared. In the computed tomography simulation, flexion ROM was measured, and its relationship to the distance between TD and AIIS was investigated. DDH had a more medial (male: DDH, 36.9 ± 5.8; pOA, 45.5 ± 6.1; p < 0.001) (female: DDH, 31.5 ± 10.0; pOA, 36.2 ± 4.7; p < 0.001) position of AIIS than pOA. In the male with pOA group, flexion ROM was significantly smaller than that in the other groups, and there was a correlation between flexion ROM and horizontal distances (r = -0.543; 95% confidence interval = -0.765 to -0.206; p = 0.003). AIIS position is a factor that limits ROM during flexion after THA, particularly in males. Further studies are required to develop surgical strategies for cases of impingement at the AIIS site after THA. Level of evidence: Ш, retrospective comparative study.
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Affiliation(s)
- Hiroto Funahashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kazuki Nishida
- Department of Biostatistics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Xu Z, Li Z, Li J, Zhang Y, Wang M, Zhang Y. Extra-articular Blocking Technique to Resolve Severe Acetabular Bone Defect in Developmental Dysplasia of the Hip. Orthop Surg 2023; 15:1187-1195. [PMID: 36846951 PMCID: PMC10102295 DOI: 10.1111/os.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE The reconstruction of acetabular bone defect in developmental dysplasia of the hip (DDH) is a great challenge. Although several successful solutions have been raised, their efficacy and reliability have not been fully substantiated. This work aims to present a simple, economic and effective acetabular reconstructive technique to resolve the massive acetabular bone defect in DDH scenario. METHODS This is a case series and observational study investigating the effectiveness and safety of extra-articular blocking technique in patients diagnosed as DDH of Crowe type II-III and Hartofilakidis B. Sixteen consecutive patients indicated for extra-articular blocking and treated with total hip arthroplasty were enrolled in this series from January 2019 to August 2020. The outcome measures included the surgical indicators such as acetabular coverage, prosthesis position, operational time, medical cost, and short-term follow-up indicators such as complications profile, patient-reported functional scales, overall recovery after surgery, and radiographic bone integration and remodeling. Their medical documentation and follow-up records were carefully reviewed with ethical approval. RESULTS The mean values of postoperative acetabular component inclination and anteversion were 42.3° ± 2.1° and 16.4° ± 1.8°, with an average acetabular coverage of 92.1%. The mean cost reduction for patients treated with this technique compared with those treated with trabecular metal augmentation was 15.3%. The mean time until walking under full-weight bearing decreased by 3.5 weeks compared with patients treated with autologous bone grafting. Within an average observational period of 18 months, the mean improvements in Harris hip score and WOMAC score were 31 and 22 points, respectively, which were identical to those with bone graft and metal augmentation techniques. No complications such as dislocation, acetabular loosening, periprosthetic joint infection, and limb length discrepancy were recorded. No signs of translucent line formation, third-party reaction, and wear-associated osteolysis were identified. CONCLUSION The extra-articular blocking can work simply and effectively to address acetabular bone defect in DDH patients of Crowe II-III and Hartofilakidis B, as evidenced by cost-effectiveness and instant weight-bearing advantages, low failure rate, and early osteointegration and remodeling.
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Affiliation(s)
- Zhonghua Xu
- Joint Disease & Sport Medicine Center, Department of Orthopedic Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ziqiang Li
- Department of Orthopedics, People's Hospital of Linshui, Guang'an, China
| | - Jie Li
- Joint Disease & Sport Medicine Center, Department of Orthopedic Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yiling Zhang
- Department of Technology, Longwood Valley MedTech, Beijing, China
| | - Min Wang
- Joint Disease & Sport Medicine Center, Department of Orthopedic Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yuan Zhang
- Joint Disease & Sport Medicine Center, Department of Orthopedic Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
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Tang H, Huang Y, Zhou Y, Ma Z, Guo S. Extended Fixation for Paprosky Type III Acetabular Defects in Revision Total Hip Arthroplasty with a Minimum Follow-Up of 2 Years. Orthop Surg 2022; 15:205-213. [PMID: 36419313 PMCID: PMC9837286 DOI: 10.1111/os.13577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/26/2022] [Accepted: 10/11/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Revision of total hip arthroplasty for patients with severe acetabular bone defects is challenging. This study aims to report the minimum 2 years outcome of the iliac extended fixation technique in patients with Paprosky type III acetabular defects. METHODS Fifty-seven revision total hip arthroplasty patients were retrospectively reviewed who underwent reconstruction with the concept of iliac extended fixation from 2014 to 2017 in our hospital. We proposed a new concept of "iliac extended fixation" in revision total hip arthroplasty as fixation extending superiorly 2 cm beyond the original acetabular rim with porous metal augments, which was further classified into intracavitary and extracavitary fixation. Patients were assessed using the Harris Hip Score and the Western Ontario and McMaster Universities Osteoarthritis Index Score. Radiographs and patient-reported satisfaction were assessed. RESULTS At an average follow-up of 63 months (range 25-88 months), the postoperative Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index scores were significantly improved at the last follow-up (p < 0.001). The center of rotation was significantly improved (p < 0.05). Fifty-three (93.0%) patients were satisfied with the outcome. The extracavitary iliac extended fixation group had higher rate of osteointegration in zone 1A (the superior lateral zone) than the intracavitary iliac extended fixation group (82.3% vs 55.0%, p = 0.015), and significantly more horizontal screws fixation (5.1 ± 24.7° vs 42.3 ± 36.8°, p < 0.001). CONCLUSION Intracavitary and extracavitary iliac extended fixation with porous metal augments and cementless cups are effective in reconstructing severe superior acetabular bone defects. The difference in screw direction might reflect the different biomechanics of augment fixation.
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Affiliation(s)
- Hao Tang
- Investigation performed at the Department of Orthopedic Surgery, Beijing Jishuitan HospitalFourth Clinical College of Peking UniversityBeijingChina
| | - Yong Huang
- Investigation performed at the Department of Orthopedic Surgery, Beijing Jishuitan HospitalFourth Clinical College of Peking UniversityBeijingChina
| | - Yixin Zhou
- Investigation performed at the Department of Orthopedic Surgery, Beijing Jishuitan HospitalFourth Clinical College of Peking UniversityBeijingChina
| | - Zhuyi Ma
- Investigation performed at the Department of Orthopedic Surgery, Beijing Jishuitan HospitalFourth Clinical College of Peking UniversityBeijingChina
| | - Shengjie Guo
- Investigation performed at the Department of Orthopedic Surgery, Beijing Jishuitan HospitalFourth Clinical College of Peking UniversityBeijingChina
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Bari YA, Chilmi MZ, Arianto HF, Soetojo BW. Morselized bone autograft for high placement of acetabular component closure with hip arthroplasty revision after 3-years screws and cup loosening: A case report. Int J Surg Case Rep 2022; 101:107789. [PMID: 36459851 PMCID: PMC9712815 DOI: 10.1016/j.ijscr.2022.107789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/20/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Aseptic loosening in high placement of the acetabular component seriously affects the hip and femoral head loads. Surgery revision is highly recommended with defect closure in previous place. CASE PRESENTATION A-40-year-old man came with chief complaint of right groin pain and noticeable leg length discrepancy gait. The first hip arthroplasty through pseudo-acetabulum cup was done three years ago after neglected femoral head necrosis due to eight years of unknown hip dislocation in vehicle accident. On hip x-ray there is a screws and cup loosening, without any sign of infection from blood or from soft tissue which undergoes pathological and mold examination. The patient than assessed with periprosthetic aseptic loosening of hip dextra and simple total hip arthroplasty revision using true acetabulum location was done. The pseudo-acetabulum area closed with morselized bone autograft. One weeks after surgery, the wound healed properly. Hence, the patient sent to the rehabilitation. CLINICAL DISCUSSION Hip arthroplasty revision of aseptic loosening in high placement acetabular component should perform by returning to anatomical acetabular position. Cancellous morselized bone autograft (MBA) was used to closed the defect formed by previous procedure. CONCLUSION Revision of hip arthroplasty combined with morselized bone autograft can be considered for high placement acetabular component defect closure to provide better stability and strength in weight loads transfer.
