1
|
Mimendia I, Lakhani K, Núñez JH, Barro V, Guerra-Farfán E, Collado D, Hernández A. Total hip arthroplasty associated with transverse subtrochanteric shortening osteotomy and conical stem fixation in Crowe type IV hip dysplasia. Musculoskelet Surg 2023; 107:367-372. [PMID: 36869994 DOI: 10.1007/s12306-023-00779-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 02/26/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Total hip arthroplasty (THA) in high-dislocated hip dysplasia is a surgical challenge, presenting difficulties in the biomechanical reconstruction of the hip. The purpose of the present study is to analyze clinical and radiological outcomes of a series of patients with Crowe type IV hip dysplasia who underwent a THA with transverse subtrochanteric shortening osteotomy and conical stem fixation in our Hip surgery unit. METHODS This non-interventional retrospective study included all patients diagnosed with Crowe type IV hip dysplasia who underwent a THA using a subtrochanteric shortening osteotomy and uncemented conical stem fixation between January 1, 2008, and December 31, 2015. Demographic, clinical and radiologic data were analyzed, including Harris Hip Score and Oxford Hip Score. RESULTS Seventeen hips in 13 patients were included in the final analysis. All patients were women and mean age was 39 years (range 35-45). Mean follow-up was 5.6 years (range 1-8). Average length of the osteotomy was 3.4 cm (range 3-4.5) and mean lowering of the center of rotation was 5.67 cm (range 3.8-9.1). Mean time for bone union was 5.5 months. No nerve palsy or non-union was detected at the end of follow-up period. CONCLUSION The use of cementless conical stem fixation associated with a transverse subtrochanteric shortening osteotomy for treating Crowe type IV hip dysplasia permits to correct the rotational alterations of the femur and provides good stability of the osteotomy, with very low risk of nerve palsy and non-union rates.
Collapse
Affiliation(s)
- I Mimendia
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - K Lakhani
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
- Traumatology and Rehabilitation, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebrón, 119., 08035, Barcelona, Spain.
| | - J H Núñez
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - V Barro
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - E Guerra-Farfán
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - D Collado
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - A Hernández
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| |
Collapse
|
2
|
Chen X, Li S, Liu X, Wang Y, Ma R, Zhang Y, Qian W. Acetabular Diameter Assessment and Three-Dimensional Simulation for Acetabular Reconstruction in Dysplastic Hips. J Arthroplasty 2023:S0883-5403(23)00087-6. [PMID: 36764404 DOI: 10.1016/j.arth.2023.01.067] [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] [Received: 10/14/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND This study aimed to investigate the relationship between acetabular width, three-dimensional (3D) simulation, and surgical results in total hip arthroplasty patients who have developmental dysplasia of the hip (DDH). METHODS This retrospective study included 216 DDH cases. Inner and outer acetabular width (OAW) was measured at the plane passing through the center of acetabular fossa. 3D simulation and 2D standard templating were performed. The actual cup size and the use of augments during surgery were recorded. Association among the indices and their distribution in different types of DDH were analyzed. RESULTS A difference of 13 to 14 millimeters (mm) was found between the inner acetabular width and actual cup size used in type II, III, and IV cases, while the difference was 0.2 to 3.6 mm for OAW. The accuracy of 2D templating and 3D simulation in predicting cup size was comparable in Crowe type I (86.5 versus 76%, P = .075), type II (72.7 versus 51.5%, P = .127), and type III (93.3 versus 66.7%, P = .169). The 3D simulation was significantly more accurate in Crowe type IV (89.1% versus 60.9%, P = .001). Augments and bone grafts were significantly more commonly used in type II (25%) than in the other types (0 to 6.5%). CONCLUSION OAW more accurately predicted actual cup size than inner acetabular width. The supero-lateral acetabular bone defects in type II cases require additional attention. Compared with 2D templating, 3D simulation is more accurate in predicting actual cup size in dysplastic hips with severe deformity and may be recommended in these selected cases, especially for Crowe IV patients.
Collapse
Affiliation(s)
- Xi Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China; Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China; Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Songlin Li
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xingyu Liu
- School of Life Sciences, Tsinghua University, Beijing, China; Institute of Biomedical and Health Engineering (iBHE), Tsinghua Shenzhen International Graduate School, Shenzhen, China; Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China; Longwood Valley, Beijing, China
| | - Yiou Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ruichen Ma
- School of Medicine, Tsinghua University, Beijing, China
| | | | - Wenwei Qian
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
3
|
Femoral Head Autograft to Manage Acetabular Bone Loss Defects in THA for Crowe III Hips by DAA: Retrospective Study and Surgical Technique. J Clin Med 2023; 12:jcm12030751. [PMID: 36769400 PMCID: PMC9918157 DOI: 10.3390/jcm12030751] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
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.
