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Hu Y, Zou D, Jiang M, Qian Q, Li H, Tsai TY, Zhang J. Postoperative hip center position is associated with gait symmetry in range of axial rotation in dysplasia patients after THA. Front Surg 2023; 10:1135327. [PMID: 37234957 PMCID: PMC10206229 DOI: 10.3389/fsurg.2023.1135327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Background This study aimed to explore whether pre- or postoperative hip structures or surgical changes significantly influence hip range of motion (ROM) symmetry in patients with hip dysplasia during gait after total hip arthroplasty (THA) and provide possible surgical suggestions. Methods Fourteen patients with unilateral hip dysplasia underwent computed tomography before and after surgery to create three-dimensional hip models. Pre- and postoperative acetabular and femoral orientations, hip rotation centers (HRC), and femoral lengths were measured. Bilateral hip ROM during level walking after THA was quantified using dual fluoroscopy. The ROM symmetry in flexion-extension, adduction-abduction, and axial rotation was calculated using the symmetry index (SI). The relationship between SI and the above anatomical parameters and demographic characteristics was tested using Pearson's correlation and linear regression. Results The average SI values for flexion-extension, adduction-abduction, and axial rotation during gait were -0.29, -0.30, and -0.10, respectively. Significant correlations were detected mainly in the postoperative HRC position. A distally placed HRC was associated with increased SI values for adduction-abduction (R = -0.47, p = 0.045), while a medially placed HRC was associated with decreased SI values for axial rotation (R = 0.63, p = 0.007). A regression analysis indicated that horizontal HRC positions significantly determined axial rotational symmetry (R2 = 0.40, p = 0.015). Normal axial rotation SI values were achieved with HRC between 17 mm medially and 16 mm laterally. Conclusions Postoperative HRC position was significantly correlated with gait symmetry in the frontal and transverse planes in patients with unilateral hip dysplasia after THA. Surgical reconstruction of the HRC to between 17 mm medially and 16 mm laterally may contribute to gait symmetry.
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Affiliation(s)
- Yi Hu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Diyang Zou
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Mengda Jiang
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingyu Qian
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 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, Shanghai, China
| | - Tsung-Yuan Tsai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- TaoImage Medical Technologies Corporation, Shanghai, 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, Shanghai, China
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Qian H, Wang X, Wang P, Zhang G, Dang X, Wang K, Liu R. Total Hip Arthroplasty in Patients with Crowe III/IV Developmental Dysplasia of the Hip: Acetabular Morphology and Reconstruction Techniques. Orthop Surg 2023. [PMID: 37114450 DOI: 10.1111/os.13733] [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: 10/08/2022] [Revised: 03/12/2023] [Accepted: 03/17/2023] [Indexed: 04/29/2023] Open
Abstract
The severe anatomic deformities render acetabular reconstruction as one of the greatest challenges in total hip arthroplasty (THA) for patients with Crowe III/IV developmental dysplasia of the hip (DDH). Thorough understanding of acetabular morphology and bone defect is the basis of acetabular reconstruction techniques. Researchers have proposed either true acetabulum position reconstruction or high hip center (HHC) position reconstruction. The former can obtain the optimal hip biomechanics, including bulk femoral head autograft, acetabular medial wall displacement osteotomy, and acetabular component medialization, while the latter is relatively easy for hip reduction, as it can avoid neurovascular lesions and obtain more bone coverage; however, it cannot achieve good hip biomechanics. Both techniques have their own advantages and disadvantages. Although there is no consensus on which approach is better, most researchers suggest the true acetabulum position reconstruction. Based on the various acetabular deformities in DDH patients, evaluation of acetabular morphology, bone defect, and bone stock using the 3D image and acetabular component simulation techniques, as well as the soft tissue tension around the hip joint, individualized acetabular reconstruction plans can be formulated and appropriate techniques can be selected to acquire desired clinical outcomes.
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Affiliation(s)
- Hang Qian
- Department of Orthopaedics, The Second Hospital Affiliated to Medical College, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Xu Wang
- Department of Orthopaedics, The Second Hospital Affiliated to Medical College, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Pengbo Wang
- Department of Orthopaedics, The Second Hospital Affiliated to Medical College, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Guangyang Zhang
- Department of Orthopaedics, The Second Hospital Affiliated to Medical College, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Xiaoqian Dang
- Department of Orthopaedics, The Second Hospital Affiliated to Medical College, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Kunzheng Wang
- Department of Orthopaedics, The Second Hospital Affiliated to Medical College, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Ruiyu Liu
- Department of Orthopaedics, The Second Hospital Affiliated to Medical College, Xi'an Jiaotong University, Xi'an, 710004, China
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Motififard M, Mir Miran Yazdi M, Teimouri M, Hatami S, Rafiee M, Toghyani A, Andalib A. Comparing the effect of cup placement between true and false acetabula in total hip arthroplasty in patients with Crowe type 3 dysplastic hip: A randomized clinical trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2022; 27:72. [PMID: 36353351 PMCID: PMC9639713 DOI: 10.4103/jrms.jrms_766_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 05/16/2022] [Accepted: 07/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Hip dysplasia is one of the most widespread hip disorders. Total hip arthroplasty (THA) is the preferred treatment in patients with cup placement choices in true or false acetabulum. The objective of this research was to compare the effectiveness of the two mentioned procedures. MATERIALS AND METHODS This study was a randomized, open-label, parallel-group clinical trial, in which 46 patients/51 hips with Crowe type 3 dysplastic hip having THA were assigned to two groups: Group 1 - patients who had cup placement in the true acetabulum and Group 2 - patients who underwent cup placement in the false acetabulum. The variables that were evaluated and analyzed included severity of pain using the visual analog scale (VAS), range of motion (ROM), gait ability, the need for repeated joint replacement, and the Harris Hip Score (HHS). RESULTS Forty-six patients/51 hips were included in the present study. The patients who were evaluated included 30 (65.2%) males and 16 (34.8%) females. The mean age in the population under study was 71.0 ± 10.22, and the mean body mass index of participants was 26.34 ± 2.22 kg/m2. The basic parameters in the two research groups were similar (P > 0.05). There were no significant differences between the two groups in terms of the mean values of VAS and ROM (P > 0.05); however, the mean HHS was significantly higher in the true acetabulum group, 57.90 ± 18.47 versus 48.29 ± 13.80 (P = 0.04). CONCLUSION The effectiveness of cup placements both in the true and false acetabula was similar in all of the evaluated variables in terms of clinical outcomes except for HHS which was higher in the true acetabulum group. To further support the results of this research, it is recommended that more research be done on a greater population.
