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Yang C, Zhu K, Dai H, Zhang X, Wang Q, Wang Q. Mid- to Long-term Follow-up of Severe Acetabular Bone Defect after Revision Total Hip Arthroplasty Using Impaction Bone Grafting and Metal Mesh. Orthop Surg 2023; 15:750-757. [PMID: 36644857 PMCID: PMC9977582 DOI: 10.1111/os.13651] [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: 09/17/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE In revision total hip arthroplasty (THA), reconstruction of severe acetabular bone defect continues to be problematic for orthopedic surgeons. This study reports the mid- to long-term survivorship, radiological outcomes, and complications of impaction bone grafting (IBG) and metal mesh with a cemented acetabular component in the reconstruction of severe acetabular bone defects in revision THA. METHODS This retrospective consecutive study included 26 patients (29 hips: type II B, four; type II C, three; type III A, 10; and type III B, 12) who underwent revision THA, which was performed using IBG and metal mesh, between 2007 and 2014 in our institution. All patients were followed up regularly for clinical and radiographical assessments. Migration and loosening of prosthesis graft integration and complications were observed and analyzed. Survival analysis was performed using a Kaplan-Meier survival analysis. RESULTS At the time of revision, 75.9% of the hips (22 hips) were classified as type III bone defects. The average follow-up period was 9.4 ± 2.8 (range, 2.4-14.0) years. Of the 29 hips, four hips (13.8%) were assessed as clinical failures; at the last follow-up, two had undergone re-revision THA, and two had not been scheduled for re-revision THA despite radiological failure of the acetabular component. Among them, three clinical failures (10.3%) were due to aseptic loosening, and one (3.4%) was due to infection. Radiographic evaluation showed bone graft integration in all hips during the follow-up. The Kaplan-Meier survivorship analysis revealed an acetabular reconstruction survival rate of 86.5% (95% confidence interval, 61.4%-95.7%) at 10 years. CONCLUSION IBG and metal mesh with a cemented acetabular component for revision THA is an effective technique for treating severe acetabular bone defects, with effective mid- to long-term outcomes due to the solid reconstruction of the acetabular bone defect and restoration of the hip rotation center.
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Affiliation(s)
- Chao Yang
- Department of OrthopaedicsShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Kechao Zhu
- Department of OrthopaedicsShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Huiyong Dai
- Department of OrthopaedicsShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Xianlong Zhang
- Department of OrthopaedicsShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Qiaojie Wang
- Department of OrthopaedicsShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Qi Wang
- Department of OrthopaedicsShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
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Güneş Z, Bekmez Ş, Çağlar Ö, Mazhar Tokgözoğlu A, Atilla B. Anatomic acetabular reconstruction with femoral head autograft for developmental dysplasia of the hip (DDH) with a minimum follow-up of 10 years. Hip Int 2022:11207000221099580. [PMID: 35757909 DOI: 10.1177/11207000221099580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND DDH with coxarthrosis causes significant deformity and bone deficiency. Various reconstructive techniques have been proposed to treat developmental dysplasia of the hip. However, the existing literature has not yet reached a consensus on the best technique regarding long-term survival. OBJECTIVES This study aims to evaluate the long-term survival of uncemented hydroxyapatite (HA) coated acetabular components augmented with a femoral head autograft. METHODS We retrospectively reviewed the cases of 31 hips in 29 patients (24 female, 5 male, mean age 45.06 years) treated with HA-coated cementless components and femoral head autograft between 2000-2008 with a minimum follow-up of 10 years. Graft resorption, cup loosening and the anatomical hip centre were determined. Functional outcomes were calculated using the Harris Hip Scoring system. The survival of the acetabular component was evaluated using the Kaplan-Meier method. RESULTS In 24 hips (77,4%), we reconstructed the hip centre anatomically. The remaining cups had variable deviations from the anatomical rotation centre. Only one patient required revision due to loosening. Survival analysis revealed 96.8% survival at 10 years. The mean Harris Hip Score was 39.23 preoperatively and 84.77 at final follow-up. There was no statistical correlation between revision and any of the measured parameters. DISCUSSION Acetabular reconstruction with a femoral head autograft allows for anatomical cup positioning, early structural support and increases bone stock for future revisions. Although our prior cemented cup study showed that anatomical cup orientation is critical, this study demonstrated the absence of a correlation between implant failure and cup positioning, suggesting that HA-coated cementless cups are more stable and forgiving. CONCLUSIONS HA-coated acetabular cups augmented with femoral head autograft provided long-term, reliable and durable cup fixation in dysplastic hips of young adults.
