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

Femoral Head Autograft to Manage Acetabular Bone Loss Defects in THA for Crowe III Hips by DAA: Retrospective Study and Surgical Technique

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.

Meta-analysis of the Efficacy of the Anatomical Center and High Hip Center Techniques in the Treatment of Adult Developmental Dysplasia of the Hip

Background. In total hip arthroplasty for the treatment of adult developmental dysplasia of the hip, there is considerable controversy regarding the placement of the acetabular cup, anatomic center, and upward in acetabular reconstruction. This article explores the efficacy of the anatomical center technique and high hip center technique in the treatment of adult developmental dysplasia of the hip. Method. By searching for articles in the Cochrane Library, PubMed, CNKI, and Wanfang databases, we collected the literature on the treatment of adult developmental dysplasia of the hip by anatomical center and high hip center technology and screened the literature according to the inclusion and exclusion criteria. The Cochrane risk of bias assessment tool was used to assess the risk of bias of randomized controlled trials, the quality of the literature in retrospective cohort studies was assessed using the Newcastle–Ottawa scale, and the RevMan 5.4 software was used to analyze the extracted outcome indicators. Results. Nine studies were finally included, including one prospective cohort study, eight retrospective cohort studies, two high-quality studies, and six moderate-quality studies. The meta-analysis results showed that the reconstruction of the acetabulum in two positions was significantly different in terms of operation time ( $\text{WMD}=-37$ , 95% CI: -45.25-28.74, $P<0.00001$ ), intraoperative blood loss ( $\text{WMD}=-91.88$ , 95% CI: -108.57-75.19, $P<0.00001$ ), postoperative drainage volume ( $\text{WMD}=80.55$ , 95% CI: -140.56-301.66, $P=0.48$ ), time to ground ( $\text{WMD}=-0.68$ , 95% CI: -1.37-0.0, $P=0.05$ ), Harris score ( $\text{WMD}=-0.04$ , 95% CI: -0.91-0.82, $P=0.92$ ), lower limb length difference ( $\text{WMD}=0.21$ , 95% CI: -0.22-0.64, $P=0.33$ ), WOMAC score ( $\text{WMD}=-1.24$ , 95% CI: -4.89-2.41, $P=0.51$ ), postoperative complications ( $\text{RD}=-0.02$ , 95% CI: -0.06-0.02, $P=0.44$ ), Trendelenburg sign ( $\text{RD}=-0.02$ , 95% CI: -0.02-0.05, $P=0.31$ ), limb lengthening ( $\text{WMD}=0.85$ , 95% CI: 0.61-1.09, $P<0.00001$ ), prosthesis wear ( $\text{WMD}=0.01$ , 95% CI: 0-0.02, $P=0.17$ ), and prosthesis loosening ( $\text{RD}=0.01$ , 95% CI: -0.02-0.04, $P=0.45$ ). Conclusions. The high hip center technique can reduce operative time, intraoperative blood loss, and downtime. The anatomical center technique is superior to the high hip center technique in terms of limb lengthening. Compared with acetabular anatomical reconstruction, there was no significant difference in postoperative drainage, lower limb length difference, postoperative complications, Trendelenburg sign, and prosthesis survival or wear. For DDH patients who are not severely shortened in the lower limbs and have severe acetabular bone defects, joint surgeons can choose to reconstruct the acetabulum in the upper part to simplify the operation, reduce the trauma of the patient, and accelerate the recovery of the patient, and they can choose to adjust the length of the neck and the angle of the neck shaft to maintain the moment arm of the abductor muscle. A ceramic interface or a highly cross-linked polyethylene interface minimizes the effect of hip response forces. To further evaluate the efficacy of the anatomical center technique and the high hip center technique in the treatment of adult developmental dysplasia of the hip, more large-sample, high-quality, long-term follow-up randomized controlled trials are still needed for verification.