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Affiliation(s)
- Mehdi Motififard
- Department of Orthopedic Surgery, School of Medicine, Kashani University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Mir Miran Yazdi
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Teimouri
- Department of Orthopedic Surgery, School of Medicine, Kashani University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Hatami
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Moslem Rafiee
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Toghyani
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Andalib
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Fujita M, Hayashi S, Hashimoto S, Kuroda Y, Kuroda R, Matsumoto T. The influence of stem alignment on the bone mineral density around the Polarstem following total hip arthroplasty. Arch Orthop Trauma Surg 2022; 143:3621-3627. [PMID: 36125537 DOI: 10.1007/s00402-022-04607-x] [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: 12/16/2021] [Accepted: 08/29/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Bone mineral density is important in detecting implant loosening after total hip arthroplasty. The Polarstem can improve postoperative bone mineral density changes, but no information exists on the influence of postoperative stem alignment. Therefore, we investigated the relationship between bone mineral density change and stem alignment following total hip arthroplasty using a cementless Polarstem. MATERIALS AND METHODS This retrospective study included 42 patients (50 hips) who underwent total hip arthroplasty using a cementless Polarstem. Bone mineral density around the stem was measured according to the established Gruen zone classification using dual-energy X-ray absorptiometry. Measurements were performed 2 months postoperatively (baseline) and 6, 12, 18, and 24 months postoperatively. Bone mineral density changes at each follow-up were calculated as (bone mineral density at follow-up/at 2 weeks) × 100 (%). The stem varus, anterior tilt, and anteversion angles were measured using computed tomography. The correlation coefficient between bone mineral density changes and stem alignment were investigated. RESULTS The 24-month postoperative bone mineral density increased in zones 4 (106.0%) and 5 (107.3%) and decreased in zones 1 (89.6%) and 7 (90.6%). The mean stem varus angle, anterior tilt, and anteversion error were - 0.3° ± 1.8°, 1.9° ± 2.2°, and 6.8° ± 5.4°. Negative correlations were observed between the stem varus angle and 24-month postoperative bone mineral density change in zone 1 (r = - 0.34, p = 0.02), and the stem anteversion error and 24-month postoperative bone mineral density change in zone 1 (r = - 0.48, p < 0.01) and zone 7 (r = - 0.31, p = 0.03). CONCLUSIONS The cementless Polarstem may have a positive effect on postoperative bone mineral density in the distal femur. However, varus malalignment and anteversion error of the stem could have a negative influence on the bone mineral density changes in the proximal femur.
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Affiliation(s)
- Masahiro Fujita
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Shinya Hayashi
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan.
| | - Shingo Hashimoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Yuichi Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
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Tu Q, Ding HW, Chen H, Shen JJ, Miao QJ, Liu B, Yu GW, Huang XH, Zhu CR, Tang Y, Xia H, Xu JZ. Preliminary application of 3D-printed individualised guiding templates for total hip arthroplasty in Crowe type IV developmental dysplasia of the hip. Hip Int 2022; 32:334-344. [PMID: 32750257 DOI: 10.1177/1120700020948006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the feasibility and accuracy of three-dimensional (3D)-printed individualised guiding templates in total hip arthroplasty (THA) for the treatment of developmental dysplasia of the hip (DDH). METHODS 12 hips in 12 patients with Crowe type IV DDH were treated with THA. A 3D digital model of the pelvis and lower limbs was reconstructed using the computed tomography data of the patients. Preoperative surgical simulations were performed to determine the most suitable surgical planning, including femoral osteotomy and prosthesis placement. Based on the ideal surgical planning, individualised guiding templates were designed by software, manufactured using a 3D printer, and used in acetabulum reconstruction and femoral osteotomy during surgery. RESULTS 12 patients were followed up for an average of 72.42 months (range 38-135 months). During surgery, the guiding template for each case was matched to the bony markers of the acetabulum and proximal femur. Preoperative and follow-up Harris Hip Scores were 34.2 ± 3.7 and 85.2 ± 4.2; leg-length discrepancy, 51.5 ± 6.5 mm and 10.2 ± 1.5 mm; and visual analogue scale scores, 6.2 ± 0.8 and 1.3 ± 0.3, respectively, with statistical difference. Shortened deformity and claudication of the affected limb were obviously improved after surgery. However, 1 patient had artificial hip dislocation 2 weeks after surgery, and another patient had sciatic nerve traction injury, both of whom recovered after physical treatment. CONCLUSIONS Preoperative surgical simulation and 3D-printed individualised guiding templates can fulfil surgeon-specific requirements for the treatment of Crowe type IV DDH. Accurate THA can be achieved using 3D-printed individualised templates, which provide a new personalised surgical plan for the precise positioning and orientation of acetabular reconstruction and femoral osteotomy.