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Affiliation(s)
- Zirvecan Güneş
- Orthopaedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Şenol Bekmez
- Orthopaedics and Traumatology, Istinye University Faculty of Medicine, İstanbul, Turkey
| | - Ömür Çağlar
- Orthopaedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Bülent Atilla
- Orthopaedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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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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Hamrayev AJ, Buyukkuscu MO, Misir A, Gursu SS. The fate of femoral head autograft in acetabular reconstruction in dysplastic hips at midterm. J Orthop Surg (Hong Kong) 2021; 28:2309499020957109. [PMID: 32996378 DOI: 10.1177/2309499020957109] [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: 11/17/2022] Open
Abstract
PURPOSE To evaluate the acetabular cup and graft survival in patients who underwent total hip arthroplasty (THA) with the diagnosis of dysplastic hip osteoarthritis and received a femoral head autograft due to acetabular coverage deficiency. METHODS Between January 2005 and December 2016, 83 hip prostheses of 80 patients who underwent THA using femoral head autografts and were followed up for at least 2 years were retrospectively evaluated. Seventy-four hips of the remaining 71 patients (57 female (80%)) were included. Mean patient age at surgery was 51 ± 16 (range 18-76) years. The mean follow-up duration was 76 ± 25 (range 25-161) months. Acetabular inclination and graft thickness, contact length, percentage of coverage, and graft resorption were examined on postoperative and final follow-up radiographs. The presence of a radiolucent area around the acetabular and femoral components indicating loosening was also evaluated. RESULTS The mean postoperative acetabular component inclination was 44 ± 5.1° (range 30-48°) with mean graft coverage of 34 ± 4.8% (range 24-46%). In all patients, autograft union with the pelvis was seen and the lateral overflow was remodeled. Fifteen patients (20%) underwent revision surgery due to aseptic acetabular component loosening in four, nontraumatic recurrent dislocations in eight, periprosthetic infection in one, acetabular component protrusion in one, and traumatic hip dislocation in one. CONCLUSION In patients with osteoarthritis secondary to developmental hip dysplasia, the use of femoral head autografts to eliminate acetabular coverage deficiency during THA achieves acceptable midterm postoperative radiological outcomes. Increased acetabular bone stock may be beneficial in possible future revision surgeries.
