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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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Nishii T. CORR Insights®: Subtrochanteric Shortening Osteotomy Provides Superior Function to Trochanter Slide Osteotomy in THA for Patients With Unilateral Crowe Type IV Dysplasia at a Minimum of 3 Years. Clin Orthop Relat Res 2024; 482:1048-1050. [PMID: 38289712 PMCID: PMC11124589 DOI: 10.1097/corr.0000000000002999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Takashi Nishii
- Department of Orthopaedic Surgery, Osaka General Medical Center, Osaka, Japan
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Takahashi E, Chen M, Kaneuji A, Soma D, Fukui M, Kawahara N. Comparative Study of Highly Cross-Linked Polyethylene Liner Wear by Hip Center Location Using Elevated Hip Center Technique in Crowe I to III Hip Dysplasia: Outcomes for a Minimum of Eighteen Years of Follow-Up. J Arthroplasty 2023; 38:2655-2660. [PMID: 37279849 DOI: 10.1016/j.arth.2023.05.078] [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: 02/02/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The literature has reported that supero-lateralization of the femoral head increases the rates of aseptic loosening and prosthesis revision. However, there are few reports on the influence of different hip center positions on liner wear with more than a 15-year follow-up period. METHODS From April 2000 to August 2003, 91 patients underwent 108 total hip arthroplasties using a highly cross-linked polyethylene liner combined with zirconia femoral head and cup components. Pelvic radiographs were used to assess the vertical and horizontal distances to the center of the hip and the amount of liner wear. Mean patient age at the time of surgery was 54 years (range, 33 to 73), and mean follow-up duration was 19 years (range, 18 to 21). RESULTS Average liner wear was 0.221 mm, with average annual wear of 0.012 mm/year. Mean vertical and horizontal distances for the hip center were 24.9 and 31.8 mm, respectively. There was no difference in linear wear between patients who had different hip center heights (<20, 20 to 30, and >30 mm), and quadrant partitioning showed no differences across the 4 quadrant zones. CONCLUSION At a minimum of 18 years of follow-up in patients having developmental dysplasia of the hip who had different Crowe subtypes and different hip centers, elevated hip center and uncemented fixation techniques using a highly cross-linked polyethylene on ceramic components were associated with very low wear rates and excellent functional scores.
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Affiliation(s)
- Eiji Takahashi
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Mingliang Chen
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Daisuke Soma
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Makoto Fukui
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Norio Kawahara
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
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Yang T, Yang B, Wang P, Qin Y, You G, Shi Y, Zhang A, Shen D, Guo L. The Role of Global Femoral Offset in Total Hip Arthroplasty with High Hip Center Technique. Orthop Surg 2023; 15:2373-2382. [PMID: 37519271 PMCID: PMC10475657 DOI: 10.1111/os.13818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/30/2023] [Accepted: 06/10/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE The high hip center (HHC) technique has been proposed for the treatment of patients with developmental dysplaisa of the hip (DDH) who have an acetabular bone defect. However, the importance of global femoral offset (FO) in the application of this technique has not been sufficiently appreciated. Our goals were to confirm that the HHC technique is feasible in the treatment of patients with DDH and to assess the function of global FO in this procedure. METHODS We retrospectively analyzed 73 patients who underwent total hip arthroplasty using high hip center technique for unilateral DDH at our hospital between January 2014 and June 2019. According to global FO, the patients were split into three groups: increased FO group (increment greater than 5 mm), restored FO group (restoration within 5 mm) and decreased FO group (reduction greater than 5 mm). Patients' medical records and plain radiographs were reviewed. One-way ANOVA was used to compare radiographic outcomes and Harris hip score (HHS). Paired t-test was used to assess preoperative and postoperative HHS and leg length discrepancy. Trochanteric pain syndrome, Trendelenburg sign and postoperative limp was evaluated with Fisher's exact test. RESULTS The average follow-up time was 7.5 ± 1.4 years. The patients' HHS and leg length discrepancy were significantly improved (p < 0.05). In terms of vertical acetabular height, abductor arm, postoperative leg length difference, and acetabular cup inclination, there was no statistically significant difference between the three groups. At the last follow-up, HHS was significantly higher in the restored FO group than in the decreased FO and increased FO groups. Trochanteric pain syndrome occurred in 15.0% and Trendelenburg sign and postoperative limp in 8.2% of all patients, respectively. Trochanteric pain syndrome, Trendelenburg sign and postoperative limp did not differ significantly across the three groups. One patient in increased FO group underwent revision for dislocation 6 years after surgery. CONCLUSION The HHC technique is an alternative technique for total hip arthroplasty in patients with acetabular bone abnormalities, according to the results of the mid-term follow-up. Also, controlling the correction of the global femoral offset to within 5 mm may lead to better clinical outcomes.
