Is cup positioning easier in DDH patients previously treated with Bernese periacetabular osteotomy?

Application of 3D-printed osteotomy guides in periacetabular osteotomy: A short-term clinical study

OBJECTIVE

To compare the clinical efficacy between personalised 3-dimensional (3D) printed osteotomy and traditional osteotomy in periacetabular osteotomy (PAO).

METHODS

Twenty-two patients with acetabular dysplasia were randomly divided into a personalised 3D-printed osteotomy group and a traditional osteotomy group without 3D printing assistance. The operation time, intraoperative blood loss, X-ray frequency, quantity of postoperative drainage, postoperative transfusion rate, hip angle and Harris hip score of 6 months postoperative were studied and compared to evaluate the surgical efficacy between personalised 3D-printed osteotomy and traditional osteotomy in periacetabular osteotomy.

RESULTS

The operation time, intraoperative blood loss, X-ray frequency, postoperative 24 h drainage volume in the personalised 3D-printed osteotomy group (114.70 ± 2.21 min, 639.70 ± 5.00 mL, 11.82 ± 0.42 times, 231.20 ± 3.86 mL) was superior to the traditional group (150.40 ± 2.45 min, 850.50 ± 5.34 mL, 17.09 ± 0.39 times, 324.30 ± 4.06 mL). There was a statistically significant difference between the 3D-printed osteotomy group and the traditional osteotomy group in terms of the operation time, intraoperative blood loss, X-ray frequency and postoperative 24 h drainage volume (p < 0.05). And there were no substantial differences in the hip angle and the 6-month postoperative Harris hip score between the two groups (p > 0.05).

CONCLUSION

The 3D-printed osteotomy template for PAO is a valid method and its short-term clinical effect is superior to that of traditional osteotomy.

Total hip arthroplasty after rotational acetabular osteotomy for developmental dysplasia of the hip: a retrospective observational study

Background

Total hip arthroplasty after osteotomy is more technically challenging than primary total hip arthroplasty, especially concerning cup placement. This is attributed to bone morphological abnormalities caused by acetabular bone loss and osteophyte formation. This study aimed to investigate the clinical and radiological outcomes of total hip arthroplasty after rotational acetabular osteotomy compared with those of primary total hip arthroplasty, focusing mainly on acetabular deformity and cup position.

Methods

The study included 22 hips that had undergone rotational acetabular osteotomy and 22 hips in an age- and sex-matched control group of patients who underwent total hip arthroplasties between 2005 and 2020. We analyzed cup abduction and anteversion; lateral, anterior, and posterior cup center–edge angle; hip joint center position; femoral anteversion angle; and presence of acetabular defect using postoperative radiography and computed tomography. Operative results and clinical evaluations were also analyzed.

Results

The clinical evaluation showed that the postoperative flexion range of motion was lower in total hip arthroplasty after rotational acetabular osteotomy than in primary total hip arthroplasty, although no significant difference was noted in the postoperative total Japanese Orthopedic Association hip score. The operative time was significantly longer in the rotational acetabular osteotomy group than in the control group, but there was no significant difference in blood loss. The lateral cup center–edge angle was significantly higher and the posterior cup center–edge angle was significantly lower in the total hip arthroplasty after rotational acetabular osteotomy, suggesting a posterior bone defect existed in the acetabulum. In total hip arthroplasty after rotational acetabular osteotomy, the hip joint center was located significantly superior and lateral to the primary total hip arthroplasty.

Conclusions

In total hip arthroplasty after rotational acetabular osteotomy, the cup tended to be placed in the superior and lateral positions, where there was more bone volume. The deformity of the acetabulum and the high hip center should be considered for treatment success because they may cause cup instability, limited range of motion, and impingement.