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Affiliation(s)
- Arif Jan Hamrayev
- Department of Orthopaedics and Traumatology, 147008Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Ozbey Buyukkuscu
- Department of Orthopaedics and Traumatology, 147020Health Science University Gaziosmanpasa Education and Research Hospital, Istanbul, Turkey
| | - Abdulhamit Misir
- Department of Orthopaedics and Traumatology, 147020Health Science University Gaziosmanpasa Education and Research Hospital, Istanbul, Turkey
| | - Sukru Sarper Gursu
- Department of Orthopaedics and Traumatology, 147008Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
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Is Ranawat triangle method accurate in estimating hip joint center in Japanese population? J Orthop Sci 2021; 26:219-224. [PMID: 32245695 DOI: 10.1016/j.jos.2020.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/26/2020] [Accepted: 03/10/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Little information has been available regarding the usefulness of Ranawat triangle method in estimating anatomical hip joint center in the Japanese population. In this study, we aimed to determine the accuracy of the method in estimating hip joint center. METHODS Using digitally reconstructed radiographs of 123 normal hips (123 patients), we measured the hip joint center coordinates (Cx, Cy) with reference to the ipsilateral lowest point of the teardrop, the pelvic width, and the pelvic height. Using these measurement values, we performed the following analyses: (1) the relationship of hip joint center location with pelvic dimensions; (2) accuracy of Ranawat method in estimating hip joint center; (3) alternative methods to estimate hip joint center using pelvic height. RESULTS The mean Cx and Cy were 32 ± 3.0 mm and 13 ± 2.1 mm, respectively. Pelvic height was positively correlated with Cx (r = 0.51, p < 0.001) and Cy (r = 0.69, p < 0.001), but the correlations of pelvic width with Cx and Cy were negligible. The mean estimation error of the Ranawat method was -6.7 ± 2.6 mm in x-axis and 6.6 ± 1.9 mm in y-axis, respectively. The hip joint center was estimated within a 5 mm error in both axes in only 8 hips (6.5%). Thus, we developed two estimating methods using pelvic height, modified Ranawat method and pelvic height ratio method, and the estimation errors of these methods were within 5 mm in both axes in 118 hips (96%) and 116 hips (94%), respectively. CONCLUSIONS Ranawat method showed poor accuracy in estimating anatomical hip joint center and is not recommended for clinical use. Our alternative methods may be useful for surgeons planning the position of the acetabular component in total hip arthroplasty.
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Jin JY, Yoon TR, Park KS, Jin SY, Jung DM, Li QS. Mid-term results of total hip arthroplasty with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip. BMC Surg 2021; 21:9. [PMID: 33407340 PMCID: PMC7789222 DOI: 10.1186/s12893-020-01002-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 12/06/2020] [Indexed: 12/05/2022] Open
Abstract
Background This study aimed to explore mid-term clinical results of cementless total hip arthroplasty (THA) with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip (DDH). Methods Thirteen patients (13 hips) with Crowe type IV DDH who underwent THA with modified trochanteric osteotomy between May 2013 and October 2015 were retrospectively analyzed. The mean follow-up duration was 5.2 years (range, 4.9–6.1 years). Results The mean Harris Hip Score (HHS) significantly (p < 0.05) improved from 30.7 (range, 22–38) to 87.5 (range, 83–93). The mean leg length discrepancy (LLD) was 53.4 mm (range, 42.1–68.5 mm) preoperatively. The final LLD was 5.6 mm (range, 2.4–9.1 mm; p < 0.05). The mean leg length after surgery was 47.4 mm (range, 33.6–67.2 mm) and the femur shortening distance was 43.8 mm (range, 31.2–53.4 mm). The average duration of bone union for the greater trochanter (GT) was 2.5 months (range, 1.5–3.6 months). There was no infection, GT non-union, or loosening (septic or aseptic) of the stem or cup in any case. Conclusions THA with modified trochanteric osteotomy with a cementless cup is an effective treatment for Crowe type IV DDH. It can rebuild complex biomechanics and biology of hip dysplasia without increasing complications.
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Affiliation(s)
- Jing-Yao Jin
- Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam, Republic of Korea.,Department of Orthopedic Surgery, Center for Joint Disease, Yanbian Hospital: Yanbian University Hospital, Jilin, Yanji, China
| | - Taek-Rim Yoon
- Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam, Republic of Korea. .,Department of Orthopedic Surgery, Center for Joint Disease, Yanbian Hospital: Yanbian University Hospital, Jilin, Yanji, China.