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Affiliation(s)
- Tianyu Yang
- Department of Orthopedicsthe First Hospital of China Medical UniversityShenyangChina
| | - Boning Yang
- Department of Orthopedicsthe First Hospital of China Medical UniversityShenyangChina
| | - Penghao Wang
- Department of Orthopedicsthe First Hospital of China Medical UniversityShenyangChina
| | - Yu Qin
- Department of Orthopedicsthe First Hospital of China Medical UniversityShenyangChina
| | - Guanchao You
- Department of Orthopedicsthe First Hospital of China Medical UniversityShenyangChina
| | - Yunyi Shi
- Department of Orthopedicsthe First Hospital of China Medical UniversityShenyangChina
| | - Ao Zhang
- Department of Orthopedicsthe First Hospital of China Medical UniversityShenyangChina
| | - Dianlin Shen
- Department of Orthopedicsthe First Hospital of China Medical UniversityShenyangChina
| | - Lei Guo
- Department of Orthopedicsthe First Hospital of China Medical UniversityShenyangChina
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ÇATALTEPE A, İYETİN Y. The press-fit technique without screws and bone graft can be used as an alternative method in Crowe type II and III hip dysplasia. Turk J Med Sci 2023; 53:1448-1457. [PMID: 38813005 PMCID: PMC10763771 DOI: 10.55730/1300-0144.5712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/26/2023] [Accepted: 08/11/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim Developmental dysplasia of the hip (DDH) is the most common cause of secondary hip arthrosis. The primary purpose of this study was to assess the results of an oversized hemispherical cup via the press-fit technique used for Crowe type II and III DDH without screws and to determine if adequate medialization and initial stability of the acetabular component would allow us to avoid screw and graft use. Materials and methods Between February 2012 and May 2020, the current study analyzed 43 hips with Crowe type II and III DDH treated with a porous-coated cup by placing the press-fit technique or screw. The acetabular cup was fixed with the press-fit technique without additional screws in 27 hips and with screws in 16 hips. The inclusion criterion in this study was a minimum 2-year-period after the surgery. Results The mean duration of follow-up was 6.83 ± 2.67 years in the press-fit group and 6.21 ± 2.01 years in the screw group. The mean age of the patients was 47.96 ± 12.37 years in the press-fit group and 50.5 ± 12.37 years in the screw group. Measurements revealed that the hip center of rotation (HCR) was located more medially and superiorly postoperatively than preoperatively in both groups. The mean cup coverage in the screw group was 85.58% ± 7.51% (75.3%-97.2%), while it was less than 90.41% ± 6.15% (76.3%-98.2%) in the press-fit group (p = 0.038). No component was revised because of loosening, and all of the implants were radiologically stable within the observation period. No statistically significant differences were observed regarding the postoperative limp-length discrepancy between the groups (p = 0.496). Conclusion Press-fit implantation of a porous-coated acetabular component without screws can also be used as an alternative method for THA in Crowe type II and III DDH. The initial stability was obtained using the press-fit technique with a small cup positioned more medially and superiorly, which may allow the surgeon to avoid screw and graft use.