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Affiliation(s)
- Yunus Abdul Bari
- Department of Orthopedic and Traumatology, Universitas Airlangga Teaching Hospital, Surabaya, East Java, Indonesia,Corresponding author at: Department of Orthopedics, Universitas Airlangga Teaching Hospital, Jalan Dharmahusada Permai, East Java 60155, Indonesia.
| | - Mohammad Zaim Chilmi
- Department of Orthopedic and Traumatology, Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia
| | - Huda Fajar Arianto
- Department of Orthopedic and Traumatology, Universitas Airlangga Teaching Hospital, Surabaya, East Java, Indonesia
| | - Bagus Wibowo Soetojo
- Department of Orthopedic and Traumatology, Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia
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Harada S, Hamai S, Ikebe S, Hara D, Higaki H, Gondo H, Kawahara S, Shiomoto K, Harada T, Nakashima Y. Elucidation of target implant orientations with the safety range of hip rotation with adduction or abduction during squatting: Simulation based on in vivo replaced hip kinematics. Front Bioeng Biotechnol 2022; 10:1023721. [DOI: 10.3389/fbioe.2022.1023721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives: The study aimed to elucidate target cup orientation and stem anteversions to avoid impingement between the liner and stem neck even at hip rotation with adduction during the deeply flexed posture.Methods: A computer simulation analysis was performed on 32 total hip arthroplasty patients applying patient-specific orientation of the components and in vivo hip kinematics obtained from three-dimensional analysis of the squatting motion. The anterior/posterior liner-to-neck distance and impingement were evaluated based on a virtual change in internal/external rotation (0°–60°) and adduction/abduction (0°–20°) at actual maximum flexion/extension during squatting. Cutoff values of cup orientations, stem anteversion, and combined anteversion to avoid liner-to-neck impingements were determined.Results: The anterior liner-to-neck distance decreased as internal rotation or adduction increased, and the posterior liner-to-neck distance decreased as external rotation or adduction increased. Negative correlations were found between anterior/posterior liner-to-neck distances at maximum flexion/extension and internal/external rotation. Anterior/posterior liner-to-neck impingements were observed in 6/18 hips (18/56%) at 45° internal/external rotation with 20° adduction. The range of target cup anteversion, stem anteversion, and combined anteversion to avoid both anterior and posterior liner-to-neck impingements during squatting were 15°–18°, 19°–34°, and 41°–56°, respectively.Conclusion: Simulated hip rotations caused prosthetic impingement during squatting. Surgeons could gain valuable insights into target cup orientations and stem anteversion based on postoperative simulations during the deeply flexed posture.
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Harada T, Hamai S, Hara D, Kawahara S, Fujii M, Ikemura S, Motomura G, Nakashima Y. Three-dimensional kinematics and kinetics of getting into and out of a car in patients after total hip arthroplasty. Gait Posture 2022; 98:305-312. [PMID: 36265218 DOI: 10.1016/j.gaitpost.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/23/2022] [Accepted: 10/06/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND In modern society, car usage is one of the most important activities of daily living. However, the three-dimensional (3D) mechanics of getting into and out of a car in total hip arthroplasty (THA) patients have not been studied. RESEARCH QUESTION This study aimed to elucidate the hip kinematics and kinetics of unilateral THA patients while getting into and out of a car. METHODS 3D motion and ground reaction force data were collected for 40 unilateral primary THA and 30 control participants using motion capture of getting into and out of a car. Normalized joint power was used to determine the individual joint contribution and was calculated by dividing the power of each joint by the total lower-extremity power. These kinematic and kinetic data were compared between unilateral THA and control participants. RESULTS When getting into the car using the surgical side as the pivot limb, the peak flexion, abduction angle, and normalized power of the pivot hip were significantly lower, and the normalized power of the contralateral ankle was significantly higher. The peak flexion and abduction angle of the pivot hip were significantly lower, and normalized contralateral hip power was significantly higher when getting out of the car. In getting into and out of the car using the contralateral side as the pivot limb, there was no significant difference in the range of motion (RoM) and normalized joint power. SIGNIFICANCE The restoration of RoM and muscle strength in the surgical hip joint and adopting the normal side as the pivot limb may allow for a more appropriate balance in motion of getting into and out of a car, which will lead to safe mobility, assist in social participation, and improved quality of life. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Tetsunari Harada
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Department of Medical-Engineering Collaboration for Healthy Longevity, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Daisuke Hara
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Saga University, 5-1-1 Nabeshima, Saga 849-0937, Japan.
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Goro Motomura
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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Association between Hip Center Position and Isokinetic Hip Muscle Performance after Anterolateral Muscle-Sparing Total Hip Arthroplasty. Medicina (B Aires) 2022; 58:medicina58040538. [PMID: 35454377 PMCID: PMC9029787 DOI: 10.3390/medicina58040538] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/04/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background and objectives: The superior placement of the acetabular cup induced the delayed recovery of abductor muscle moment after total hip arthroplasty (THA) with a conventional posterior approach. The anterior-based muscle-sparing (ABMS) THA effectively reduces soft tissue damage, including muscles. The influence of hip center position on anterior-based muscle-sparing (ABMS) total hip arthroplasty (THA) for post-operative hip muscle strength was unclear. We evaluate whether the hip center position affects the recovery of hip muscle strength after ABMS THA. Materials and Methods: The study was performed as a retrospective cohort study, and included 38 hips in 38 patients that underwent primary ABMS THA. Muscle strength was measured using isokinetic dynamometry before the operation, and at 6 and 12 months after surgery. The horizontal and vertical centers of rotation (H-COR and V-COR), vertical shift (V-shift), leg length, and global femoral offset were determined radiographically in reference to a previous report. Results: A weak negative correlation was observed between abduction muscle strength at 6 months and V-shift; a V-shift more than 15 mm demonstrated significantly decreased abductor muscle strength at 6 months. Conclusions: The superior placement of the hip center caused delayed recovery of abductor muscle strength in hips with anterolateral minimally invasive THA. There seems to exist no biomechanical reason why the same should not also be the case for the muscle-sparing approach.
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Does accelerometer-based portable navigation provide more accurate and precise cup orientation without prosthetic impingement than conventional total hip arthroplasty? A randomized controlled study. Int J Comput Assist Radiol Surg 2022; 17:1007-1015. [DOI: 10.1007/s11548-022-02592-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/04/2022] [Indexed: 11/05/2022]
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Evaluation of optimal implant alignment in total hip arthroplasty based on postoperative range of motion simulation. Clin Biomech (Bristol, Avon) 2022; 92:105555. [PMID: 35026659 DOI: 10.1016/j.clinbiomech.2021.105555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dislocation after total hip arthroplasty is a frequent cause of revision surgery. This study was performed to determine the optimal implant alignment in total hip arthroplasty by simulating the postoperative range of motion. METHODS All operations were performed via posterolateral approach using combined anteversion of the stem and cup technique. Maximum range of motion without implant impingement was simulated in 79 replaced hips using postoperative computed tomography and the achievement of the required range of motion defined by previous studies was assessed. Optimal cup and stem alignment for impingement-free range of motion were statistically determined using the receiver operator coefficient curve. FINDINGS Cup inclination and anteversion, stem anteversion, and combined anteversion were 37.6°, 20.1°, 26.2°, and 46.3°, respectively. Maximum range of motion in flexion, extension, internal rotation at 90° of flexion, and external rotation were 131.8°, 42.3°, 56.4°, and 64.5°, respectively. Flexion >110°, extension >30°, internal rotation >30° at 90° of flexion, and external rotation >30° were fulfilled by 96%, 86%, 92%, and 96% of all replaced hips, respectively. Optimal implant alignment for impingement-free range of motion was 34°-43° of cup inclination, 18°-26° of cup anteversion, 17°-29° of stem anteversion, and 35°-56° of combined anteversion. Both cup and stem anteversion showed significant relationship with postoperative range of motion. INTERPRETATION Surgeons could gain valuable insights into optimal cup and stem alignment to perform postoperative range of motion simulations.