| | - Kyung-Soon Park
- Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam, Republic of Korea
| | - Sheng-Yu Jin
- Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam, Republic of Korea
| | - Dong-Min Jung
- Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam, Republic of Korea
| | - Qing-Song Li
- Department of Orthopedic Surgery, Center for Joint Disease, Yanbian Hospital: Yanbian University Hospital, Jilin, Yanji, China
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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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Qin Y, Zhou Z. [Research progress of total hip arthroplasty for patients with sequelae of suppurative hip arthritis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:139-144. [PMID: 31939249 DOI: 10.7507/1002-1892.201905083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To summarize the research progress of total hip arthroplasty (THA) in treatment of sequelae of suppurative hip arthritis. Methods The relevant literature was systematically searched and the operation timing, treatments of acetabular and femoral sides, and prosthesis selection in THA for sequelae of suppurative hip arthritis were summarized. Results THA is an effective way to treat the sequelae of suppurative hip arthritis. In order to avoid the recurrence of infection, THA is recommended to be performed after 10 years of resting period of hip septic infection. These patients may have acetabulum dysplasia and poor coverage of acetabulum. When performing THA, high position acetabulum, osteotomy of the medial acetabular wall, structural bone graft, Cage, tantalum augment, or three-dimensional printing prosthesis can be chosen. The femoral side may has small medullary cavity, increased femoral neck anteversion, increased femoral neck-stem angle, extend trochanter, and poor bone mass. When performing THA, the femoral osteotomy and appropriate prosthesis can be selected for treatment. The patients with sequelae of suppurative hip arthritis are mostly young, cementless THA is preferred for a better long-term survivorship. Conclusion THA is an effective method for the sequelae of suppurative hip arthritis, but the operation is difficult and has relative high complication rate. Surgeons should have full understanding.
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Affiliation(s)
- Yongzhi Qin
- Department of Orthopedics, the People's Hospital of Guang'an City, Guangan Sichuan, 638000, P.R.China
| | - Zongke Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Long-term wear failure analysis of uhmwpe acetabular cup in total hip replacement. J Mech Behav Biomed Mater 2018; 87:1-9. [DOI: 10.1016/j.jmbbm.2018.07.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 11/20/2022]
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Ozden VE, Dikmen G, Beksac B, Tozun IR. Long-term retrospective study on the placement of the cementless acetabular cup and clinical outcomes in patients undergoing femoral head autografting for hip dysplasia and total hip arthroplasty. J Orthop Sci 2018; 23:525-531. [PMID: 29503037 DOI: 10.1016/j.jos.2018.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 01/02/2018] [Accepted: 02/12/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Placement of acetabular cup in the dysplastic hip is a challenging procedure. Using bulk femoral head autograft to increase the bony coverage of the cup is one of the techniques, which have been described. The impact of cup position on cup and autograft survival is a controversial issue. We aimed to determine whether the position of cementless acetabular cup used in conjunction with femoral head autograft in dysplastic hips affected the autograft-host incorporation with its final radiographic appearance and the cup survivorship into the second decade. METHODS Thirty-eight dysplastic hips with varying Crowe types in 31 patients (30 women and one man) were included. The mean age was 47 years (range, 29-64 years) and the mean follow-up was 20.3 years (range, 14.8-25.9 years). The initial postoperative and final radiographs were evaluated. The survival rate of the cups was analysed using Kaplan-Meier statistics and the log-rank test. Multivariate analysis was used to evaluate the effect of variables (Crowe type, radiographic initial host bone coverage over the cup and position of the cup) on survivorship. RESULTS The acetabular cups were positioned anatomical in 27/38 hips according to Ranawat measurement technique. Trabecular bridging at graft-host interface was seen in all cases at an average 22.1 months. Neither acetabular cup position nor initial host bone coverage over acetabular cup less than 50% had any significant effect on either cup survival or final radiographic appearance of the graft. The 20-year cup survival rate without aseptic revision was 66% (95 CI, 52%-84%). No revision was performed due to graft resorption. CONCLUSION Twenty-year survival rate of the cementless cup combination with femoral head autograft showed no significant differences whether it was placed at high or anatomic hip centre. The final radiographic appearance of the autograft was not affected from either the cup location or the initial radiographic horizontal host bone coverage.