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Affiliation(s)
- Qiang Tu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China.,Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China.,Department of Orthopaedics, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Huan-Wen Ding
- Department of Anatomy, School of Medicine, South China University of Technology, Guangzhou, China.,Department of Orthopaedics, Guangzhou First People's Hospital, Guangzhou, China
| | - Hu Chen
- Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China.,Department of Orthopaedics, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jian-Jian Shen
- Department of Spinal Surgery, Guangdong Integrative Medicine Hospital, Foshan, China
| | - Qiu-Ju Miao
- Department of Anatomy, School of Medicine, South China University of Technology, Guangzhou, China
| | - Bao Liu
- Department of Orthopaedics, Zhongshan Torch Development Zone Hospital, Zhongshan, China
| | - Guang-Wen Yu
- Department of Sports Medicine, Guangzhou Orthopaedics Hospital, Guangzhou, China
| | - Xian-Hua Huang
- Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Chang-Rong Zhu
- Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Yong Tang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Hong Xia
- Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Jian-Zhong Xu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
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Taylor AJ, Runner RP, Kay RD, Najibi S. Femoral Head Autograft Can Reliably Reconstruct Dysplastic Acetabula Through the Direct Anterior Approach for Total Hip Arthroplasty. Arthroplast Today 2022; 14:154-162. [PMID: 35313717 PMCID: PMC8933727 DOI: 10.1016/j.artd.2022.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/16/2022] [Accepted: 02/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background Bone deficiencies in dysplastic acetabula create technical difficulties during total hip arthroplasty (THA). Bulk femoral head autograft (FHA) is one method to increase cup coverage and bone stock of the true acetabulum; however, only limited data exist on its efficacy through a direct anterior approach (DAA). This study aimed to evaluate the outcomes of FHA during THA via a DAA in dysplastic hips. Methods Retrospective review of 34 patients (41 hips) with hip dysplasia (Crowe I-III) who underwent primary THA via a DAA with FHA at a single institution was performed. Surgical procedures were performed on a traction table with intraoperative fluoroscopy and highly porous-coated cup placement in the true acetabulum. Patients were assessed clinically and radiographically at a minimum of 2 years postoperatively (range, 2 to 7). Results The average modified Harris Hip Score improved from 31.9 ± 10.8 to 94.1 ± 5.8, Merle d'Aubigné Hip Score from 7.5 ± 2.8 to 16.6 ± 1.1, and visual analog pain score from 7.9 ± 2.7 to 1.4 ± 1.4 (all P < .001). All hips had an “anatomic” inferomedial cup position postoperatively, with an average increase in horizontal coverage of 43.4%. Mean postoperative limb-length discrepancy improved from 21.8 ± 16.1 mm to 1.6 ± 5.7 mm (P < .001). There were no cases of revision THA, nor complications such as dislocation, infection, or osteolysis. Conclusion Reconstructing dysplastic acetabula (Crowe I-III) with FHA during THA can be successfully accomplished via the DAA with increased acetabular bone stock and accurate correction of limb-length discrepancy.
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Affiliation(s)
- Adam J. Taylor
- Department of Orthopaedic Surgery, Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
- Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
- Corresponding author. 7601 E Imperial Hwy, Downey, CA 90242, USA. Tel: +1 916 832 2326.
| | - Robert P. Runner
- Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Robert D. Kay
- Department of Orthopaedic Surgery, Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
- Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Soheil Najibi
- Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
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Hu Y, Zou D, Sun Q, Jiang M, Li H, Tsai TY, Zhang J. Postoperative Hip Center Position Associated With the Range of Internal Rotation and Extension During Gait in Hip Dysplasia Patients After Total Hip Arthroplasty. Front Bioeng Biotechnol 2022; 10:831647. [PMID: 35295644 PMCID: PMC8918532 DOI: 10.3389/fbioe.2022.831647] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/03/2022] [Indexed: 12/13/2022] Open
Abstract
Background: Total hip arthroplasty (THA) for hip dysplasia patients is sometimes complex and compromises pathomorphological changes in these patients. However, it remains unclear whether it is preoperative deformities or postoperative structures or anatomic changes during THA that have the most remarkable correlation with the hip dynamic function during gait. The purpose of this study was to investigate this relationship and propose insights into the surgical reconstruction strategy in patients with developmental dysplasia of the hip.Methods: A total of 21 unilateral hip dysplasia patients received computed tomography scans for the creation of 3D hip models before surgery and at the last follow-up. Acetabular and femoral orientations, hip center positions, and femoral length were measured before and after THA. Hip kinematics of the operated side during gait was quantified using a dual fluoroscopic imaging technique. Pearson correlation and multiple linear regression were performed to evaluate the relationship between hip maximum range of motion in six directions and demographics characters and above hip anatomic parameters before and after THA and their changes in surgery.Results: Pearson correlation analysis found significant correlations with the gait range of motion mainly in postoperative structures, including postoperative hip center positions and acetabulum and combined anteversion. Further multiple linear regression indicated that a laterally placed hip center was significantly correlated with an increased internal rotation (R2 = 0.25, p = 0.021), which together with increased postoperative acetabulum anteversion explained 45% of external rotation decreasing (p = 0.004). A proximally placed hip center was correlated with more extension (R2 = 0.30, p = 0.010). No significant demographic characters or preoperative deformities or surgical changes were included into other multiple regression models.Conclusion: Strong correlations between postoperative structures, especially hip center positions and gait range of motion in unilateral hip dysplasia patients after THA were found. It indicated that postoperative prosthesis structures, particularly hip center positions had significant impact on the hip gait motion range and should be treated with particular caution in surgery.