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Shiomoto K, Hamai S, Ikebe S, Higaki H, Hara D, Gondo H, Komiyama K, Yoshimoto K, Harada S, Nakashima Y. Computer simulation based on in vivo kinematics of a replaced hip during chair-rising for elucidating target cup and stem positioning with a safety range of hip rotation. Clin Biomech (Bristol, Avon) 2022; 91:105537. [PMID: 34847472 DOI: 10.1016/j.clinbiomech.2021.105537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023]
Abstract
Background After total hip arthroplasty, dislocation can occur when a patient unexpectedly assumes internal/external limb positions, even during chair-rising, which is a frequently activity of daily life. Therefore, determining the target cup position to avoid impingement in unexpected limb positions using in vivo data of daily life activities is critical. Methods A computer simulation was performed on 21 total hip arthroplasty patients using patient-specific component placements and hip kinematics obtained during chair-rising analysis using image-matching techniques. The liner-to-neck distance and impingement were evaluated by simulating the change in internal/external rotation angle at maximum hip flexion/extension from 0 to 90°. The cutoff values of cup anteversion and combined anteversion at 60° of internal/external rotation were determined. Findings The anterior/posterior liner-to-neck distances were negatively correlated with internal/external rotation angles (r = -0.82 and -0.78, respectively) and decreased by 1.7 and 1.8 mm for every 15° increase, respectively. Three cases (14%) of anterior/posterior impingement were observed at 60° of internal/external rotation angle, respectively. The cutoff values for cup anteversion and combined anteversion to avoid impingement at 60° of internal/external rotation angle were 12°-25°/38°-62°, respectively. The stem anteversion, adjustable by cup anteversion to meet both the target cup anteversion and combined anteversion, was 13°-50°. Interpretation Simulated unintentional internal or external hip rotation, even during chair-rising, caused impingement and posed a dislocation risk. If the stem anteversion is excessively small or large in meeting the target combined anteversion, adjustments to stem anteversion could be recommended in addition to adjustments in cup anteversion.
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Affiliation(s)
- Kyohei Shiomoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Department of Medical-Engineering Collaboration for Healthy Longevity, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Satoru Ikebe
- Department of Creative Engineering, National Institute of Technology, Kitakyushu College, 5-20-1 Shii, Kokuraminami-ku, Kitakyushu, Fukuoka 802-0985, Japan
| | - Hidehiko Higaki
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka 813-8583, Japan
| | - Daisuke Hara
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Department of Artificial Joints and Biomaterials, Faculty of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hirotaka Gondo
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka 813-8583, Japan
| | - Keisuke Komiyama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kensei Yoshimoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Satoru Harada
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Makida K, Seki T, Osawa Y, Takegami Y, Higuchi Y, Kusano T, Ishiguro N. Effects of additional neck cut of the femur on the range of motion in total hip arthroplasty for hip dislocation: a computer simulation study. Hip Int 2022; 32:39-44. [PMID: 32594771 DOI: 10.1177/1120700020938657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Subtrochanteric shortening osteotomy (SSO) is commonly performed in total hip arthroplasty (THA) for high hip dislocation. However, this procedure is technically difficult and includes complications. Additional neck cut (ANC) of the femur is a procedure that involves femoral shortening by possibly eliminating the need for SSO in THA for high hip dislocation. Herein, we evaluated the effect and the depth limit of ANC of the femur on the range of motion (ROM) in THA for high hip dislocation. METHODS ROM was measured in 26 patients with high hip dislocation using computer software. The stem was deeply positioned at 5-mm intervals from 0 mm to 30 mm (7 groups). The ROM before impingement was measured during flexion, internal rotation (IR) at 90° flexion, external rotation (ER) and abduction. Receiver operator coefficient (ROC) curves for abduction were generated. The cut-off value of ANC where the required ROM was achieved was also determined. RESULTS Deeper ANCs increased the ROM values during flexion and IR, but they decreased the ROM values during ER and abduction. The ROM values during ER were also limited in 0-mm ANCs. According to the result of the ROC curve for abduction, 15 mm was considered as the permissible range of ANC. CONCLUSIONS In THA for high hip dislocation additional neck cut should be taken into consideration for hips requiring less than 15-mm shortening. For more extended corrections a subtrochanteric shortening osteotomy should be performed.
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Affiliation(s)
- Kazuya Makida
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshitoshi Higuchi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taiki Kusano
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Kannan A, Madurawe C, Pierrepont J, McMahon S. Does total hip arthroplasty with high hip centre in dysplasia compromise acetabular bone stock? Hip Int 2021; 33:518-524. [PMID: 34886688 DOI: 10.1177/11207000211059442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The placement of uncemented acetabular components during total hip arthroplasty (THA) in Crowe II and Crowe III dysplasia can be at the anatomic or high hip centre position. PURPOSES Using computerised tomography data, we simulated acetabular cup placement at the anatomic hip centre and the high hip centre positions to assess whether there is a difference between the 2 in terms of bone loss from acetabular reaming and in acetabular coverage by host bone. METHODS The study population included a consecutive cohort of 19 patients (22 hips) with Crowe II or III dysplasia. 3-dimensional models of the pelvis were created for each patient and digital templating was used to determine the anatomic and high hip centre positions. The coordinates of the digitally templated cup positions were fed into an image processing software to estimate the amount of bone reamed, the cup coverage by host bone and the elevation from tear drop. RESULTS The mean volume of bone reamed was greater in the high hip centre position as compared to the anatomic position (27.3 ± 11. 4 cm3 vs. 19.4 ± 12.2 cm3, p < 0.0001). The coverage of the acetabular cup by host bone was greater in the high hip centre position (87.3 ± 5.9% vs. 68.3 ± 10%). The mean elevation in the high hip centre group was 13 mm with 3 hips having a breach of the medial wall. CONCLUSIONS In Crowe II and III dysplasia, placement of acetabular cups at the anatomic hip centre better preserves bone stock as compared to high hip centre placement and should be preferred in young patients requiring THA.
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Affiliation(s)
- Arun Kannan
- Apollo Main Hospital, Chennai, Tamilnadu, India
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16
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Bone defect map of the true acetabulum in hip dysplasia (Crowe type II and III) based on three-dimensional image reconstruction analysis. Sci Rep 2021; 11:22955. [PMID: 34824356 PMCID: PMC8617136 DOI: 10.1038/s41598-021-02448-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/16/2021] [Indexed: 12/04/2022] Open
Abstract
The high hip center technique (HHC) is considered to be feasible for acetabular reconstruction in patients with DDH, but there is little in-depth study of its specific impact on Crowe type II and III DDH. The purpose of this study was to simultaneously analyze the effect of HHC on bone coverage of the cup (CC) in the acetabular reconstruction of type II and III DDH patients and to propose a map of acetabular bone defects from the perspective of the cup. Forty-nine hip CT data of 39 patients with DDH (Crowe type II and III) were collected to simulate acetabular reconstruction by cup models of different sizes (diameter 38mm–50 mm, 2 mm increment) with the HHC technique. The frequency distribution was plotted by overlapping the portions of the 44 mm cups that were not covered by the host bone. The mean CC of cups with sizes of 38 mm, 40 mm, 42 mm, 44 mm, 46 mm, 48 mm, and 50 mm at the true acetabula were 77.85%, 76.71%, 75.73%, 74.56%, 73.68%, 72.51%, and 71.75%, respectively, and the maximum CC increments were 21.24%, 21.58%, 20.86%, 20.04%, 18.62%, 17.18%, and 15.42% (P < 0.001), respectively, after the cups were elevated from the true acetabula. The bone defect map shows that 95% of type II and III DDH acetabula had posterosuperior bone defects, and approximately 60% were located outside the force line of the hip joint. Acetabular cups can meet a CC of more than 70% at the true acetabulum, and approximately 60% of Crowe type II and III DDH patients can obtain satisfactory CC at the true acetabulum by using a 44-mm cup without additional operations.