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Affiliation(s)
- Vahit Emre Ozden
- Acibadem University, Faculty of Medicine, Acibadem Maslak Hospital, Department of Orthopedics and Traumatology, Maslak, 34457, Istanbul, Turkey.
| | - Goksel Dikmen
- Acibadem University, Faculty of Medicine, Acibadem Maslak Hospital, Department of Orthopedics and Traumatology, Maslak, 34457, Istanbul, Turkey
| | - Burak Beksac
- Acibadem University, Faculty of Medicine, Acibadem Maslak Hospital, Department of Orthopedics and Traumatology, Maslak, 34457, Istanbul, Turkey
| | - Ismail Remzi Tozun
- Acibadem University, Faculty of Medicine, Acibadem Maslak Hospital, Department of Orthopedics and Traumatology, Maslak, 34457, Istanbul, Turkey
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Atilla B. Reconstruction of neglected developmental dysplasia by total hip arthroplasty with subtrochanteric shortening osteotomy. EFORT Open Rev 2017; 1:65-71. [PMID: 28461930 PMCID: PMC5367593 DOI: 10.1302/2058-5241.1.000026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Patients with neglected developmental dysplasia (DDH) face with early osteoarthritis of the hip, limb length inequality and marked disability while total hip reconstruction is the only available choice. DDH has severe morphologic consequences, with distorted bony anatomy and soft tissue contractures around the hip. It is critical to evaluate patients thoroughly before surgery. Anatomic reconstruction at the level of true acetabulum with uncemented implant is the mainstay of treatment. This requires a subtrochanteric shortening osteotomy, which can be realised using different osteotomy and fixation options. Although a demanding technique with a high rate of related complications, once anatomic reconstruction of the hip is achieved, patients have a remarkably good functional capacity and implant survival during long follow-up periods.
Cite this article: Atilla B. Reconstruction of neglected developmental dysplasia by total hip arthroplasty with subtrochanteric shortening osteotomy. EFORT Open Rev 2016;1:65–71. DOI: 10.1302/2058-5241.1.000026.
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Affiliation(s)
- Bülent Atilla
- Hacettepe University Faculty of Medicine, Ankara, Turkey
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El Ayoubi A, Nasri M, Krite A, Idrissi ME, Shimi M, Ibrahimi AE, Elmrini A. [Total hip arthroplasty for the treatment of congenital hip dislocations in adults: about 15 cases]. Pan Afr Med J 2016; 25:201. [PMID: 28292158 PMCID: PMC5326186 DOI: 10.11604/pamj.2016.25.201.10534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/24/2016] [Indexed: 11/11/2022] Open
Abstract
Total hip arthroplasty for the treatment of congenital dislocation represents a challenge for the orthopedic surgeon. It is now well established that the treatment of congenital hip dislocation in adults is a real "functional miracle". The evolution of surgical techniques and materials has expanded the indications for prosthetic replacement including the most complex cases and thus going against Charnley and Feagin who wrote in 1973 that there was no place for total hip arthroplasty in inveterate dislocations. We conducted a retrospective study of a series of THP 15 for the treatment of congenital hip dislocation in adults;sociodemographic, clinical, paraclinical and therapeutic data were collected from the medical records of 15 patients and also via a written questionnaire which was completed during their last follow-up visit. The average age of our patients was 28 years; female sex ratio was 2F/1H. Severe dysplasia stage VI according to Crowe's classification was present in 4 cases, type III in 9 cases and type II only in 2 cases. All patients underwent cemented total hip arthroplasty, a reinforcement ring was used in 9 cases and a bone graft in 2 cases. At last follow-up visit PMA functional scores were excellent and very good in 74% of cases. Surgical treatment of congenital hip dislocations in adults must meet strict health standards as congenital hip dislocations often occurs in young female population that is more demanding as to the aesthetic and functional outcomes. Several surgical techniques have tried to solve the problems related to this disease, acetabular and femoral hypoplasia, leg length inequality. Total hip arthroplasty for the treatment of congenital dislocations in adults remains a challenge for the orthopaedic surgeon. This is a difficult surgical procedure which requires technical skills and careful pre-design programming to reduce the occurrence of adverse events especially in the particular case of young female population.