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Affiliation(s)
- Yi Hu
- Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Diyang Zou
- Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Qi Sun
- Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengda Jiang
- Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiwu Li
- Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Huiwu Li, ; Tsung-Yuan Tsai, ; Jingwei Zhang,
| | - Tsung-Yuan Tsai
- Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- TaoImage Medical Technologies Corporation, Shanghai, China
- *Correspondence: Huiwu Li, ; Tsung-Yuan Tsai, ; Jingwei Zhang,
| | - Jingwei Zhang
- Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Huiwu Li, ; Tsung-Yuan Tsai, ; Jingwei Zhang,
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Clement ND, Immelman RJ, MacDonald D, Breusch SJ, Howie CR. Survivorship and functional outcome of a cemented acetabular component with bulk roof autograft for severe acetabular dysplasia: 12- to 23-year follow-up. Hip Int 2021; 33:508-517. [PMID: 34802296 DOI: 10.1177/11207000211056905] [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
AIMS Primary aim was to determine survival of a cemented acetabular component with bulk roof autograft with a minimum of 12 years follow-up. The secondary aim was to determine the clinical outcome. METHODS A cohort of 62 consecutive patients (74 hips) undergoing cemented total hip arthroplasty with acetabular bulk roof autograft for acetabular dysplasia were retrospectively identified. The group consisted of 57 female patients (67 hips) and 5 male patients (7 hips) with a mean age at operation of 45 years. No patient was lost to follow-up, however 9 patients died had during the study period. The Oxford Hip Score (OHS), Forgotten Joint Score (FJS), EuroQol 5-Dimensional Score (EQ-5D), Short Form (SF-12) physical score and patient satisfaction were used to assess clinical outcome for patients with a surviving prosthesis. RESULTS The median follow-up was 16.6 (13.4-19.1) years. 6 revisions were performed during the follow-up period, all of which were due to aseptic loosening of the acetabular component. The all-cause Kaplan Meier survival rate for the acetabular component was 99% at 10 years, 95% at 15 years and 83% at 20 years. Neither age, gender, femoral osteotomy or polyethylene (UHMW vs. cross-linked) were significant predictors of aseptic revision of the acetabular component. There were no case of graft resorption and all grafts were radiologically incorporated. 45 patients were available for functional assessment at a mean follow-up of 18.2 years. The mean OHS was 37.8, FJS was 55.7, EQ5D was 0.73, and SF-12 physical component was 43.2. No patient was dissatisfied, with 2 patients reporting a neutral satisfaction, 7 stating they were satisfied and the remaining 36 were very satisfied. CONCLUSIONS A cemented acetabular component with bulk roof autograft for dysplasia offers excellent survival with good to excellent functional outcome with high patient satisfaction in the medium- to long-term.
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Affiliation(s)
- Nick D Clement
- Edinburgh Orthopaedics, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Deborah MacDonald
- Edinburgh Orthopaedics, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Steffen J Breusch
- Edinburgh Orthopaedics, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Colin R Howie
- Edinburgh Orthopaedics, The Royal Infirmary of Edinburgh, Edinburgh, UK
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Hao LJ, Zhang YM, Wen PF. Comment on "The Influence of Femoral Proximal Medullary Morphology on Subtrochanteric Osteotomy in Total Hip Arthroplasty for Unilateral High Dislocated Hips". Orthop Surg 2021; 13:2477-2478. [PMID: 34796686 PMCID: PMC8654666 DOI: 10.1111/os.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/08/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lin-Jie Hao
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yu-Min Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Peng-Fei Wen
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
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10
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Peng YW, Shen JM, Zhang YC, Sun JY, Du YQ, Zhou YG. Jumbo cup in hip joint renovation may cause the center of rotation to increase. World J Clin Cases 2021; 9:6300-6307. [PMID: 34434996 PMCID: PMC8362550 DOI: 10.12998/wjcc.v9.i22.6300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Utilizing the large jumbo cup in revision total hip arthroplasty is an effective approach to cure many lacunar and segmental peripheral bone defects. However, with the use of the jumbo cup, the center of the hip joint may become elevated relative to the primary acetabulum, and the diameter of the large cup is greater.
AIM To study the height and the significance of the elevation of the hip joint center.
METHODS Eighty-eight patients matched the criteria for this condition and were included in the study. The center height of the hip joint was measured relative to the opposite normal hip joint. The diameter of the jumbo cup was measured and checked according to operation notes, and the diameter of the jumbo cup was measured with a prosthesis label. Then, the horizontal and vertical centers of rotation were measured on the surgical side and opposite side. The average center height of the hip joint on the renovated side and the opposite side and the position of the hip cup relative to the teardrop were compared using a paired t-test.
