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Lu Z, Chen Q, Lan Y, Xie S, Lin F, Feng E. Subtrochanteric Osteotomy in Direct Anterior Approach Total Hip Arthroplasty for Crowe IV Dysplasia-Surgical Technique and Literature Review. Orthop Surg 2024; 16:766-774. [PMID: 38296797 PMCID: PMC10925515 DOI: 10.1111/os.13996] [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: 09/03/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024] Open
Abstract
For Crowe IV dysplasia, the clinical efficacy and surgical technique of subtrochanteric osteotomy (SO) within the direct anterior approach total hip arthroplasty (DAA-THA) was a subject of debate. This study aimed to describe the surgical technique and clinical outcomes in 11 cases of SO in DAA-THA and to summarize the relevant literature on this topic. Between June 2016 and June 2023, we retrospectively evaluated patients diagnosed with Crowe IV hip dysplasia at our institution. Criteria identified 11 patients who underwent SO during DAA-THA. Comprehensive data encompassing demographic information, radiological data, prosthetic implant type, and surgical intricacies were collected. In addition, an exhaustive review of existing case series literature was undertaken utilizing the PubMed databases. There were no revisions, deaths, dislocations, or infections. One hip (9.09%) had an intraoperative proximal split fracture, two hips (18.2%) had lower limb deep vein thrombosis, and one hip (9.09%) had symptoms of femoral nerve injury. Radiological data showed improved bilateral femoral offset, leg length discrepancy, and anatomical acetabular. During the mean follow-up of 2.18(1.06-2.46) years, patients demonstrated enhanced functional outcomes, with average changes of 25.2 in the Harris hip score and 47 in the WOMAC score. Reviewing the literature, most studies have favored S-ROM prostheses and transverse osteotomy techniques. Intraoperative fractures were notably frequent, with rates peaking at 25%. Nonunion and nerve injury were secondary common complications. SO via DAA-THA may offer satisfactory clinical and radiographic outcomes, but the literature review underscores the need for heightened awareness of intraoperative fracture risk. Proximal detachment of the vastus intermedius plays a pivotal role in SO exposure through the DAA.
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Affiliation(s)
- Zhiming Lu
- Department of Arthrosis SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Qinghuang Chen
- Department of OrthopedicAnxi County HospitalQuanzhouChina
| | | | | | | | - Eryou Feng
- Department of Arthrosis SurgeryFujian Medical University Union HospitalFuzhouChina
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Faldini C, Tassinari L, Pederiva D, Rossomando V, Brunello M, Pilla F, Geraci G, Traina F, Di Martino A. Direct Anterior Approach in Total Hip Arthroplasty for Severe Crowe IV Dysplasia: Retrospective Clinical and Radiological Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:114. [PMID: 38256376 PMCID: PMC10820098 DOI: 10.3390/medicina60010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: total hip arthroplasty (THA) for Crowe IV hip dysplasia poses challenges due to severe leg shortening, muscle retraction and bone stock issues, leading to an increased neurological complication, and revision rate. The direct anterior approach (DAA) is used for minimally invasive THA but its role in Crowe IV dysplasia is unclear. This retrospective study examines if DAA effectively restores hip biomechanics in Crowe IV dysplasia patients with <4 cm leg length discrepancy, managing soft tissue and yielding functional improvement, limb length correction, and limited complications. Materials and Methods: 19 patients with unilateral Crowe IV hip osteoarthritis and <4 cm leg length discrepancy undergoing DAA THA were reviewed. Surgery involved gradual soft tissue release, precise acetabular cup positioning, and stem placement without femoral osteotomy. Results: results were evaluated clinically and radiographically, with complications recorded. Follow-up revealed significant Harris Hip Score and limb length discrepancy improvements. Abductor muscle insufficiency was present in 21%. The acetabular component was accurately placed, centralizing the prosthetic joint's rotation. Complications occurred in 16% of cases, including fractures, nerve issues, and infection. DAA in THA showcased positive outcomes for hip function, limb length, and biomechanics in Crowe IV dysplasia. Conclusions: the technique enabled accurate cup positioning and rotation center adjustment. Complications were managed well without implant revisions. DAA is a viable option for Crowe IV dysplasia, restoring hip function, biomechanics, and reducing limb length discrepancy. Larger, longer studies are needed for validation.
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Affiliation(s)
- Cesare Faldini
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (C.F.); (L.T.); (D.P.); (V.R.); (M.B.); (F.P.); (G.G.)