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Affiliation(s)
- Aziz ÇATALTEPE
- Department of Orthopedic Surgery and Traumatology, Medipol University, İstanbul,
Turkiye
| | - Yusuf İYETİN
- Department of Orthopedic Surgery and Traumatology, Pendik Hospital, İstanbul,
Turkiye
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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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Femoral Head Autograft to Manage Acetabular Bone Loss Defects in THA for Crowe III Hips by DAA: Retrospective Study and Surgical Technique. J Clin Med 2023; 12:jcm12030751. [PMID: 36769400 PMCID: PMC9918157 DOI: 10.3390/jcm12030751] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Introduction: The pathologic anatomy of Crowe III is characterized by the erosion of the superior rim of acetabulum, with a typical bone defect in its supero-lateral portion. The performance of a total hip arthroplasty requires the management of the acetabular bone defect, and femoral head autograft can be a valid option to optimize implant coverage. Material and Methods: In all, eight Crowe III patients (nine hips), seven of which having unilateral hip affected, and one with bilateral involvement by secondary osteoarthritis in DDH; maximum limb length discrepancy (LLD) of 3.5 cm in unilateral patients. All were operated on by direct anterior approach. Patients were evaluated in terms of clinical, surgical, and radiological (center-edge, horizontal coverage, cup inclination) parameters. Results: Cup placement was implanted with a mean of 39.5 ± 7.5°. Stem alignment showed average 1.5 ± 2.3° in valgus. LLD showed an overall average preoperative of -29.5 ± 10.5 mm at the affected side, with a significant improvement to -2.5 ± 6.4 mm (p = 0.023). The mean initial coverage evaluated like a percentage of the horizontal bone host was 52.1 ± 7.1%, while the mean final coverage at the last post-operative X-ray from femoral autograft bone was 97.0 ± 4.5% with an average improvement of 44.5%. Average CE improved from -9.5 ± 5.2° (CE I) to the immediate post-operative (CE II) of 40.6 ± 8.2°. At the final follow up, CE III showed a mean of 38.6 ± 6.2°, with an average decrease of 2.0°. Discussion: Acetabular bone defect in Crowe III DDH patients undergoing THA by DAA, can be efficiently managed by massive autograft femoral head, which allowed an adequate and long-lasting coverage of the implant, with cup positioning at the native acetabulum.
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Jia CQ, Pan HF, Wu YJ, You YG, Cao SQ, Zhang XS. Mid-term outcomes after total hip arthroplasty in 106 Crowe II/III hips: different hip center positions. Eur J Med Res 2022; 27:282. [PMID: 36494873 PMCID: PMC9733288 DOI: 10.1186/s40001-022-00936-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Under the obvious acetabular superolateral bone defect of Crowe II/III hips, this study aimed to investigate the difference in surgical technique of different hip center positions from the surgical data and clinical outcomes. METHODS From July 2007 to December 2016, 87 patients (106 Crowe II/III hips) consecutively received total hip arthroplasty (THA). The minimum follow-up time was 5 years. The mean limb length discrepancy was 1.97 ± 1.81 cm. Twenty-four hips had surgical histories. The patients were divided into three groups according to the acetabular prosthesis positions, depending on the Crowe classification, respectively, group 1 (Crowe I), group 2 (Crowe II) and group 3 (Crowe III). The surgical data and clinical results were used to evaluate the outcome of different surgical techniques of different hip center positions, including surgical time, blood loss, blood transfusion, number of osteotomy hips, osteotomy length, the distribution of prothesis, postoperative inpatient days, Harris hip scores, Visual Analogue Scale (VAS), Back Pain Function Scale (BPFS) and complications. RESULTS The mean follow-up time was 8.93 ± 2.55 years. Nineteen hips performed intraoperative osteotomy. From group 1 to group 3, the mean osteotomy length were 0.53 ± 1.11 cm, 0.05 ± 0.22 cm, and 0.00 ± 0.00 