RESULTS Radiometric analysis showed that the average hip joint center was elevated by 7.6 mm. The rotational center height delta of the renovated hip was 7.6 ± 5.6 mm, and there was an obvious difference between the two groups (P = 0.00). The difference in horizontal distance was 0.5 ± 5.1 mm (-11.5 -14.0 mm), and there was no obvious difference between the two groups (P = 0.38). According to the foreign standard, the rotational center height delta of the renovated hip was 7.5 ± 6.2 mm, and there was a significant difference between the two groups (P = 0.00). There was no obvious difference between the domestic and foreign standards (P > 0.05) between the two groups.
CONCLUSION The application of the jumbo cup elevates the rotational center of the hip joint, but it is feasible and effective to use the jumbo cup.
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Affiliation(s)
- Ya-Wen Peng
- Department of Orthopedics, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Jun-Min Shen
- Department of Orthopedics, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Yan-Chao Zhang
- Department of Orthopedics, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Jing-Yang Sun
- Department of Orthopedics, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Yin-Qiao Du
- Department of Orthopedics, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Yong-Gang Zhou
- Department of Orthopedics, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
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11
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Kitajima H, Kaneuji A, Soma D, Fukui M, Kawahara N. Bone ingrowth observed in a cup removed during revision surgery for early dislocation after primary THA: A case report. Int J Surg Case Rep 2021; 83:105941. [PMID: 33989873 PMCID: PMC8134982 DOI: 10.1016/j.ijscr.2021.105941] [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: 04/02/2021] [Revised: 04/24/2021] [Accepted: 04/24/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance Recently cementless total hip arthroplasty (THA) has shown good long-term results with excellent stability resulted from the porous coating of the implant. A hydroxyapatite-tricalcium phosphate (HA-TCP) coating on the porous surface is expected to promote bone ingrowth and to improve initial fixation of the implant. Here we report a case of bone ingrowth observed in a cup removed during revision surgery for early dislocation, 37 days after primary THA using a porous coating cup with HA-TCP. Case presentation A 61-year-old woman who has bilateral osteoarthritis underwent same-day bilateral THA. Both sides used porous coating cups with HA-TCP. Line-to-line technique and screw fixation were utilized. Anterior dislocation of the left hip occurred on days 27 and 31, and we performed cup revision on day 37 after surgery. We noted bone-like tissue on the posterior surface of the cup and in a vacant screw hole. Bone tissue was also confirmed in pathological findings. Clinical discussion Studies in animals have confirmed early bone ingrowth about 4 weeks after surgery with HA-TCP coated implants. In humans, the earliest report of bone ingrowth in cups is for a cup without HA-TCP coating, detected 5 weeks after surgery. In the present case, we used a porous coating cup with HA-TCP, and bone ingrowth was confirmed at approximately the same time as for the previous case. Conclusion Early clinical bone ingrowth was confirmed in an HA-TCP coated cup, occurring at about the same time after surgery as in previous reports. Cementless THA shows excellent long-term results for porous coating of implant. HA-TCP coating promotes bone ingrowth of mesenchymal cells. Post-THA revision showed good initial fixation with porous coating cup and HA-TCP.
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Affiliation(s)
- Hironori Kitajima
- Department of Orthopedic Surgery, Kanazawa Medical University, Japan.
| | - Ayumi Kaneuji
- Department of Orthopedic Surgery, Kanazawa Medical University, Japan
| | - Daisuke Soma
- Department of Orthopedic Surgery, Kanazawa Medical University, Japan
| | - Makoto Fukui
- Department of Orthopedic Surgery, Kanazawa Medical University, Japan
| | - Norio Kawahara
- Department of Orthopedic Surgery, Kanazawa Medical University, Japan
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12
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Taylor AJ, Runner RP, Longjohn DB, Najibi S. Anterior Total Hip Arthroplasty With Bulk Femoral Head Autograft in a Patient With Camurati-Engelmann Disease. Arthroplast Today 2021; 8:204-210. [PMID: 33937459 PMCID: PMC8076616 DOI: 10.1016/j.artd.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 12/05/2022] Open
Abstract
Camurati-Engelmann disease (CED) is an extremely rare, sclerosing bone disorder of intramedullary ossification with only 300 reported cases worldwide. The pathogenesis is related to activating mutations in transforming growth factor beta 1, which results in bilateral, symmetric hyperostosis affecting primarily the diaphysis of long bones. Despite effective pharmacological treatment options, the diagnosis of CED is problematic owning to its rarity and variability of clinical presentation. We present a patient with known CED with advanced early hip osteoarthritis, secondary to underlying hip dysplasia, for which she underwent a successful total hip arthroplasty via a direct anterior approach with the use of bulk femoral head autograft to reconstruct her native acetabulum.