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Affiliation(s)
| | - Mohamed Nasri
- Service de Chirurgie Osteo-Articulaire B4, CHU Hassan II, Fès, Maroc
| | - Ali Krite
- Service de Chirurgie Osteo-Articulaire B4, CHU Hassan II, Fès, Maroc
| | | | - Mohamed Shimi
- Service de Chirurgie Osteo-Articulaire B4, CHU Hassan II, Fès, Maroc
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Tikhilov R, Shubnyakov I, Burns S, Shabrov N, Kuzin A, Mazurenko A, Denisov A. Experimental study of the installation acetabular component with uncoverage in arthroplasty patients with severe developmental hip dysplasia. INTERNATIONAL ORTHOPAEDICS 2015; 40:1595-1599. [PMID: 26255058 DOI: 10.1007/s00264-015-2951-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/24/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was stimation of optimal percentage of lateral uncoverage of the acetabular component during total hip arthroplasty for patients with severe developmental hip dysplasia. METHODS Mathematical computer modeling based on the finite element technique and the mechanical experiment were performed. Critical values of uncoverage enabling safe primary fixation of acetabular component were estimated in designed models. RESULTS Using the finite element technique and the mechanical experiment on pelvis models, a possibility of mounting an acetabular component with moderate uncoverage within 25% without screws and with significant uncoverage to 35% with an additional two-screw fixation was demonstrated. CONCLUSIONS This study provides additional guidance on optimal acetabular uncoverage assessment and fixation methods of surgeons performing THA on patients with DDH.
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Affiliation(s)
- Rashid Tikhilov
- Vreden Russian Research Institute of Traumatology and Orthopaedics, St. Petersburg, Russia
| | - Igor Shubnyakov
- Vreden Russian Research Institute of Traumatology and Orthopaedics, St. Petersburg, Russia
| | - Scott Burns
- Department of Physical Therapy, Temple University, Philadelphia, PA, USA
| | - Nikolay Shabrov
- Institute Of Metallurgy, Mechanical Engineering and Transport, Saint Petersburg State Polytechnic University, St. Petersburg, Russia
| | - Alexey Kuzin
- Institute Of Metallurgy, Mechanical Engineering and Transport, Saint Petersburg State Polytechnic University, St. Petersburg, Russia
| | - Andrey Mazurenko
- Federal Centre of Traumatology, Orthopaedics and Arthroplasty, Cheboksary, Russia
| | - Alexey Denisov
- Vreden Russian Research Institute of Traumatology and Orthopaedics, St. Petersburg, Russia.
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Günther KP, Stiehler M, Goronzy J, Schneiders W, Hartmann A. [Arthroplasty for osteoarthritis secondary to hip dysplasia: Problem-oriented treatment strategies]. DER ORTHOPADE 2015; 44:497-8, 500-9. [PMID: 25860120 DOI: 10.1007/s00132-015-3106-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Because of anatomical variations total hip arthroplasty (THA) can be demanding in patients with osteoarthritis secondary to hip dysplasia. OBJECTIVES Depending on the degree of bony deformation, hip dislocation and soft tissue alteration numerous treatment strategies are available. This review describes current approaches that address frequent deformities. MATERIALS AND METHODS Review of relevant clinical studies, meta-analyses, and presentation of our own approach. RESULTS Pre-operative planning (based on a thorough clinical and radiographic examination) is essential. Acetabular reconstruction close to the primary acetabulum should always be intended. Roof augmentation and/or cup medialization can support stable bony implant fixation. Subtrochanteric shortening osteotomy of the femur is a demanding but reliable technique that avoids nerve damage in cases where inappropriate lengthening would be necessary (i.e., high riding dislocation). CONCLUSIONS Although the post-operative complication rate is elevated after THA for dysplastic hips compared with primary osteoarthritis, the overall functional results and implant survival are comparable.