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Hayashi S, Hashimoto S, Kuroda Y, Nakano N, Matsumoto T, Ishida K, Shibanuma N, Kuroda R. Robotic-arm assisted THA can achieve precise cup positioning in developmental dysplasia of the hip : a case control study. Bone Joint Res 2021; 10:629-638. [PMID: 34592109 PMCID: PMC8559969 DOI: 10.1302/2046-3758.1010.bjr-2021-0095.r1] [Citation(s) in RCA: 9] [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] [Indexed: 12/21/2022] Open
Abstract
AIMS This study aimed to evaluate the accuracy of implant placement with robotic-arm assisted total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). METHODS The study analyzed a consecutive series of 69 patients who underwent robotic-arm assisted THA between September 2018 and December 2019. Of these, 30 patients had DDH and were classified according to the Crowe type. Acetabular component alignment and 3D positions were measured using pre- and postoperative CT data. The absolute differences of cup alignment and 3D position were compared between DDH and non-DDH patients. Moreover, these differences were analyzed in relation to the severity of DDH. The discrepancy of leg length and combined offset compared with contralateral hip were measured. RESULTS The mean values of absolute differences (postoperative CT-preoperative plan) were 1.7° (standard deviation (SD) 2.0) (inclination) and 2.5° (SD 2.1°) (anteversion) in DDH patients, and no significant differences were found between non-DDH and DDH patients. The mean absolute differences for 3D cup position were 1.1 mm (SD 1.0) (coronal plane) and 1.2 mm (SD 2.1) (axial plane) in DDH patients, and no significant differences were found between two groups. No significant difference was found either in cup alignment between postoperative CT and navigation record after cup screws or in the severity of DDH. Excellent restoration of leg length and combined offset were achieved in both groups. CONCLUSION We demonstrated that robotic-assisted THA may achieve precise cup positioning in DDH patients, and may be useful in those with severe DDH. Cite this article: Bone Joint Res 2021;10(10):629-638.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.,Kobe Kaisei Hospital, Kobe, Japan
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | | | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Total hip arthroplasty after periacetabular osteotomy versus primary total hip arthroplasty: a propensity-matched cohort study. Arch Orthop Trauma Surg 2021; 141:1411-1417. [PMID: 33625543 DOI: 10.1007/s00402-021-03817-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Controversy still exist regarding the outcomes of total hip arthroplasty (THA) after periacetabular osteotomy (PAO). The purpose of this study was to compare the clinical and radiologic outcomes of THA after PAO with primary THA based on balanced baseline characteristics with propensity score matching. METHODS Using propensity score matching, 1:2 matched cohort to facilitate comparison between patients who underwent primary cementless THA with or without previous PAO. Then, we compared the operative time, blood loss, complications, postoperative clinical score, cup size, position, and alignment of acetabular cup, and degree of bony coverage on cup between the two groups. RESULTS Thirty-five patients with 37 hips who underwent THA after PAO were successfully matched to 70 patients with 74 hips who underwent primary THA. The operative time and blood loss in THA after PAO were significantly longer and larger than those in primary THA (P < 0.001 and = 0.0067, respectively). Clinical score showed no difference between the groups (P > 0.05). For THA after PAO, the cup size and bony coverage were larger (P = 0.0014 and < 0.001, respectively), and the hip center was significantly higher and laterally (P < 0.001 and < 0.001, respectively) comparing primary THA. CONCLUSION This study demonstrated longer operative time and larger blood loss without difference in the postoperative clinical score or complications between THA after PAO and primary THA. Furthermore, THA after PAO provided larger cup size and superolaterally positioned cup center without difference in the cup inclination or anteversion comparing primary THA.
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19
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Kaszuba SV, Behrens KM, Anderson CB, Gordon AC. A Workflow Change in Anterior Approach Total Hip Arthroplasty Leads to Improved Accuracy of Biomechanical Reconstruction Without Increased Risk of Complications. Arthroplast Today 2021; 10:99-104. [PMID: 34337115 PMCID: PMC8318915 DOI: 10.1016/j.artd.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/26/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background During anterior approach total hip arthroplasty (THA), the femur may be an impediment for acetabular access, pushing reamers proximally and consequently altering the hip center. In an effort to address this, the senior author changed the surgical workflow from acetabulum first (AF) to femur first (FF). The objective of this study was to compare the precision of biomechanical hip reconstruction and clinical outcomes between the FF and AF techniques. Methods This is a retrospective, case-control study of 267 anterior THAs (132 AF and 135 FF). A normal, contralateral hip was used to determine the native biomechanical parameters. Using a calibrated software program, radiographic measurements were performed to calculate the hip center position, femoral offset, global offset, and leg length of the operative and native hips using 2-week postoperative anteroposterior pelvis radiographs. Demographics, operative information, hemoglobin change, and complication data were obtained. Functional outcomes were assessed with the Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement survey at 1 year postoperatively. Results The groups exhibited similar demographic characteristics. The FF group demonstrated significantly more accurate and more precise reconstruction of horizontal and vertical hip centers, femoral offset, and leg length. There was no significant difference in operative time, hemoglobin change, complication rate, or Hip Disability and Osteoarthritis Outcome Score, Joint Replacement scores between groups. Conclusions The FF technique allowed for more accurate and precise reconstruction of the hip center, leg length, and offset in THA than the AF workflow. Furthermore, the FF approach demonstrated no significant differences in complication rate or blood loss, nor in clinical outcomes. Level of Evidence Therapeutic Study Level III.
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Affiliation(s)
- Stephanie V. Kaszuba
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Department of Orthopedic Surgery, Illinois Bone & Joint Institute, Morton Grove, IL, USA
| | - Kyle M. Behrens
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Department of Orthopedic Surgery, Illinois Bone & Joint Institute, Morton Grove, IL, USA
| | - Chad B. Anderson
- Department of Orthopedic Surgery, Illinois Bone & Joint Institute, Morton Grove, IL, USA
- Department of Orthopedic Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA
- Department of Orthopedic Surgery, NorthShore Skokie Hospital, Skokie, IL, USA
| | - Alexander C. Gordon
- Department of Orthopedic Surgery, Illinois Bone & Joint Institute, Morton Grove, IL, USA
- Department of Orthopedic Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA
- Department of Orthopedic Surgery, NorthShore Skokie Hospital, Skokie, IL, USA
- Corresponding author. Department of Orthopedic Surgery, Illinois Bone & Joint Institute, 9000 Waukegan Road, Suite 200, Morton Grove, IL 60053, USA. Tel.: +1 847-375-3000.
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Flick TR, Ross BJ, Sherman WF. Instability After Total Hip Arthroplasty and the Role of Advanced and Robotic Technology. Orthop Clin North Am 2021; 52:191-200. [PMID: 34053564 DOI: 10.1016/j.ocl.2021.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Instability remains the leading cause of reoperation following total hip arthroplasty (THA). In this article, the risk factors for instability after THA are reviewed, including patient-related characteristics, surgical techniques, positioning of implants, and the role of advanced technology and robotics as a platform that may reduce the incidence of instability.
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Affiliation(s)
- Travis R Flick
- Department of Orthopaedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - Bailey J Ross
- Department of Orthopaedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - William F Sherman
- Adult Reconstruction Hip/Knee, Department of Orthopaedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
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Takasago T, Goto T, Wada K, Hamada D, Sairyo K. Postoperative radiographic evaluation and simulation study for optimal cup placement in high-hip centre total hip arthroplasty. Hip Int 2021; 31:335-341. [PMID: 31646897 DOI: 10.1177/1120700019884547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Achieving favourable outcomes in high-hip centre reconstruction in hip dysplasia requires the optimal cup height and size, which can provide sufficient bone coverage for stable cup fixation that fits the anteroposterior acetabular rim without increasing the cup height more than necessary. METHODS We retrospectively reviewed 214 patients who underwent primary total hip arthroplasty (THA) and identified 30 hips with Crowe II (n = 15) or III (n = 15) developmental dysplasia of the hip (DDH). We measured the cup-centre-edge angle (cup-CE) and the vertical and horizontal distances from the teardrop. In a simulation study, we examined the cup-CE and optimal cup size by changing the cup height in 5-mm increments over a distance of 15-40 mm above the inter-teardrop line using a 3-dimensional template system. RESULTS Postoperative radiographic evaluation revealed a mean cup-CE of 19.9° in Crowe II hips and 15.2° in Crowe III hips; the respective mean vertical distances were 26.6 mm and 27.6 mm (p = 0.511). There was no evidence of cup loosening or lateralisation at a minimum of 7 years (7-11 years) follow-up. Simulation showed that the hip centre needed to be elevated to 20 mm to acquire a cup-CE of more than 0°. More than 10° of cup-CE could be expected by elevating the hip centre to 25 mm in both Crowe II and III. CONCLUSIONS Even in severe DDH, a high-hip centre positioned approximately 25 mm superior to the inter-teardrop line was sufficient to achieve optimal bone coverage, which could lead to more secure cup fixation.