Collapse
|
4
|
Viamont-Guerra MR, Chen AF, Stirling P, Nover L, Guimarães RP, Laude F. 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; 35:1642-1650. [PMID: 32046871 DOI: 10.1016/j.arth.2020.01.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/20/2019] [Accepted: 01/10/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The direct anterior approach (DAA) is increasingly used for total hip arthroplasty (THA). Although the DAA can reduce pain, recovery time, and dislocations in nondysplastic hips, few studies report its results in patients with severe dysplasia. We aimed to evaluate outcomes of primary THA through the DAA with cup placement at the true acetabulum in hips with severe dysplasia. METHODS We retrospectively evaluated 23 consecutive patients (29 hips) who underwent THA by DAA for osteoarthritis secondary to Crowe III-IV dysplasia. Surgical procedures were performed on a traction table, and the acetabular cup was placed in the true acetabulum. Patients were assessed clinically (complications, modified Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford Hip Score) and radiographically (radiolucencies, subsidence, leg length discrepancies, cup inclination, and cup coverage) at a minimum of 2 years. RESULTS One patient (2 hips) died with original implants (at 13 and 14 years), 3 patients (3 hips) were revised due to wear-induced loosening (at 14, 16, and 18 years), and there were no dislocations or infections. The remaining 19 patients (24 hips) were assessed at 8.4 ± 4.7 years (range 2-20); 2 patients (2 hips) had complications that required reoperation without implant removal. The modified Harris Hip Score improved from 32 ± 9 to 94 ± 7, Western Ontario and McMaster Universities Osteoarthritis Index from 46 ± 18 to 90 ± 7, and Oxford Hip Score was 56 ± 4. Patients were very satisfied (90%) or satisfied (10%). Limb length discrepancy was 2.5 ± 9.0 mm. CONCLUSION THA through the DAA with cup placement at the true acetabulum provides satisfactory mid to long-term clinical and radiographic outcomes compared to other approaches for hips with severe dysplasia. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
Collapse
Affiliation(s)
- Maria-Roxana Viamont-Guerra
- Département d'Orthopédie, Ramsay Santé, Clinique du Sport Paris V, Paris, France; Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Antonia F Chen
- Department of Orthopaedics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Luca Nover
- Medical Technology, ReSurg SA, Nyon, Switzerland
| | | | - Frederic Laude
- Département d'Orthopédie, Ramsay Santé, Clinique du Sport Paris V, Paris, France
| |
Collapse
|
5
|
Segmental uncoverage ratio analysis of Crowe type-IV developmental dysplasia of the hip via 3-dimensional implantation simulation. ARTHROPLASTY 2020; 2:14. [PMID: 35236434 PMCID: PMC8796355 DOI: 10.1186/s42836-020-00032-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To study the segmental uncoverage ratio (UCR) of a 44-mm cup model placed in a true acetabulum of Crowe type-IV developmental dysplasia of the hip via 3-Dimensional (3D) implantation simulation. METHODS Qualified CT imaging data of 26 patients (involving 30 hips) with Crowe type-IV DDH were imported into Mimics software for reconstruction. Then a 44-mm eggshell cup model was placed in a true acetabulum. First, total uncoverage ratio (TUCR) was measured. Then the virtual cup was divided into 4 segments according to the quadrant setting of the true acetabulum, i.e., anterior-superior (A-S) segment, anterior-inferior (A-I) segment, posterior-superior (P-S) segment and posterior-inferior (P-I) segment. The UCRs of the aforementioned segments were measured, i.e., anterior-superior uncoverage ratio (A-SUCR), anterior-inferior uncoverage ratio (A-IUCR), posterior-superior uncoverage ratio (P-SUCR) and posterior-inferior uncoverage ratio (P-IUCR). The acetabular height and anterior-posterior diameter on the 3-D model were also calculated. Statistic analyses were performed by using SPSS software package. RESULTS TUCR was 0.2958 ± 0.1003 (95% [CI], 0.1020 to 0.5400) in this cohort of Crowe Type-IV hips. P-SUCR had the greatest value among all the segmental UCRs (0.1012 ± 0.0435, 95% confidence interval [CI],0.0152 to 0.1914) and the most significant positive correlation with TUCR (Pearson correlation = 0.889, p < 0.01. Linear regression R2 = 0.791). Similarly, P-IUCR and A-SUCR showed a significant positive correlation with TUCR. However, A-IUCR exhibited no correlation with either total or other segmental UCRs. P-SUCR was found to bear significant positive correlation with P-IUCR (pearson correlation = 0.644, p < 0.01. Linear regression R2 = 0.415). Acetabular height and A-P diameter were not correlated with TUCR. CONCLUSION Implantation of a 44-mm cup into Crowe type IV acetabulum is feasible and could achieve acceptable host bone coverage in most of the cases. P-SUCR contributed most to TUCR. TUCR had no linear relationship with the size of the host acetabulum, suggesting that the pre-operative plan should be individualized.
Collapse
|
6
|
Macheras GA, Lepetsos P, Anastasopoulos PP, Galanakos SP. The necessity to restore the anatomic hip centre in congenital hip disease. ANNALS OF TRANSLATIONAL MEDICINE 2017; 4:470. [PMID: 28090526 DOI: 10.21037/atm.2016.11.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Total hip replacement (THR) is the treatment of choice for the patient suffering from end-stage hip osteoarthritis. In the presence of deformities due to congenital hip disease (CHD), THR is, in most of the cases, a difficult task, since the technique of performing such an operation is demanding and the results could vary. We present our experience and preferred strategies focusing on challenges and surgical techniques associated with reconstructing the dysplastic hip.
Collapse
Affiliation(s)
- George A Macheras
- Fourth Department of Trauma & Orthopaedics, KAT Hospital, Athens, Greece
| | | | | | | |
Collapse
|