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Affiliation(s)
- K P Günther
- UniversitätsCentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Deutschland,
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15
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Park KS, Yoon TR, Song EK, Seon JK, Lee KB. Total hip arthroplasty in high dislocated and severely dysplastic septic hip sequelae. J Arthroplasty 2012; 27:1331-1336.e1. [PMID: 22209158 DOI: 10.1016/j.arth.2011.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 11/21/2011] [Indexed: 02/01/2023] Open
Abstract
The authors analyzed a consecutive series of 20 total hip arthroplasties performed using a cementless conical stem with shortening osteotomy combined with greater trochanter transfer in cases with a highly dislocated hip secondary to sequelae of a septic hip in childhood. Mean patient age was 47.3 years and the mean follow-up period was 3.4 years. An acetabular metal cup was inserted in 5 cases, and only a liner was inserted after cementing in 15 cases. Mean Harris hip score improved from 42.4 preoperatively to 84.2 at final follow-up. Mean leg lengthening was 36.5 mm, and time to greater trochanter union was 3.72 months. No complete radiolucent line of thickness >2 mm was observed in any case. These surgical methods produced satisfactory clinical and radiological results.
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Affiliation(s)
- Kyung-Soon Park
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun-Eup, Hwasun-Gun, Jeonnam, Korea
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16
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Wegner A, Kauther MD, Landgraeber S, von Knoch M. Fixation method does not affect restoration of rotation center in hip replacements: a single-site retrospective study. J Orthop Surg Res 2012; 7:25. [PMID: 22686355 PMCID: PMC3489585 DOI: 10.1186/1749-799x-7-25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 06/01/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aseptic loosening is one of the greatest problems in hip replacement surgery. The rotation center of the hip is believed to influence the longevity of fixation. The aim of this study was to compare the influence of cemented and cementless cup fixation techniques on the position of the center of rotation because cemented cup fixation requires the removal of more bone for solid fixation than the cementless technique. METHODS We retrospectively compared pre- and post-operative positions of the hip rotation center in 25 and 68 patients who underwent artificial hip replacements in our department in 2007 using cemented or cementless cup fixation, respectively, with digital radiographic image analysis. RESULTS The mean horizontal and vertical distances between the rotation center and the acetabular teardrop were compared in radiographic images taken pre- and post-operatively. The mean horizontal difference was -2.63 mm (range: -11.00 mm to 10.46 mm, standard deviation 4.23 mm) for patients who underwent cementless fixation, and -2.84 mm (range: -10.87 to 5.30 mm, standard deviation 4.59 mm) for patients who underwent cemented fixation. The mean vertical difference was 0.60 mm (range: -20.15 mm to 10.00 mm, standard deviation 3.93 mm) and 0.41 mm (range: -9.26 mm to 6.54 mm, standard deviation 3.58 mm) for the cementless and cemented fixation groups, respectively. The two fixation techniques had no significant difference on the position of the hip rotation center in the 93 patients in this study. CONCLUSIONS The hip rotation center was similarly restored using either the cemented or cementless fixation techniques in this patient cohort, indicating that the fixation technique itself does not interfere with the position of the center of rotation. To completely answer this question further studies with more patients are needed.
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Affiliation(s)
- Alexander Wegner
- Department of Trauma Surgery, University Hospital Essen, Essen, Germany.