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Affiliation(s)
- Tomoya Takasago
- Department of Orthopaedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tomohiro Goto
- Department of Orthopaedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Keizo Wada
- Department of Orthopaedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Daisuke Hamada
- Department of Orthopaedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopaedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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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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23
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Takahashi E, Kaneuji A, Florissi I, Bragdon CR, Malchau H, Kawahara N. Satisfactory Outcomes in Patients Operated With Primary Total Hip Arthroplasty for Perthes-like Deformities: Results From a Surgical Technique Utilizing a Conical Stem, an Elevated Hip Center, and No Shortening Femoral Osteotomy. Arthroplast Today 2020; 7:29-36. [PMID: 33521194 PMCID: PMC7818598 DOI: 10.1016/j.artd.2020.11.016] [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: 05/22/2020] [Revised: 11/01/2020] [Accepted: 11/21/2020] [Indexed: 11/18/2022] Open
Abstract
Background Total hip arthroplasty (THA) performed on patients with Perthes-like deformities are technically challenging because of the patient's abnormal hip anatomy. Patients with Perthes-like deformities are at a higher risk of revision, aseptic loosening, nerve injury, and intraoperative fracture after THA, especially if shortening osteotomies are performed. This analysis sought to examine the clinical and radiographic outcomes of a patient cohort with Perthes-like deformities receiving THA with a conical stem, an elevated hip center, and no shortening femoral osteotomy. Methods Twenty-six patients (27 hips) received THA with MODULUS femoral stems, ceramic or metal femoral heads, and highly cross-linked polyethylene liners between April 2011 and March 2016. All patients were treated at a single center by 4 participating surgeons. Patients completed 2 questionnaires preoperatively and at the final follow-up visit (between 1 and 5 years postoperatively): Harris Hip Score and Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire. Differences in patient-reported outcome measures (PROM) scores were measured by paired t-tests. Preoperative and postoperative anteroposterior radiographs were analyzed to monitor patient outcomes. Results Significant clinical improvements were observed in all individual subcategories of the Harris Hip Score and of the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire; the largest magnitude improvements were observed in the subcategory of pain relief for both questionnaires. No complications, including intraoperative and postoperative femoral fractures, nerve palsy, dislocations, or deep venous thrombosis, were observed. Conclusion This study found that patients treated with an elevated hip center and low stem-positioning technique using a conical, modular implant system had good clinical outcomes and did not suffer complications at the mean follow-up from surgery of 2.8 years (range: 1-5 years).
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Affiliation(s)
- Eiji Takahashi
- Department of Orthopedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawak, Japan
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
- Corresponding author. Daigaku 1-1, Uchinada-Machi, Kahoku-Gun, Ishikawa 920-0293, Japan. Tel.: +81 76 218 8000.
| | - Ayumi Kaneuji
- Department of Orthopedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawak, Japan
| | - Isabella Florissi
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Charles R. Bragdon
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedics, Sahlgrenska University Hospital, Mo¨lndal, Sweden
| | - Norio Kawahara
- Department of Orthopedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawak, Japan
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Wang CX, Huang ZD, Wu BJ, Li WB, Fang XY, Zhang WM. Cup-Cage Solution for Massive Acetabular Defects: A Systematic Review and Meta-Analysis. Orthop Surg 2020; 12:701-707. [PMID: 32495512 PMCID: PMC7307242 DOI: 10.1111/os.12710] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/08/2020] [Accepted: 04/25/2020] [Indexed: 12/14/2022] Open
Abstract
Our systematic review compiled multiple studies and evaluated survivorship and clinical outcomes of cup‐cage construct usage in the management of massive acetabular bone defects. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Various combinations of “acetabular”, “pelvis”, “cup cage” and their corresponding synonyms were used to search relevant articles in the Cochrane, EMBASE, and PubMed databases. Basic information of the functional scores, implant revision rate, and complication rate were selected as outcomes for analysis. Finally, a total of 11 articles published between 1999 and 2019 were selected, which include 232 patients with an average age of 68.5 years (range, 30–90). The mean follow‐up period was 48.85 months (range, 1–140). Our study shows that the cup‐cage construct has a good clinical outcome with a low revision rate and a low complication rate. Improved clinical outcomes of cup‐cage constructs were seen with a revision rate of 8% and an all‐cause complication rate of 20%. The most commonly reported complication was dislocation, followed by aseptic loosening, infection, and nerve injuries. In summary, it is a promising method for managing large acetabular bone defects in total hip revision.
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Affiliation(s)
- Chao-Xin Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zi-da Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Bai-Jian Wu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wen-Bo Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xin-Yu Fang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wen-Ming Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Segmental uncoverage ratio analysis of Crowe type-IV developmental dysplasia of the hip via 3-dimensional implantation simulation. ARTHROPLASTY 2020; 2:14. [PMID: 35236434 PMCID: PMC8796355 DOI: 10.1186/s42836-020-00032-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To study the segmental uncoverage ratio (UCR) of a 44-mm cup model placed in a true acetabulum of Crowe type-IV developmental dysplasia of the hip via 3-Dimensional (3D) implantation simulation. METHODS Qualified CT imaging data of 26 patients (involving 30 hips) with Crowe type-IV DDH were imported into Mimics software for reconstruction. Then a 44-mm eggshell cup model was placed in a true acetabulum. First, total uncoverage ratio (TUCR) was measured. Then the virtual cup was divided into 4 segments according to the quadrant setting of the true acetabulum, i.e., anterior-superior (A-S) segment, anterior-inferior (A-I) segment, posterior-superior (P-S) segment and posterior-inferior (P-I) segment. The UCRs of the aforementioned segments were measured, i.e., anterior-superior uncoverage ratio (A-SUCR), anterior-inferior uncoverage ratio (A-IUCR), posterior-superior uncoverage ratio (P-SUCR) and posterior-inferior uncoverage ratio (P-IUCR). The acetabular height and anterior-posterior diameter on the 3-D model were also calculated. Statistic analyses were performed by using SPSS software package. RESULTS TUCR was 0.2958 ± 0.1003 (95% [CI], 0.1020 to 0.5400) in this cohort of Crowe Type-IV hips. P-SUCR had the greatest value among all the segmental UCRs (0.1012 ± 0.0435, 95% confidence interval [CI],0.0152 to 0.1914) and the most significant positive correlation with TUCR (Pearson correlation = 0.889, p < 0.01. Linear regression R2 = 0.791). Similarly, P-IUCR and A-SUCR showed a significant positive correlation with TUCR. However, A-IUCR exhibited no correlation with either total or other segmental UCRs. P-SUCR was found to bear significant positive correlation with P-IUCR (pearson correlation = 0.644, p < 0.01. Linear regression R2 = 0.415). Acetabular height and A-P diameter were not correlated with TUCR. CONCLUSION Implantation of a 44-mm cup into Crowe type IV acetabulum is feasible and could achieve acceptable host bone coverage in most of the cases. P-SUCR contributed most to TUCR. TUCR had no linear relationship with the size of the host acetabulum, suggesting that the pre-operative plan should be individualized.
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Ding ZC, Zeng WN, Mou P, Liang ZM, Wang D, Zhou ZK. Risk of Dislocation After Total Hip Arthroplasty in Patients with Crowe Type IV Developmental Dysplasia of the Hip. Orthop Surg 2020; 12:589-600. [PMID: 32227469 PMCID: PMC7189031 DOI: 10.1111/os.12665] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/16/2020] [Accepted: 02/29/2020] [Indexed: 02/05/2023] Open
Abstract
Objective To investigate whether the risk of dislocation after total hip arthroplasty (THA) in patients with Crowe type IV developmental dysplasia of the hip (DDH) is high and to further identify the risk factors for postoperative dislocation in these patients. Methods This retrospective cohort study reviewed Crowe type IV DDH patients undergoing THA between January 2009 and December 2017 in our institution. Each Crowe type IV DDH patient was matched with three Crowe type I, II, or III DDH patients according to gender, side and date of operation. The primary outcome of this study was postoperative dislocation after THA. Occurrence, rate, classification, treatment and outcome of dislocation were documented in detail for all patients. The dislocation rates were compared between Crowe type IV DDH patients and Crowe type I, II, or III DDH patients. Demographic data, implant factors, and surgical factors were compared between the dislocation and no dislocation groups. Multiple logistic regression analysis was used to determine the independent risk factors for dislocation in Crowe type IV hips. Results A total of 131 Crowe type IV hips were followed up for a mean of 76.5 ± 28.1 months. Three hundred and ninety‐three Crowe type I, II and III hips, including 261 type I hips, 94 type II hips, and 38 type III hips, were identified as controls and followed up for a mean of 76.4 ± 28.2 months. No significant difference was observed in follow‐up time between two groups (P = 0.804). One or more dislocations occurred in 22 of the 524 dysplasia hips (4.20%). Of the 22 dislocated hips, 20 hips (90.9%) were successfully managed with non‐operative treatment. Two patients (9.1%, one Crowe type I and one Crowe type IV) experienced recurrent dislocation and required revision surgery. Crowe type IV hips had a significantly higher postoperative dislocation rate than type I, II, and III hips (11.45% vs 1.78%, P < 0.001). The use of a 22‐mm femoral head (odds ratio [OR] = 23.55, 95% confidence interval [CI] = 1.901–291.788, P = 0.014), older age (OR = 1.128, 95% CI = 1.037–1.275, P = 0.031), and absence of false acetabulum (OR = 12.425, 95% CI = 1.982–77.879, P = 0.007) were identified as independent risk factors for dislocation in Crowe type IV hips. Conclusions Crowe type IV DDH patients were at a high risk of dislocation after THA, and using large femoral heads and improving abductor muscle strength may help decrease the rate of postoperative dislocation in such patients.