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Affiliation(s)
- Adam J Taylor
- Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Robert P Runner
- Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Donald B Longjohn
- Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA.,Department of Orthopaedic Surgery, Keck Medical School of University of Southern California, Los Angeles, CA, USA
| | - Soheil Najibi
- Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
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13
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Shen J, Sun J, Du Y, Zhang B, Li T, Zhou Y. Functional and radiographical results of asymmetrically reconstructed total hip arthroplasty in patients with bilateral dysplastic arthritic hips with one hip Crowe II-III and the other Crowe IV: a retrospective cohort study. J Orthop Traumatol 2021; 22:11. [PMID: 33713181 PMCID: PMC7956060 DOI: 10.1186/s10195-021-00576-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background The study aimed to evaluate the functional and radiographical results of asymmetrically reconstructed total hip arthroplasty in patients with bilateral dysplastic arthritic hips with one hip Crowe II–III and the other hip Crowe IV. Materials and methods From April 2006 to April 2019, we evaluated 23 patients who had a reconstruction of one Crowe II–III hip with high hip center (HHC) and the other Crowe IV hip at the anatomical position (H group). The radiographic and clinical outcomes were compared with those of a control group of 19 patients with bilateral dysplasia who had one Crowe IV hip and the contralateral hip both reconstructed in the anatomical position (A group). Medical records and radiographs were reviewed, and a complete follow-up was conducted for all patients. Results The mean vertical center of rotation (V-COR) and horizontal center of rotation (H-COR) in the H group were 30.6 ± 5.8 mm and 30.0 ± 5.5 mm, respectively. In the A group, the corresponding values were 14.0 ± 4.3 mm and 23.0 ± 2.3 mm, respectively. A significant difference was found in terms of V-COR and H-COR between the two groups, and no significant difference was shown regarding the cup inclination, abductor lever arm (ALA), ALA ratio, and leg length discrepancy (LLD). Three patients of the H group and four patients of the A group exhibited LLD > 10 mm. All seven patients who had LLD > 10 mm underwent the shortening subtrochanteric osteotomy (SSTO) of the Crowe IV hip. Subgroup analysis based on the presence and absence of SSTO showed that the LLD of the SSTO group was greater than that of the non-SSTO group in both groups, but the difference was only statistically significant in the A group. At the last follow-up, the mean Harris Hip Scores significantly improved in the two groups, and there was no revision during the follow-up period. In the H group, four patients presented with a slight limp and three patients with a moderate limp, while it was six patients and one patient in the A group, respectively. Conclusions Asymmetrical reconstruction in patients with bilateral dysplastic arthritic hips with one hip Crowe II–III and the other Crowe IV is acceptable and comparable when compared with bilateral anatomical reconstruction. Level of evidence III, retrospective observational study. Trial registration Chinese Clinical Trail Registry. ChiCTR2000033848
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Affiliation(s)
- Junmin Shen
- Medical School of Chinese People's Liberation Army, Beijing, 100853, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jingyang Sun
- Medical School of Chinese People's Liberation Army, Beijing, 100853, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yinqiao Du
- Medical School of Chinese People's Liberation Army, Beijing, 100853, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Bohan Zhang
- Medical School of Chinese People's Liberation Army, Beijing, 100853, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Tiejian Li
- Medical School of Chinese People's Liberation Army, Beijing, 100853, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yonggang Zhou
- Medical School of Chinese People's Liberation Army, Beijing, 100853, China. .,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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14
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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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15
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Viamont-Guerra MR, Saffarini M, Laude F. Surgical Technique and Case Series of Total Hip Arthroplasty with the Hueter Anterior Approach for Crowe Type-IV Dysplasia. J Bone Joint Surg Am 2020; 102:99-106. [PMID: 32530875 DOI: 10.2106/jbjs.20.00081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) is being increasingly performed via the Hueter anterior approach (HAA), which has proven benefits with nondysplastic hips; however, little has been published on its outcomes with dysplastic hips, where it can provide better acetabular exposure. We describe our technique for THA via the HAA in hips with Crowe type-IV developmental dysplasia and report the mid-term outcomes of cases that were performed over 5 consecutive years. METHODS We retrospectively evaluated a continuous series of 8 hips (6 patients) with Crowe type-IV dysplasia; the patient ages ranged from 44 ± 20 years (range, 17 to 65 years) at the index THA. All of the patients received uncemented implants via the HAA on a traction table to restore the hip center of rotation to the true acetabulum. Femoral head autografts (FHAs) were used to increase acetabular coverage in 6 hips, and subtrochanteric shortening osteotomies (SSOs) were performed in 5 hips. Patients were assessed clinically and radiographically at a minimum follow-up of 2 years. RESULTS There were no revisions, deaths, dislocations, or infections. Two hips (25%) had intraoperative complications, and 1 hip (13%) had a postoperative complication that required reoperation without implant removal. All of the hips were assessed clinically and radiographically at 4 ± 1 years (range, 2 to 6 years). The modified Harris hip score (mHHS) improved from 33 ± 7 to 90 ± 7, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) improved from 53 ± 14 to 89 ± 6; the postoperative leg-length discrepancy was 3.2 mm (range, -10 to 20 mm). None of the hips had osteolysis or radiolucent lines of >2 mm. CONCLUSIONS THA via the HAA on a traction table for hips with Crowe type-IV dysplasia yielded satisfactory mid-term outcomes. Both FHA and SSO can be adequately performed via the HAA to help restore the hip center of rotation to the true acetabulum. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Maria-Roxana Viamont-Guerra
- Ramsay Générale de Santé, Clinique du Sport Paris V, Paris, France.,Hip Surgery Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Frederic Laude
- Ramsay Générale de Santé, Clinique du Sport Paris V, Paris, France
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16
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Shen J, Sun J, Ma H, Du Y, Li T, Zhou Y. High Hip Center Technique in Total Hip Arthroplasty for Crowe Type II-III Developmental Dysplasia: Results of Midterm Follow-up. Orthop Surg 2020; 12:1245-1252. [PMID: 32776482 PMCID: PMC7454156 DOI: 10.1111/os.12756] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/13/2020] [Accepted: 06/21/2020] [Indexed: 12/19/2022] Open
