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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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Di Martino A. Observations on the Present and the Future of Hip Surgery. J Clin Med 2023; 12:jcm12103464. [PMID: 37240570 DOI: 10.3390/jcm12103464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Each period in history has its own peculiar fashions and trends, and contemporary research on hip surgery is no exception [...].
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Affiliation(s)
- Alberto Di Martino
- 1st Orthopedic Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neurimotor Sciences-DIBINEM, University of Bologna, 40136 Bologna, Italy
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
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