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Affiliation(s)
- Zi-Chuan Ding
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Wei-Nan Zeng
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Ping Mou
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhi-Min Liang
- Clinic Research Management Department, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Duan Wang
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Zong-Ke Zhou
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
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Zheng LL, Lin YY, Zhang XY, Ling QH, Liao WM, Wu PH. Best bone of acetabulum for cup component placement in Crowe types I to III dysplastic hips: a computer simulation study. Chin Med J (Engl) 2019; 132:2820-2826. [PMID: 31856053 PMCID: PMC6940065 DOI: 10.1097/cm9.0000000000000527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND During cup implantation, vertical height of the cup center (V-HCC) should be precisely controlled to achieve sufficient bone-cup coverage (BCC). Our study aimed to investigate the acetabular bone stock and the quantitative relationship between V-HCC and BCC in Crowe types I to III hips. METHODS From November 2013 to March 2016, pelvic models of 51 patients (61 hips) with hip dysplasia were retrospectively reconstructed using a computer software. Acetabular height and doom thickness were measured on the mid-acetabular coronal cross section. V-HCC was defined as the vertical distance of cup rotational center to the interteardrop line (ITL). In the cup implantation simulation, the cup was placed at the initial preset position, with a V-HCC of 15 mm, and moved proximally by 3-mm increments. At each level, the BCC was automatically calculated by computer. Analysis of variance and Kruskal-Wallis test were used to compare the differences between groups. RESULTS There were no significant between-group differences in maximum thickness of the acetabular doom; however, peak bone stock values were obtained at heights of 41.63 ± 5.14 mm (Crowe type I), 47.58 ± 4.10 mm (Crowe type II), and 55.78 ± 3.64 mm (Crowe type III) above the ITL. At 15 mm of V-HCC, median BCC was 78% (75-83%) (Crowe type I), 74% (66-71%) (Crowe type II), and 61% (57-68%) (Crowe type III). To achieve 80% of the BCC, the median V-HCC was 16.27 (15.00-16.93) mm, 18.19 (15.01-21.53) mm, and 24.13 (21.02-28.70) mm for Crowe types I, II, and III hips, respectively. CONCLUSION During acetabular reconstruction, slightly superior placement with V-HCC <25 mm retained sufficient bone coverage in Crowe I to III hips.
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Affiliation(s)
- Lin-Li Zheng
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Yang-Yang Lin
- Department of Rehabilitation Medicine, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China
| | - Xiao-Yan Zhang
- College of Computer Science & Software Engineering, Shenzhen University, Shenzhen, Guangdong 518060, China
| | - Qian-Hui Ling
- Zhongshan Medical School, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Wei-Ming Liao
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Pei-Hui Wu
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
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Komiyama K, Hamai S, Ikebe S, Yoshimoto K, Higaki H, Shiomoto K, Gondo H, Hara D, Wang Y, Nakashima Y. In vivo kinematic analysis of replaced hip during stationary cycling and computer simulation of optimal cup positioning against prosthetic impingement. Clin Biomech (Bristol, Avon) 2019; 68:175-181. [PMID: 31229697 DOI: 10.1016/j.clinbiomech.2019.05.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/21/2019] [Accepted: 05/30/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dynamic hip kinematics during stationary cycling after total hip arthroplasty (THA) have been unclear. Furthermore, no computer simulation of optimal cup position based on in vivo kinematics has yet been assessed. METHODS This study consisted of 7 patients who underwent unilateral primary THA for symptomatic osteoarthritis. Using a flat-panel X-ray detector, continuous radiographs were obtained during stationary cycling. We analyzed the three-dimensional replaced hip kinematics from the top to the bottom position of the crank using image-matching techniques and quantified minimum liner-to-stem neck distance. Simulation analyses with in vivo kinematics were performed to examine patient-specific optimal cup placement against prosthetic impingement. FINDINGS During stationary cycling, pelvis showed 27.1° of posterior tilt on average without significant change. Hip flexed by 59.4° and 19.3° on average at the top and bottom positions, respectively. Minimum liner-to-neck distance was 8.8 mm on average at the bottom position. Liner-to-neck, bone-to-bone, or bone-to-component impingement was not observed at any positions in any hips. Simulation analysis of cup placement showed that larger cup anteversion, inclination, and use of elevated liner significantly decreased the minimum distance between posterior liner and stem neck. Cup anteversion of more than 30° with elevated liner could cause posterior liner-to-neck impingement at bottom position. INTERPRETATION Stationary cycling after THA provides no excessive hip range of motion or liner-to-neck contact. Cup placement and use of elevated liner significantly influence the minimum liner-to-neck distance, in some cases simulating posterior prosthetic impingement.
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Affiliation(s)
- Keisuke Komiyama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Satoru Ikebe
- Department of Creative Engineering, National Institute of Technology, Kitakyushu College, 5-20-1 Shii, Kokuraminami-ku, Kitakyushu, Fukuoka 802-0985, Japan
| | - Kensei Yoshimoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hidehiko Higaki
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-0004, Japan
| | - Kyohei Shiomoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hirotaka Gondo
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-0004, Japan
| | - Daisuke Hara
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yifeng Wang
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-0004, Japan
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Sakemi Y, Komiyama K, Yoshimoto K, Shiomoto K, Iwamoto M, Nakashima Y. How does anteroposterior cup placement affect bone coverage and range of motion in primary total hip arthroplasty for hip dysplasia? J Orthop Sci 2019; 24:269-274. [PMID: 30243518 DOI: 10.1016/j.jos.2018.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/20/2018] [Accepted: 08/27/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Due to anterior bone defects, high and/or posterior placement of an acetabular cup is often required to achieve sufficient coverage in patients with hip dysplasia. We examined whether posterior cup placement affected the postoperative range of motion (ROM) in primary total hip arthroplasty (THA). METHODS Using computer software, bone coverage and ROM were examined in 32 patients with unilateral osteoarthritis of the hip with Crowe type II or III hip dysplasia. We determined the cup position to satisfy cup center-edge (Cup-CE) angle ≥0° and the required ROM. The cup was placed at the anatomic hip center and moved in 2-mm increments anteroposteriorly and 10-mm increments vertically. RESULTS At vertical anatomic hip center, less than 68.8% hips fulfilled Cup-CE ≥0° regardless of anteroposterior position. Significantly more hips at higher hip center with posterior cup placement achieved Cup-CE ≥0° than hips at vertical anatomic hip center, and 10 mm higher hip center was the most suitable for achieving bone coverage. However, posterior and superior cup placement significantly decreased the flexion and IR due to early bone impingement, whereas ER and extension were not affected. A smoothing spline curve demonstrated that more posterior cup placement than 4.8 mm and 3.6 mm did not satisfy the required ROM at 10 mm and 20 mm higher hip center, respectively. CONCLUSIONS Posterosuperior cup placement gained more bone coverage but decreased the range of hip flexion and internal rotation. Consequently, posterosuperior cup placement did not satisfy the required ROM.