Abstract
Objectives We aimed to show the utility of high hip center technique used in patients with Crowe II–III developmental dysplasia of the hip at the midterm follow‐up and evaluated the clinical and radiographic results between different heights of hip center. Methods From December 2003 to November 2013, we retrospectively evaluated 69 patients (85 hips) with Crowe II–III dysplasia who underwent a high hip center cementless total hip arthroplasty. The patients were divided into two groups according to the height of hip center, respectively group A (≥ 22 mm and < 28 mm) and group B (≥28 mm). The survivorship outcomes and radiographic and clinical results, including the vertical and horizontal distances of hip center, femoral offset, abductor lever arm, cup inclination, leg length discrepancy, Trendelenburg sign, and limp were evaluated. Results The mean follow‐up time was 8.9 ± 1.8 years. The mean location of the hip center from the inter‐teardrop was 25.1 ± 1.6 mm vertically and 30.0 ± 3.8 mm horizontally in group A, and 33.1 ± 4.8 mm vertically and 31.4 ± 6.1 mm horizontally in group B. Eleven hips of group B showed a lateralization over 10 mm, and the same was shown in one hip in group A (P = 0.012). There were no statistically significant differences between two groups in postoperative femoral offset, abductor lever arm, leg length discrepancy and cup inclination. At the final follow up, the mean WOMAC and Harris hip score were significantly improved in both groups. Of the 85 hips, four hips in group A and three hips in group B showed a positive Trendelenburg sign. Additionally, four patients in group A and two patients in group B presented with a limp. No significant differences were shown regarding the Harris hip score, WOMAC score, Trendelenburg sign, and limp between two groups. One hip of group A was revised by reason of dislocation at 8.3 years after surgery. One hip of group B was diagnosed with osteolysis and underwent a revision at 8.1 years after surgery. The Kaplan–Meier implants survivorship rates at the final follow‐up for all‐causes revisions in group A and group B were similar (96.7% [95% confidence interval, 90.5%–100%] and 96.2% [95% confidence interval, 89.0%–100%], respectively). Conclusions The high hip center technique is a valuable alternative to achieve excellent midterm results for Crowe II–III developmental dysplasia of the hip. Further, between the groups with differing degrees of HHC, there were no significant differences in outcomes or survivorship in our study.
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Affiliation(s)
- Junmin Shen
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jingyang Sun
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Haiyang Ma
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yinqiao Du
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Tiejian Li
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yonggang Zhou
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
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17
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Viamont-Guerra MR, Chen AF, Stirling P, Nover L, Guimarães RP, Laude F. The Direct Anterior Approach for Total Hip Arthroplasty for Severe Dysplasia (Crowe III and IV) Provides Satisfactory Medium to Long-Term Outcomes. J Arthroplasty 2020; 35:1642-1650. [PMID: 32046871 DOI: 10.1016/j.arth.2020.01.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/20/2019] [Accepted: 01/10/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The direct anterior approach (DAA) is increasingly used for total hip arthroplasty (THA). Although the DAA can reduce pain, recovery time, and dislocations in nondysplastic hips, few studies report its results in patients with severe dysplasia. We aimed to evaluate outcomes of primary THA through the DAA with cup placement at the true acetabulum in hips with severe dysplasia. METHODS We retrospectively evaluated 23 consecutive patients (29 hips) who underwent THA by DAA for osteoarthritis secondary to Crowe III-IV dysplasia. Surgical procedures were performed on a traction table, and the acetabular cup was placed in the true acetabulum. Patients were assessed clinically (complications, modified Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford Hip Score) and radiographically (radiolucencies, subsidence, leg length discrepancies, cup inclination, and cup coverage) at a minimum of 2 years. RESULTS One patient (2 hips) died with original implants (at 13 and 14 years), 3 patients (3 hips) were revised due to wear-induced loosening (at 14, 16, and 18 years), and there were no dislocations or infections. The remaining 19 patients (24 hips) were assessed at 8.4 ± 4.7 years (range 2-20); 2 patients (2 hips) had complications that required reoperation without implant removal. The modified Harris Hip Score improved from 32 ± 9 to 94 ± 7, Western Ontario and McMaster Universities Osteoarthritis Index from 46 ± 18 to 90 ± 7, and Oxford Hip Score was 56 ± 4. Patients were very satisfied (90%) or satisfied (10%). Limb length discrepancy was 2.5 ± 9.0 mm. CONCLUSION THA through the DAA with cup placement at the true acetabulum provides satisfactory mid to long-term clinical and radiographic outcomes compared to other approaches for hips with severe dysplasia. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Maria-Roxana Viamont-Guerra
- Département d'Orthopédie, Ramsay Santé, Clinique du Sport Paris V, Paris, France; Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Antonia F Chen
- Department of Orthopaedics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Luca Nover
- Medical Technology, ReSurg SA, Nyon, Switzerland
| | | | - Frederic Laude
- Département d'Orthopédie, Ramsay Santé, Clinique du Sport Paris V, Paris, France
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18
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Computed Tomographic Osteolytic Analysis of a First-Generation Remelted Highly Cross-Linked Polyethylene in Total Hip Arthroplasty-At a Minimum of 15-Year Follow-Up. J Arthroplasty 2020; 35:1417-1423. [PMID: 31948813 DOI: 10.1016/j.arth.2019.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Low polyethylene wear rate and low incidence of osteolysis have been reported after total hip arthroplasty (THA) using first-generation remelted highly cross-linked polyethylene (HXLPE). However, osteolysis has not been evaluated in long-term studies of these patients (15 years or more). The present study assessed computed tomography (CT) images to determine the incidence of osteolysis associated with HXLPE in THA during at least 15 years of follow-up. METHODS We evaluated 105 primary THAs in 84 patients (77 women and 7 men). Mean follow-up was 15.9 years (range, 15-18 years). All THAs used a Longevity HXLPE liner and a 26-mm zirconia femoral head. Areas of osteolysis were identified from CT images using 3D and multiplanar reconstruction views. RESULTS CT 3D multiplanar reconstruction images at 15-year follow-up showed no obvious osteolysis in the acetabulum or femur of any patient. No patients developed cup loosening or liner breakage. CONCLUSION Our study indicates that first-generation remelted HXLPE liners do not increase the risk of osteolysis during 15-year follow-up and suggests that the wear particles from first-generation remelted HXLPE are less biologically active than those generated by conventional polyethylene devices.