cm, respectively (p = 0.083); the surgical time were 142.57 ± 57.94 min, 118.4 ± 41.22 min, and 120.00 ± 84.85 min, respectively (p = 0.324); the blood loss were 498.21 ± 368.53 mL, 333.33 ± 167.62 mL, and 350.00 ± 212.13 mL, respectively (p = 0.255); the blood transfusion were 288.48 ± 381.68 mL, 128.00 ± 235.17 mL, and 385.00 ± 219.20 mL, respectively (p = 0.199); the postoperative inpatient days were 7.95 ± 4.42 d, 7.47 ± 4.29 d, and 6.50 ± 0.71 d, respectively (p = 0.831). Among the groups, the distribution of acetabular prosthesis, acetabular liner, acetabular prosthesis sizes, femoral head sizes and femoral prothesis distal sizes were not significantly different (p > 0.05). Only the distribution of femoral prosthesis was significantly different (p = 0.046); the Harris, VAS, BPFS, and the distribution of complications were not significantly different (p > 0.05). CONCLUSIONS We provided a framework to guide decision-making in Crowe II/III hips for surgeons: the surgical technique of different hip center positions was stable and had good outcomes, but the acetabular prothesis position and femoral prothesis should be determined according to the intraoperative situation. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Cheng-Qi Jia
- grid.488137.10000 0001 2267 2324Medical School of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Hong-Fa Pan
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China ,grid.416966.a0000 0004 1758 1470Department of Orthopedics, Weifang People’s Hospital, Shandong, China
| | - Yu-Jie Wu
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China ,Department of Nursing, The Third People’s Hospital of Datong, Shanxi, China
| | - Yong-Gang You
- grid.488137.10000 0001 2267 2324Medical School of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Shi-Qi Cao
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Department of Orthopedics of TCM Clinical Unit, 6Th Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xue-Song Zhang
- grid.488137.10000 0001 2267 2324Medical School of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
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Zhang B, Du Y, Zhang Y, Dong Y, Zhang T, Zhou Y. Comparison of Functional and Radiographic Outcomes Between Two Fixation Methods for Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty: A Retrospective Cohort Study. J Arthroplasty 2022; 37:1844-1850. [PMID: 35436529 DOI: 10.1016/j.arth.2022.04.012] [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: 03/08/2022] [Revised: 03/28/2022] [Accepted: 04/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To compare the functional and radiographic outcomes between two fixation methods for extended trochanteric osteotomy (ETO) in revision total hip arthroplasty (rTHA). METHODS Included in this study were 64 patients who underwent ETO in rTHA using either claw-plate fixation (claw-plate group, n = 31) or cable-alone fixation (cable group, n = 33) in our hospital from 2008 to 2020. The functional and radiographic results and complications were compared between the groups during a mean follow-up period of 64 and 78 months. RESULTS The Harris hip score and visual analogue scale at the last follow-up improved significantly in both groups, showing no significant statistical difference between the two fixation methods. In the cable group, the mean abductor lever arm, the proximal migration, and medial migration in the affected hip were significantly decreased compared to those in the contralateral normal hip (P < .05), whereas in the claw-plate group no significant statistical differences were observed between two sides. No or slight limping occurred in 25 patients (81%) in the claw-plate group and 16 patients (48%) in the cable group (P = .007). A multiple logistic regression demonstrated that claw-plate fixation could reduce the incidence of postoperative moderate-to-severe limping. CONCLUSION Both claw-plate fixation and cable-alone fixation could improve the functional performance of rTHA with ETO, whereas claw-plate fixation could offer superior biomechanical results and gait improvement as compared with cable-alone fixation.