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Affiliation(s)
- Yuta Sakemi
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Keisuke Komiyama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Kensei Yoshimoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Kyohei Shiomoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Miho Iwamoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Tabata T, Kaku N, Tagomori H, Tsumura H. Influence of hip center position, anterior inferior iliac spine morphology, and ball head diameter on range of motion in total hip arthroplasty. Orthop Traumatol Surg Res 2019; 105:23-28. [PMID: 30509621 DOI: 10.1016/j.otsr.2018.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 08/29/2018] [Accepted: 09/13/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acetabular component orientation, such as high placement and femoral head diameter influence joint stability in total hip arthroplasty (THA), wherein anterior inferior iliac spine (AIIS) shape could cause femoro-acetabular impingement. Little is known regarding the combined influence of these parameters, particularly in the context of developmental dysplasia of the hip. Therefore we conducted a computer simulation study based on computed tomography (CT) data to determine whether: (1) AIIS shape, (2) high placement of acetabular cups, and (3) ball head diameter influence the range of motion (ROM) after THA. HYPOTHESIS The decrease in ROM depends on AIIS shape and the ROM decreases even if the femoral head diameter is increased when high placement of acetabular cups. PATIENTS AND METHODS CT data from 14 hips of 14 patients were evaluated. Hips were categorized by Hetsroni classification type I (n=6), type II (n=6), and type III (n=2) depending on AIIS shape. ROM was evaluated using CT-based software. Cups were placed at and 5 and 10mm above the normal hip position. The femoral heads used were 28 (standard simulation), 32, and 36mm in diameter. ROM at impingement was measured under flexion (Flex), internal rotation (IR) at 90° flexion (IR at 90Flex), IR at 45° flexion with a 20° adduction (IR at 45Flex20Add), and external rotation at 10° extension (ER at 10Ext). RESULTS The mean ROM standard simulation for Flex, IR at 90Flex, IR at 45Flex20Add and ER at 10Ext were: 119.8±5.4°, 31.0±11.3°, 70.0±11.9°, and 33.0±9.7° for type I; 118.5±5.5°, 31.5±2.9°, 71.3±2.2°, and 33.3±3.3° for type II; and 105.5±13.4°, 21.0±15.6°, 61.0±11.3°, and 34.5±2.1° for type III, respectively. There were no significant differences in the ROMs of each type (Flex, p=0.252; IR at 90Flex, p=0.461; IR at 45Flex20Add, p=0.261; and ER at 10Ext, p=0.655). For the high placement of acetabular cups, ROM increase was restricted despite the femoral head diameter increase. DISCUSSION Larger femoral head diameters increased ROM, with a lower increase in type III because of bony impingement. ROM decreased with higher cup placement. Expansion effects were minimal, even with larger ball head diameters, and were further decreased in types II and III. Attention should be paid to AIIS shape because bony impingements occur early with higher acetabular cup placement. LEVEL OF EVIDENCE VI Simulation study.
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Affiliation(s)
- Tomonori Tabata
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1, Idaigaoka Hasama-machi, 8795593 Yufu city, Oita, Japan
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1, Idaigaoka Hasama-machi, 8795593 Yufu city, Oita, Japan.
| | - Hiroaki Tagomori
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1, Idaigaoka Hasama-machi, 8795593 Yufu city, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1, Idaigaoka Hasama-machi, 8795593 Yufu city, Oita, Japan
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Does hip center location affect the recovery of abductor moment after total hip arthroplasty? Orthop Traumatol Surg Res 2018; 104:1149-1153. [PMID: 30292598 DOI: 10.1016/j.otsr.2018.06.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 06/06/2018] [Accepted: 06/17/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND In total hip arthroplasty (THA), placing the cup in an anatomic position is not always possible in case of deformities related to developmental dysplasia of the hip (DDH). Thus far, the influence of a hip center on the abductor moment after THA has not been clearly elucidated. Therefore, we performed a retrospective study to assess (1) how abductor muscle moment recovers postoperatively in THA and (2) whether acetabular cup position affects the recovery of abductor moment. HYPOTHESIS A high hip center affects the recovery of abductor moment of a dysplastic hip after THA. PATIENTS AND METHODS We evaluated 100 patients, who underwent unilateral primary THA, at 12 months postoperatively. The study included 86 women and 14 men, with a mean age of 65.5±9.9 years (range, 40 to 86 years). Patients with secondary osteoarthritis due to DDH were included (Crowe 1: 76; Crowe 2: 15, Crowe 3:9, and Crowe 4: none). A cementless straight stem was implanted in all hips. Hip abductor moment was measured using a belt-stabilized hand-held dynamometer. The ratio of moment of the affected side to that of the contralateral side was calculated as moment ratio. The horizontal and vertical centers of rotation (H-COR and V-COR) (with respect to the inter teardrop line) and vertical shift (V-shift) (difference in V-COR between the affected hip and the contralateral normal hip) were determined. RESULTS At 6 and 12 months postoperatively, the abductor moment ratios were 95.1 and 94.7%, respectively. Significant negative correlation was observed between the postoperative abductor moment ratio and V-COR at 6 months postoperatively (r=-0.2436, p=0.0238). Significant delay in the recovery of abductor moment ratio was observed in the groups with higher hip center (V-shift>15mm) (odds ratio=12.7; 95% CI: 2.11-232.1, p=0.0034) at 6 months postoperatively, which was fully recovered at 12 months postoperatively. DISCUSSION Superior placement of a hip center, more than 15mm above the true hip center, delayed the recovery of abductor muscle moment after THA. LEVEL OF EVIDENCE III, retrospective comparative study.
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Komiyama K, Fukushi JI, Motomura G, Hamai S, Ikemura S, Fujii M, Nakashima Y. Does high hip centre affect dislocation after total hip arthroplasty for developmental dysplasia of the hip? INTERNATIONAL ORTHOPAEDICS 2018; 43:2057-2063. [DOI: 10.1007/s00264-018-4154-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/10/2018] [Indexed: 01/10/2023]
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Developmental Dysplasia Treated With Cementless Total Hip Arthroplasty Utilizing High Hip Center Reconstruction: A Minimum 13-Year Follow-up Study. J Arthroplasty 2018; 33:2899-2905. [PMID: 29803578 DOI: 10.1016/j.arth.2018.04.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/16/2018] [Accepted: 04/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The primary aim of this study was to determine the clinical outcomes at 13-year follow-up of patients diagnosed with developmental dysplasia of the hip and subsequently treated with total hip arthroplasty (THA). The secondary aim was to investigate the effect of hip center location on clinical outcomes and polyethylene wear. METHODS We reviewed data from a consecutive series of 104 patients (123 hips) from a single center. Patients were treated with THA with the high hip center (HHC) technique using cementless acetabular shells and highly cross-linked liners. Radiographs were collected preoperatively and through 13-year follow-up to assess degree of dysplasia (Crowe classification), component positioning, occurrence of bone resorption, and polyethylene wear. The Harris Hip Score (HHS) was administered at 4 and 13 years. RESULTS No patients were lost to follow-up, and one was revised for femoral loosening. Radiolucency was seen in 20% of patients and was not associated with HHC (P = .560). No patients developed osteolysis. The wear rate was low for all patients (mean: 3 ± 19 μm/y) and not associated with HHC (P = .852). The median 13-year HHS was 91.9 (interquartile range: 84.8-97.0). There was a statistically significant decline from the 4- to 13-year HHS (P < .001) for the Crowe II-IV group, although 82% of these patients remained above 80 points at 13 years. The nondysplastic and Crowe I group showed no longitudinal change in HHS (P = .243). CONCLUSION This cup design and highly cross-linked polyethylene liner combination demonstrates excellent clinical outcomes, similar to THA for primary osteoarthritis, through 13-year follow-up in patients with various degrees of developmental dysplasia of the hip and HHC reconstructions.