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17
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Cereatti A, Margheritini F, Donati M, Cappozzo A. Is the human acetabulofemoral joint spherical? ACTA ACUST UNITED AC 2010; 92:311-4. [PMID: 20130330 DOI: 10.1302/0301-620x.92b2.22625] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The human acetabulofemoral joint is commonly modelled as a pure ball-and-socket joint, but there has been no quantitative assessment of this assumption in the literature. Our aim was to test the limits and validity of this hypothesis. We performed experiments on four adult cadavers. Cortical pins, each equipped with a marker cluster, were implanted in the pelvis and the femur. Movements were recorded using stereophotogrammetry while an operator rotated the cadaver’s acetabulofemoral joint, exploiting the widest possible range of movement. The functional consistency of the acetabulofemoral joint as a pure spherical joint was assessed by comparing the magnitude of the translations of the hip joint centre as obtained on cadavers, with the centre of rotation of two metal segments linked through a perfectly spherical hinge. The results showed that the radii of the spheres containing 95% of the positions of the estimated centres of rotation were separated by less than 1 mm for both the acetabulofemoral joint and the mechanical spherical hinge. Therefore, the acetabulofemoral joint can be modelled as a spherical joint within the considered range of movement (flexion/extension 20° to 70°; abduction/adduction 0° to 45°; internal/external rotation 0° to 30°).
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Affiliation(s)
- A. Cereatti
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/b 07100, Sassari, Italy
| | - F. Margheritini
- Department of Health Sciences University of Rome “Fore Italico”, Piazza Lauro de Bosis 6, 00194, Rome, Italy
| | - M. Donati
- Department of Human Movement and Sport Sciences
| | - A. Cappozzo
- Department of Human Movement and Sport Sciences
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Mont MA, McGrath MS, Bonutti PM, Ulrich SD, Marker DR, Seyler TM, Suda AJ. Anatomic and physiologic rationale for various technologies for primary total hip arthroplasty. Expert Rev Med Devices 2009; 6:169-86. [PMID: 19298164 DOI: 10.1586/17434440.6.2.169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A number of patients have anatomic or physiologic variations that may adversely affect the performance of a primary total hip arthroplasty. Various technologies have been utilized in an attempt to improve the outcomes for these patients; however, some of these potential solutions are controversial. The authors examined the complete body of literature for scientific evidence regarding the use of these new technologies. The anatomic and physiologic anomalies that were studied include extra-articular deformities, developmental dysplasia, Perthes disease, Type C femoral bone, acetabular bone deficiency, femoral rotational abnormalities, variations that increase the risk of hip dislocation, sickle cell anemia, and extremely small or large bone sizes. This article presents the current scientific evidence and imparts an unbiased view of the use of various technologies to provide individualized solutions for patients who have anatomic or physiologic variations.
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Affiliation(s)
- Michael A Mont
- Rubin Institute for Advanced Orthopaedics, Baltimore, MD 21215, USA.
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Lian YY, Yoo MC, Pei FX, Cho YJ, Cheng JQ, Chun SW. Circumferential osteotomy of the medial acetabular wall in total hip replacement for the late sequelae of childhood septic arthritis of the hip. ACTA ACUST UNITED AC 2008; 89:1149-54. [PMID: 17905949 DOI: 10.1302/0301-620x.89b9.18908] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We performed 52 total hip replacements in 52 patients using a cementless acetabular component combined with a circumferential osteotomy of the medial acetabular wall for the late sequelae of childhood septic arthritis of the hip. The mean age of the patients at operation was 44.5 years (22 to 66) and the mean follow-up was 7.8 years (5 to 11.8). The mean improvement in the Harris Hip Score was 29.6 points (19 to 51) at final follow-up. The mean cover of the acetabular component was 98.5% (87.8% to 100%). The medial acetabular wall was preserved with a mean thickness of 8.3 mm (1.7 to 17.4) and the mean length of abductor lever arm increased from 43.4 mm (19.1 to 62) to 54.2 mm (36.5 to 68.6). One acetabular component was revised for loosening and osteolysis 4.5 years postoperatively, and one had radiolucent lines in all acetabular zones at final review. Kaplan-Meier survival was 94.2% (95% confidence interval 85.8% to 100%) at 7.3 years, with revision or radiological loosening as an end-point when two hips were at risk. A cementless acetabular component combined with circumferential medial acetabular wall osteotomy provides favourable results for acetabular reconstruction in patients who present with late sequelae of childhood septic hip arthritis.
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Affiliation(s)
- Y-Y Lian
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
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