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Affiliation(s)
- Bohan Zhang
- Medical School of Chinese PLA, Beijing, People's Republic of China; Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China; Senior Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yinqiao Du
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China; Senior Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yanchao Zhang
- Medical School of Chinese PLA, Beijing, People's Republic of China; Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China; Senior Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yu Dong
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China; Senior Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China; Medical School of Nankai University, Tianjin, People's Republic of China
| | - Ti Zhang
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China; Senior Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China; Medical School of Nankai University, Tianjin, People's Republic of China
| | - Yonggang Zhou
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China; Senior Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
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Zhang B, Du Y, Sun J, Shen J, Li T, Zhou Y. Change of Pelvic Sagittal Tilt after Total Hip Arthroplasty in Patients with Bilateral Crowe Type IV Developmental Dysplasia of the Hip. Orthop Surg 2022; 14:919-926. [PMID: 35445552 PMCID: PMC9087458 DOI: 10.1111/os.13275] [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: 02/28/2021] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To explore and analyze the change of pelvic sagittal tilt (PST) after total hip arthroplasty (THA) in patients with bilateral Crowe type IV developmental dysplasia of the hip (DDH). Methods The study retrospectively evaluated 43 patients with bilateral Crowe type IV DDH undergoing THA from January 2008 to June 2019 who were followed up for 12 months postoperatively. Four parameters, including the ratio between the height and width of the obturator foramina(H/W ratio), the vertical distance between the upper edge of the symphysis and the middle of the sacrococcygeal joint (SSc distance), the vertical distance between the upper edge of the symphysis and the line connecting bilateral hip centers (SC distance) and the vertical distance between the upper edge of the symphysis and the line connecting the bilateral lower ends of the sacroiliac joints (SSi distance), which could indirectly reflect the change of PST, were observed and measured by radiographs. The change of each parameter before operation, immediately after operation, and in 3, 6 and 12 months postoperatively was compared and analyzed. Results Compared with the value before operation, the H/W ratio immediately after operation and in 3, 6 and 12 months postoperatively were 0.61 ± 0.12 (t = 0.893, P = 0.377), 0.61 ± 0.11 (t = 1.622, P = 0.112), 0.67 ± 0.10 (t = 5.995, P < 0.001) and 0.76 ± 0.12 (t = −9.313, P < 0.001), respectively, and the SSc, SC and SSi distance in 6 months postoperatively were 30.12 ± 7.06 mm (t = 3.506, P = 0.002), 42.8 ± 7.7 mm (t = 5.843, P < 0.001), 129.3 ± 12.6 mm (t = 5.888, P < 0.001), respectively, and in 12 months postoperatively were 27.24 ± 7.68 mm (t = 6.510, P < 0.001), 36.1 ± 9.1 mm (t = 9.230, P < 0.001), 118.9 ± 14.9 mm (t = 8.940, P < 0.001), respectively. The radiographs obtained in 6 and 12 months postoperatively demonstrated a significantly increased H/W ratio and decreased SSc, SC and SSi distance. At the last follow‐up, the clinical evaluations significantly improved in all patients and there were no revisions. Conclusion The significant change of pelvic sagittal posterior tilt in patients with bilateral Crowe type IV DDH might be a significant phenomenon after THA, which could occur in 6 months postoperatively.
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Affiliation(s)
- Bohan Zhang
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, China.,Senior Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yinqiao Du
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, China.,Senior Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jingyang Sun
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, China.,Senior Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Junmin Shen
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, China.,Senior Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, China.,Medical School of Nankai University, Tianjin, China
| | - Tiejian Li
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, China.,Senior Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yonggang Zhou
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, China.,Senior Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
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11
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Wang Y, Wang M, Li C, Nakamura Y, Deng L, Yamako G, Chosa E, Pan C. Biomechanical effect of metal augment and bone graft on cup stability for acetabular reconstruction of total hip arthroplasty in hip dysplasia: a finite element analysis. BMC Musculoskelet Disord 2022; 23:277. [PMID: 35321681 PMCID: PMC8943934 DOI: 10.1186/s12891-022-05168-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Different methods of acetabular reconstruction with total hip arthroplasty (THA) for Crowe II and III of adult developmental dysplasia of the hip (DDH) acetabular bone defect have been implemented clinically. However, the biomechanical effect of different augmented materials for acetabular reconstruction in THA on shell stability has never been discussed. Methods In the present study, autologous bone graft (BG)and metal (Ti6Al4V) augment (MA) were simulated with several acetabular bone defect models of DDH in THA. The contact pressure and micromotion between the shell and host bone were measured for evaluating the shell stability using a finite element method. Results The peak contact stress between shell and host bone was higher in the MA situation (12.45 vs 8.71 MPa). And the load transfer path was different, for BG models, the high local contact stresses were found at the junction of bone graft and host bone while for MA models the concentrated contact stresses were at the surface of MA. The peak relative micromotion between shell and host bone was higher in the MA situation (12.61 vs 11.13 µm). However, the peak micromotion decreased in the contact interface of MA and cup compared to the BG models. Conclusions The higher micromotion was found in MA models, however, enough for bone ingrowth, and direct stronger fixation was achieved in the MA-cup interface. Thus, we recommended the MA can be used as an option, even for Crowe III, however, the decision should be made from clinical follow-up results.