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19
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Shi XT, Li CF, Han Y, Song Y, Li SX, Liu JG. Total Hip Arthroplasty for Crowe Type IV Hip Dysplasia: Surgical Techniques and Postoperative Complications. Orthop Surg 2019; 11:966-973. [PMID: 31755242 PMCID: PMC6904615 DOI: 10.1111/os.12576] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/11/2019] [Accepted: 10/20/2019] [Indexed: 01/01/2023] Open
Abstract
Total hip arthroplasty (THA) of Crowe type IV developmental dysplasia of the hip (DDH) is challenging. Although traditional (lateral, posterolateral, and posterior) THA approaches have been used with great anatomic success, they damage periarticular muscles, which are already quite weak in type IV DDH. The recently developed direct anterior approach (DAA) can provide an inter‐nerve and inter‐muscle approach for THA of type IV dysplasia hips. However, femur exposure with the DAA could be difficult during surgery and it is hard to apply femoral shortening osteotomy. THA techniques used for type IV DDH include anatomic hip center techniques (true acetabular reconstruction) and high hip center techniques, wherein an acetabulum is reconstructed above the original one. Although anatomic construction of the hip center is considered “the gold standard” treatment, it is impossible if the anatomical acetabular is too small and shallow. Procedures used to support type IV DDH reduction with anatomic hip center techniques include greater trochanter osteotomy, lesser trochanter osteotomy, and subtrochanteric osteotomy. However, these techniques have yet to be standardized, and it is unclear which is best for type IV DDH. One‐state and two‐state non‐osteotomy reduction techniques have also been introduced to treat type IV DDH. Potential complications of THA performed in patients with type IV DDH include leg length discrepancy (LLD), peri‐operative femur fracture, nonunion of the osteotomy site, and nerve injury. It is worth noting that nowadays an increasing number of Crowe type IV DDH patients are more sensitive to postoperative LLD.
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Affiliation(s)
- Xiao-Tong Shi
- Department of Orthopaedics, Jilin University First Hospital, Jilin University First Hospital, Changchun, Jilin Province, China
| | - Chao-Feng Li
- Department of Orthopaedics, Jilin University First Hospital, Jilin University First Hospital, Changchun, Jilin Province, China
| | - Yu Han
- Department of Orthopaedics, Jilin University First Hospital, Jilin University First Hospital, Changchun, Jilin Province, China
| | - Ya Song
- Department of Orthopaedics, Jilin University First Hospital, Jilin University First Hospital, Changchun, Jilin Province, China
| | - Shu-Xuan Li
- Department of Orthopaedics, Jilin University First Hospital, Jilin University First Hospital, Changchun, Jilin Province, China
| | - Jian-Guo Liu
- Department of Orthopaedics, Jilin University First Hospital, Jilin University First Hospital, Changchun, Jilin Province, China
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20
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Osawa Y, Seki T, Takegami Y, Kusano T, Ishiguro N, Hasegawa Y. Failed periacetabular osteotomy leads to acetabular defects during subsequent total hip arthroplasty. Arch Orthop Trauma Surg 2019; 139:729-734. [PMID: 30904985 DOI: 10.1007/s00402-019-03174-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acetabular wall defects after periacetabular osteotomy (PAO) lead to technical difficulties when performing subsequent total hip arthroplasty (THA). There is no unified consensus regarding the solution for THA socket installation after PAO. In the current study, we performed computed tomography (CT)-based simulation of socket installation and evaluated the acetabular defect following THA after PAO and after primary osteoarthritis (OA). PATIENTS AND METHODS The study group comprised 55 patients (56 hips) who underwent THA after PAO. For the control group, after matching for age, sex, and Crowe classification, we included 55 patients (56 hips) who underwent primary THA for hip dysplasia. We evaluated the anterior, posterior, and superior acetabular sector angle (ASA) and medial wall thickness (MWT) at the anatomical hip center (at the 20-mm vertical hip level from teardrop) in the study group (anatomical PAO group) and control group (primary OA group). In addition, we investigated the changes in the socket covering when the socket was positioned 10 mm above the anatomical hip center (30 mm above the teardrop; elevated osteotomy group). RESULTS All ASA and MWT values were significantly smaller in the anatomical PAO group than in the primary OA group. In particular, the individuals with a Crowe classification of II/III in the anatomical PAO group presented severe acetabular defects. However, the elevated PAO group had a significantly larger ASA compared to the anatomical PAO group, with improved socket coverings. CONCLUSION Acetabular defects in the anatomical hip center following THA after PAO were significantly common compared to those after primary THA. Elevation of hip joint centers as much as 10 mm is one therapeutic option in the case of severe acetabular defects following THA after PAO.
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Affiliation(s)
- Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Taiki Kusano
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare Science, Kashiwara, Japan
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