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40126 Bologna, Italy;
| | - Leonardo Tassinari
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (C.F.); (L.T.); (D.P.); (V.R.); (M.B.); (F.P.); (G.G.)
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40126 Bologna, Italy;
| | - Davide Pederiva
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (C.F.); (L.T.); (D.P.); (V.R.); (M.B.); (F.P.); (G.G.)
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40126 Bologna, Italy;
| | - Valentino Rossomando
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (C.F.); (L.T.); (D.P.); (V.R.); (M.B.); (F.P.); (G.G.)
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40126 Bologna, Italy;
| | - Matteo Brunello
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (C.F.); (L.T.); (D.P.); (V.R.); (M.B.); (F.P.); (G.G.)
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40126 Bologna, Italy;
| | - Federico Pilla
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (C.F.); (L.T.); (D.P.); (V.R.); (M.B.); (F.P.); (G.G.)
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40126 Bologna, Italy;
| | - Giuseppe Geraci
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (C.F.); (L.T.); (D.P.); (V.R.); (M.B.); (F.P.); (G.G.)
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40126 Bologna, Italy;
| | - Francesco Traina
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40126 Bologna, Italy;
- Orthopedics-Traumatology and Prosthetic Surgery and Hip and Knee Revision, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Di Martino
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (C.F.); (L.T.); (D.P.); (V.R.); (M.B.); (F.P.); (G.G.)
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40126 Bologna, Italy;
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Taylor AJ, Runner RP, Kay RD, Najibi S. Femoral Head Autograft Can Reliably Reconstruct Dysplastic Acetabula Through the Direct Anterior Approach for Total Hip Arthroplasty. Arthroplast Today 2022; 14:154-162. [PMID: 35313717 PMCID: PMC8933727 DOI: 10.1016/j.artd.2022.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/16/2022] [Accepted: 02/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background Bone deficiencies in dysplastic acetabula create technical difficulties during total hip arthroplasty (THA). Bulk femoral head autograft (FHA) is one method to increase cup coverage and bone stock of the true acetabulum; however, only limited data exist on its efficacy through a direct anterior approach (DAA). This study aimed to evaluate the outcomes of FHA during THA via a DAA in dysplastic hips. Methods Retrospective review of 34 patients (41 hips) with hip dysplasia (Crowe I-III) who underwent primary THA via a DAA with FHA at a single institution was performed. Surgical procedures were performed on a traction table with intraoperative fluoroscopy and highly porous-coated cup placement in the true acetabulum. Patients were assessed clinically and radiographically at a minimum of 2 years postoperatively (range, 2 to 7). Results The average modified Harris Hip Score improved from 31.9 ± 10.8 to 94.1 ± 5.8, Merle d'Aubigné Hip Score from 7.5 ± 2.8 to 16.6 ± 1.1, and visual analog pain score from 7.9 ± 2.7 to 1.4 ± 1.4 (all P < .001). All hips had an “anatomic” inferomedial cup position postoperatively, with an average increase in horizontal coverage of 43.4%. Mean postoperative limb-length discrepancy improved from 21.8 ± 16.1 mm to 1.6 ± 5.7 mm (P < .001). There were no cases of revision THA, nor complications such as dislocation, infection, or osteolysis. Conclusion Reconstructing dysplastic acetabula (Crowe I-III) with FHA during THA can be successfully accomplished via the DAA with increased acetabular bone stock and accurate correction of limb-length discrepancy.
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Affiliation(s)
- Adam J. Taylor
- Department of Orthopaedic Surgery, Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
- Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
- Corresponding author. 7601 E Imperial Hwy, Downey, CA 90242, USA. Tel: +1 916 832 2326.
| | - Robert P. Runner
- Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Robert D. Kay
- Department of Orthopaedic Surgery, Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
- Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Soheil Najibi
- Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
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Viamont-Guerra MR, Chen AF, Stirling P, Nover L, Guimarães RP, Saffarini M, Laude F. Reply to Letter to the Editor on "The Direct Anterior Approach for Total Hip Arthroplasty for Severe Dysplasia (Crowe III and IV) Provides Satisfactory Medium to Long-Term Outcomes". J Arthroplasty 2020; 35:3065-3066. [PMID: 32684395 DOI: 10.1016/j.arth.2020.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Maria-Roxana Viamont-Guerra
- Ramsay Santé, Clinique du Sport Paris V, Paris, France; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Antonia F Chen
- Department of Orthopaedics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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