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Affiliation(s)
- Yuzhu Wang
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Mincong Wang
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Chengguo Li
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yoshihiro Nakamura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Liwei Deng
- Department of Radiology, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Go Yamako
- Department of Mechanical Engineering, Faculty of Engineering, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Etsuo Chosa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Chenglong Pan
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China.
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12
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Zhang B, Sun J, Du Y, Shen J, Li T, Zhou Y. Treatment of Osteoarthritis Secondary to Severe Coxa Vara with Modular Total Hip Arthroplasty. Ther Clin Risk Manag 2021; 17:1199-1207. [PMID: 34824533 PMCID: PMC8610750 DOI: 10.2147/tcrm.s335015] [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: 08/20/2021] [Accepted: 11/06/2021] [Indexed: 11/23/2022] Open
Abstract
Objective We aimed to demonstrate the methods of treatment for coxa vara with modular total hip arthroplasty (THA) and evaluate clinical and radiographic outcomes, and further survivorship at the midterm follow-up. Methods We retrospectively reviewed 33 patients (42 hips) who underwent modular THA for coxa vara deformity from May 2008 to December 2019. The clinical and radiographic results, including Harris Hip Score (HHS), leg length discrepancy (LLD), greater trochanteric height, femoral offset, abductor lever arm, stem alignment and limp, and complications, were evaluated. Results The follow-up time was mean 69.9±43.7 months. Clinically, the HHS improved significantly (p<0.001) on average from 42.90±14.44 points to 89.54±4.75 points. The mean LLD decreased from 33.3±19.4 mm to 5.0±5.8 mm (p<0.001), and 27 patients (82%) thought that total equality of the lower limbs was obtained. Patients demonstrated diminished or no limping in 88% (29/33) of hips and a significant improvement of biomechanics. At the final follow-up, all stems of hips were in clinical neutral alignment and the prostheses survivorship rates for all-causes revisions was 97.6%. Conclusion Modular THA is a valuable alternative to render favorable outcomes for treatment of osteoarthritis secondary to severe coxa vara.
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Affiliation(s)
- Bohan Zhang
- Medical School of Chinese PLA, Beijing, 100853, People's Republic of China.,Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Jingyang Sun
- Medical School of Chinese PLA, Beijing, 100853, People's Republic of China.,Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Yinqiao Du
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, 100853, People's Republic of China.,Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Junmin Shen
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, 100853, People's Republic of China.,Medical School of Nankai University, Tianjin, 300071, People's Republic of China
| | - Tiejian Li
- Medical School of Chinese PLA, Beijing, 100853, People's Republic of China.,Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Yonggang Zhou
- Medical School of Chinese PLA, Beijing, 100853, People's Republic of China.,Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, 100853, People's Republic of China.,Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, 100048, People's Republic of China
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13
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Bose VC, Pichai S, Ashok Kumar PS, Kanniyan K, Yadlapalli S, Patil S. Does Balancing a Total Hip Arthroplasty Require a New Paradigm? Functional 3-Dimensional Balancing in Total Hip Arthroplasty. Indian J Orthop 2021; 55:1240-1249. [PMID: 34824725 PMCID: PMC8586388 DOI: 10.1007/s43465-021-00505-3] [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: 06/12/2021] [Accepted: 08/29/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Traditional principles for successful outcomes in Total Hip Arthroplasty (THA) have relied largely on placing the socket in the native position and trying to restore static anatomical femoral parameters gauged on X-rays or intra-operative measurement. Stability is conventionally achieved by making appropriate changes during the time of trial reduction. Post-operative complications of dislocation and significant Limb Length Discrepancy (LLD) requiring foot wear modification represents opposite ends of the spectrum from a biomechanical perspective and these continue to be relatively high. A move towards giving more importance to functional dynamic parameters rather than static anatomical parameters and less reliance on stability testing at trial reduction is warranted. METHODS Intraoperative 3D functional balancing of THA without stability testing at trial reduction was