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Shimodaira H, Tensho K, Akaoka Y, Koyama S, Maruyama M, Kato H, Saito N. The Acetabular Fossa May Not Be Located at the True Center of the Acetabulum: A Detailed Analysis Using Preoperative CT Images. J Bone Joint Surg Am 2018; 100:e27. [PMID: 29509621 DOI: 10.2106/jbjs.17.00362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The acetabular fossa is thought to be located in the center of the acetabulum, and acetabular reaming in total hip arthroplasty is conventionally performed in the center of the fossa. However, the actual location of the fossa and the influence that hypoplasia or deformity may have on the position of the fossa are unknown. We hypothesized that the fossa is located in the center of the acetabulum, regardless of hypoplasia or deformity. METHODS Fifty patients with normal hips (normal hip group), 50 patients with dysplasia who underwent rotational acetabular osteotomy (dysplastic hip group), and 46 patients with osteoarthritis who underwent total hip arthroplasty (osteoarthritic hip group) were evaluated by computed tomography (CT) imaging. On the horizontal plane that passes through the center of the femoral head, the center line of the acetabulum was defined as the perpendicular bisector of the anterior and posterior rims of the acetabulum. The angle and distance of the center of the acetabular fossa in relation to the center line of the acetabulum were evaluated; furthermore, the center position of the fossa from the anterior margin of the acetabulum was calculated as a ratio relative to acetabular size. A 1-way analysis of variance was performed to compare measurements among the 3 groups. RESULTS The center of the acetabular fossa was positioned anteriorly to the center line of the acetabulum in all 3 groups. The mean center angle of the acetabular fossa was 14.0° ± 3.8°, 15.2° ± 5.6°, and 14.9° ± 5.5° in the normal, dysplastic, and osteoarthritic hip groups, respectively (p = 0.33). The mean center distance of the acetabular fossa was 5.6 ± 1.8, 5.8 ± 2.3, and 6.1 ± 2.2 mm, respectively (p = 0.55). The mean center position of the acetabular fossa was 38.8% ± 3.3%, 38.5% ± 4.2%, and 38.3% ± 3.9%, respectively (p = 0.71). CONCLUSIONS The center of the acetabular fossa is positioned anteriorly to the center of the acetabulum, and the positioning is affected by neither dysplasia nor osteoarthritis. The preconception that the center of the acetabulum corresponds to the center of the acetabular fossa may risk eccentric reaming, possibly damaging the anterior wall. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hiroki Shimodaira
- Department of Orthopedic Surgery (H.S., K.T., Y.A., S.K., and H.K.) and Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research (N.S.), Shinshu University School of Medicine, Matsumoto, Japan
| | - Keiji Tensho
- Department of Orthopedic Surgery (H.S., K.T., Y.A., S.K., and H.K.) and Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research (N.S.), Shinshu University School of Medicine, Matsumoto, Japan
| | - Yusuke Akaoka
- Department of Orthopedic Surgery (H.S., K.T., Y.A., S.K., and H.K.) and Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research (N.S.), Shinshu University School of Medicine, Matsumoto, Japan
| | - Suguru Koyama
- Department of Orthopedic Surgery (H.S., K.T., Y.A., S.K., and H.K.) and Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research (N.S.), Shinshu University School of Medicine, Matsumoto, Japan
| | - Masaaki Maruyama
- Department of Orthopedic Surgery, Shinonoi General Hospital, Nagano, Japan
| | - Hiroyuki Kato
- Department of Orthopedic Surgery (H.S., K.T., Y.A., S.K., and H.K.) and Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research (N.S.), Shinshu University School of Medicine, Matsumoto, Japan
| | - Naoto Saito
- Department of Orthopedic Surgery (H.S., K.T., Y.A., S.K., and H.K.) and Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research (N.S.), Shinshu University School of Medicine, Matsumoto, Japan
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Osawa Y, Hasegawa Y, Seki T, Takegami Y, Amano T, Ishiguro N. Patient-reported outcomes in patients who undergo total hip arthroplasty after periacetabular osteotomy. J Orthop Sci 2018; 23:346-349. [PMID: 29187291 DOI: 10.1016/j.jos.2017.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND There has been constant discussion about whether the clinical outcome of THA after periacetabular osteotomy (PAO) is equivalent to that after primary total hip arthroplasty (THA). However, there have been few reports about patient-reported outcomes (PRO) for those who undergo THA after PAO. We compared the pre- and postoperative PRO of patients who underwent THA after PAO and those who underwent primary THA alone. METHODS We performed a case-control study. Twenty-seven patients (29 hips) underwent THA after PAO (osteotomy group); their mean age at surgery was 57.2 years, and they underwent postoperative follow-up for a mean period of 3.0 years. For the control group, after matching age, sex, and Crowe classification, we included 54 patients (58 joints) who underwent primary THA for hip dysplasia. Assessment performed preoperatively and at the last follow-up included the Harris hip score, the Short Form 36 (SF-36) for the Physical Component Summary (PCS), Mental Component Summary (MCS), and Role/Social Component Summary (RCS) domains, Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) for pain, movement, and mental health, and the visual analog scale (VAS) score of hip pain and satisfaction. RESULTS The two groups demonstrated no significant difference in the preoperative Harris hip score, each domain of the SF-36, JHEQ, and the VAS score of hip pain and satisfaction. The osteotomy group demonstrated significantly poor Harris hip scores for gait and activity, and JHEQ for movement at the last follow-up. There was no significant difference in each domain of the SF-36 and the VAS score of hip pain and satisfaction at the last follow-up. CONCLUSION Previous PAO affects the quality of physical function in patients who undergo subsequent THA.
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Affiliation(s)
- Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yukiharu Hasegawa
- Department of Hip and Knee Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takafumi Amano
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Liu B, Gao YH, Ding L, Li SQ, Liu JG, Qi X. Computed Tomographic Evaluation of Bone Stock in Patients With Crowe Type III Developmental Dysplasia of the Hip: Implications for Guiding Acetabular Component Placement Using the High Hip Center Technique. J Arthroplasty 2018; 33:915-918. [PMID: 29129617 DOI: 10.1016/j.arth.2017.10.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/11/2017] [Accepted: 10/11/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We evaluated acetabular cup coverage (CC) and rim contact (RC) to evaluate the bone stock above the acetabulum for guiding acetabular component placement using the high hip center technique in patients with Crowe type III developmental dysplasia of the hip. METHODS Using hip computed tomography and image processing software, pelvises were reconstructed digitally in 20 hips with Crowe type III developmental dysplasia of the hip. Mimicked cup was placed with anteversion angles of 0° (group I), 5° (group II), and 10° (group III) respectively. In each group, the cup was placed at the anatomical hip center at first, and then the cup was moved up to 40 mm vertically about the native rotation center with an increment of 2.5 mm at each step. CC and RC were calculated and documented with each movement. RESULTS CC was 65.87%, 67.77%, and 68.98% for group I, group II, and group III at the native rotation center, and increased progressively to 86.45%, 85.85%, and 84.71% at 25 mm above. RC was 49.17%, 50.25%, and 51.92% for group I, group II, and group III at the native rotation center, and increased progressively to 86.87%, 86.39%, and 84.94% at 22.5 mm above. CC and RC were positively correlated, despite the different anteversion angles (r = 0.687 at 0°, 0.683 at 5°, and 0.645 at 10°; P < .001). CONCLUSION Computed tomography analysis and computer stimulation demonstrate that it is feasible to use high hip center technique in Crowe type III hips.
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Affiliation(s)
- Bo Liu
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Yu-Hang Gao
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Lu Ding
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Shu-Qiang Li
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Jian-Guo Liu
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Xin Qi
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
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Bombaci H, Simsek B, Soyarslan M, Murat Yildirim M. Determination of the hip rotation centre from landmarks in pelvic radiograph. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:470-473. [PMID: 29029869 PMCID: PMC6197315 DOI: 10.1016/j.aott.2017.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/08/2017] [Accepted: 09/19/2017] [Indexed: 11/02/2022]
Abstract
OBJECTIVE The hip rotation centre (HRC) is an important reference point in cases of total hip arthroplasty (THA). The aim of this study is to investigate the reference points in the Turkish population that enable the identification of the HRC in standard pelvic radiographs. METHODS The pelvic radiographs of 50 women and 50 men were examined. The mean age was 46.2 (range; 18-91). Patients with deformity of the hip joint and non-standard pelvic radiograph due to hip flexion contracture were excluded from the study. The pelvic height (PH), the distance between the HRC and teardrop (HRC-Td), and the HRC and the line tangent tuber ischiadicums (HRC-TI) were measured. The ratio of HRC-Td and HRC-TI to PH were calculated. The first is called "the horizontal-HRC ratio" and the second, "the vertical-HRC ratio". RESULTS Mean PH was 239 (±13.58) mm in males and 225 (±12.52) in females (p < 0.0001). The distances of HRC-TI were 71 (±6.35) and 65 (±6.72) mm (p < 0.0001) and the distance of HRC-Td were 34 (±3.73) and 30 (±4.05) mm (p = 0.0007), respectively. The vertical-HRC ratios were 30.01% (±2.05) for males, 29.10% (±2.35) for females, the horizontal-HRC ratio, 14.25% (±1.42) and 13.69% (±1.38), respectively (p > 0.05). CONCLUSION Although the quantitative values obtained in the present study differ between the genders, the ratios ("vertical-HRC" and "horizontal-HRC") are comparable in both sexes. The results show that these proposed ratios can be used in THA planning, regardless of gender in the Turkish population LEVEL OF EVIDENCE: Level IV, diagnostic study.
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