practiced in all subjects undergoing THA in our unit from April 2014. To date 1019 patients have had their hips replaced with the same technique. They were followed up till April 2020 for post-operative complications of dislocation and significant LLD needing footwear modification. A secondary cohort of 114 patients from 1st January to December 31st 2017 within this primary group were analyzed clinically and radiologically to ascertain the implications of functional 3D balancing on X-ray parameters, clinical outcome scores (Harris Hip Score and Oxford Hip Score), ability to squat, and subtle subjective post-operative perception of limb lengthening (POPLL). RESULTS In the primary group of 1019 patients, there were only two dislocations and no patient needed footwear modification for LLD. In the detailed analysis of the secondary cohort of 114 patients, the correlation with restoration of static radiological parameters was inconsistent. 40 patients could not squat and 4 patients had subtle subjective post-operative perceived limb lengthening (POPLL). Measured outcomes such as HHS and OHS were improved in all patients with significant statistical significance (P < 0.001). CONCLUSION This study underlines the fact that more importance must be given to functional dynamic parameters by 3D balancing of the THA and not on static anatomical X-rays parameters and stability testing during trial reduction. This represents a paradigm shift in the evolution of total hip arthroplasty. LEVEL OF EVIDENCE A Level II study. (Data collected from the ongoing prospective study) (http://www.spine.org/Documents/LevelsofEvidenceFinal.pdf). SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00505-3.
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Affiliation(s)
- Vijay C. Bose
- Asian Joint Reconstruction Institute @ SIMS Hospitals, Chennai, Tamil Nadu India
| | - Suryanarayan Pichai
- Asian Joint Reconstruction Institute @ SIMS Hospitals, Chennai, Tamil Nadu India
| | - P. S. Ashok Kumar
- Asian Joint Reconstruction Institute @ SIMS Hospitals, Chennai, Tamil Nadu India
| | - Kalaivanan Kanniyan
- Asian Joint Reconstruction Institute @ SIMS Hospitals, Chennai, Tamil Nadu India
| | | | - Shantanu Patil
- SRM Medical College, SRM IST, Kattankulathur, Tamil Nadu India
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14
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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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15
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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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16
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Acetabular Bone Defect in Total Hip Arthroplasty for Crowe II or III Developmental Dysplasia of the Hip: A Finite Element Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4809013. [PMID: 32908892 PMCID: PMC7468597 DOI: 10.1155/2020/4809013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/08/2020] [Indexed: 11/17/2022]
Abstract
Background The purpose of this study was to establish the finite element analysis (FEA) model of acetabular bone defect in Crowe type II or III developmental dysplasia of the hip (DDH), which could evaluate the stability of the acetabular cup with different types of bone defects, different diameters of femoral ceramic heads, and the use of screws and analyze the stress distribution of screws. Methods The FEA model was based on the CT scan of a female patient without any acetabular bone defect. The model of acetabular bone defect in total hip arthroplasty for Crowe II or III DDH was made by the increasing superolateral bone defect area of the acetabular cup. Point A was located in the most medial part of the acetabular bone defect. A 52 mm PINNACLE cup with POROCOAT Porous coating was implanted, and two screws (the lengths were 25 mm and 40 mm) were implanted to fix the acetabular cup. The stability of the acetabular cup and the von Mises stress of point A and screws were analyzed by a single-legged stance loading applied in 1948 N (normal working). The different diameters of the femoral ceramic head (28 mm, 32 mm, and 36 mm) were also analyzed. Results The von Mises stress of point A was gradually increased with the increasing uncoverage values. When the uncoverage values exceeded 24.5%, the von Mises stress of point A without screws increased significantly, leading to instability of the cup. Screws could effectively reduce the von Mises stress of point A with uncoverage values of more than 24.5%. However, the peak von Mises stress in the screws with the uncoverage values that exceeded 24.5% was considerably increased. The diameter of the femoral ceramic head had no significant effect on the von Mises stress and the stability of the acetabular cup. Conclusions We recommend that uncoverage values of less than 24.5% with or without screw is safe for patients with Crowe II or III DDH.
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