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Liu P, Qiao YJ, Lou JP, Cao G, Chang Y, Zhou SH. Cementless total hip arthroplasty for treatment of acetabular protrusion secondary to rheumatoid arthritis. J Orthop Surg Res 2023; 18:282. [PMID: 37024933 PMCID: PMC10080900 DOI: 10.1186/s13018-023-03764-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND To explore the surgical technique and clinical outcomes of cementless total hip arthroplasty (THA) combined with impacted bone grafting for the treatment of moderate and severe acetabular protrusion with rheumatoid arthritis (RA). METHODS From January 2010 to October 2020, 45 patients (56 hips), including 17 men (22 hips) and 28 women (34 hips) with acetabular impingement secondary to RA, were treated with bioprosthetic THA combined with autologous bone grafting at our hospital. According to the Sotello-Garza and Charnley classification criteria, there were 40 cases (49 hips) of type II (protrusio acetabuli 6-15 mm) and 5 cases (7 hips) of type III (protrusio acetabuli > 15 mm). At the postoperative follow-up, the ROM of the hip joint, the VAS score, and the Harris score were evaluated. The healing of the bone graft, the restoration of the hip rotation center, and the prosthesis loosening were assessed by plain anteroposterior radiographs. RESULTS The average operation time was 95.53 ± 22.45 min, and the mean blood loss was 156.16 ± 69.25 mL. There were no neurovascular complications during the operation. The mean follow-up duration was 5.20 ± 1.20 years. The horizontal distance of the hip rotation center increased from preoperative 10.40 ± 2.50 mm to postoperative 24.03 ± 1.77 mm, and the vertical distance increased from preoperative 72.36 ± 3.10 mm to postoperative 92.48 ± 5.31 mm. The range of flexion motion of the hip joint increased from 39.48 ± 8.36° preoperatively to 103.07 ± 7.64° postoperatively, and the range of abduction motion increased from 10.86 ± 4.34° preoperatively to 36.75 ± 3.99° postoperatively. At the last follow-up, the Harris score increased from 37.84 ± 4.74 to 89.55 ± 4.05. All patients were able to move independently without assistance. CONCLUSIONS Cementless THA combined with impacted grafting granule bone of the autogenous femoral head and biological acetabular cup can reconstruct the acetabulum, restore the rotation center of the hip joint, and achieve good medium-term outcomes in the treatment of moderate to severe acetabular herniation secondary to RA.
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Affiliation(s)
- Peng Liu
- Department of Joint Surgery, The 940Th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, South Binhe Road, No. 333, Lanzhou City, 730050, Gansu Province, People's Republic of China
| | - Yong-Jie Qiao
- Department of Joint Surgery, The 940Th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, South Binhe Road, No. 333, Lanzhou City, 730050, Gansu Province, People's Republic of China
| | - Jin-Peng Lou
- Department of Joint Surgery, The 940Th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, South Binhe Road, No. 333, Lanzhou City, 730050, Gansu Province, People's Republic of China
| | - Guoding Cao
- Department of Orthopaedics, Lanzhou University Second Hospital, Cuiying Gate, No. 82, Chengguan District, Lanzhou City, 730030, Gansu Province, People's Republic of China
| | - Yanfeng Chang
- Department of Joint Surgery, The 940Th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, South Binhe Road, No. 333, Lanzhou City, 730050, Gansu Province, People's Republic of China
| | - Sheng-Hu Zhou
- Department of Joint Surgery, The 940Th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, South Binhe Road, No. 333, Lanzhou City, 730050, Gansu Province, People's Republic of China.
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Tan Z, Shek HT, Dong Z, Feng L, Zhou Y, Yin S, Qiu A, Dong L, Gao B, Chen P, To MKT. Retrospective analyses of clinical features in 28 Chinese patients with type V osteogenesis imperfecta: new perspectives in an old issue. Osteoporos Int 2023; 34:369-377. [PMID: 36456709 PMCID: PMC9852172 DOI: 10.1007/s00198-022-06581-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/19/2022] [Indexed: 12/04/2022]
Abstract
UNLABELLED Type V osteogenesis imperfecta (OI) is a form of OI characterized by radial head dislocation (RHD), calcification of interosseous membrane (CIM), and hyperplastic callus (HPC). In this study, we characterized the clinical features of 28 type V OI patients. We presented that dysfunctions of elbow, hip joint, and abnormal epiphyseal growth plate were associated with ectopic calcification and summarized the history of HPC progression and treatment. INTRODUCTION The current study aims to systematically characterize the skeletal phenotypes of patients with type V OI and suggested possible surgical solutions. METHODS A total of 28 patients were admitted for inpatient care at The Hong Kong University-Shenzhen Hospital diagnosed with type V OI (either clinically diagnosed or genetically confirmed with the IFITM5 c.-14C > T mutation). RESULTS Prevalence of type V radiological features was comparable to previous literatures (RHD, 100%; CIM, 100%; HPC, 44%; and scoliosis, 50%). Novel skeletal phenotypes were presented including extension of coronoid process, acetabular labrum, acetabular protrusion, spontaneous autofusion of the hip, bulbous epiphysis, and popcorn calcification. Significant increase in BMD was observed in patients with bisphosphonate treatment. Twenty-five percent (3/12) of patients with preoperative use of indomethacin developed HPC postoperatively, and HPCs were absorbed in 2 young patients 2 years later. CONCLUSION This retrospective study summarized the clinical features and highlighted the abnormalities in elbow, hip joint, and growth plate in type V OI patients. Our study contributed to a more comprehensive clinical spectrum of type V OI. We also characterized the natural progression of HPC formation and resorption in patients in different ages. The use of bisphosphonate treatment is effective in improving bone mineral density in type V OI patients, and whether indomethacin can reduce incidence of HPC formation deserves further investigation.
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Affiliation(s)
- Zhijia Tan
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hiu Tung Shek
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zhongxin Dong
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Lin Feng
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Yapeng Zhou
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Shijie Yin
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Anmei Qiu
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Lina Dong
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Bo Gao
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Peikai Chen
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Michael Kai Tsun To
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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Abstract
Loeys-Dietz syndrome is an autosomal dominant aortic aneurysm syndrome characterized by multisystemic involvement. The most typical clinical triad includes hypertelorism, bifid uvula or cleft palate and aortic aneurysm with tortuosity. Natural history is significant for aortic dissection at smaller aortic diameter and arterial aneurysms throughout the arterial tree. The genetic cause is heterogeneous and includes mutations in genes encoding for components of the transforming growth factor beta (TGFβ) signalling pathway: TGFBR1, TGFBR2, SMAD2, SMAD3, TGFB2 and TGFB3. Despite the loss of function nature of these mutations, the patient-derived aortic tissues show evidence of increased (rather than decreased) TGFβ signalling. These insights offer new options for therapeutic interventions.
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Abstract
BACKGROUND The treatment of acetabular protrusions during total hip arthroplasty of patients with rheumatoid arthritis is difficult. A lack of bone stock, deficient medial cup support, and medialization of the joint center in those with protrusio acetabuli must be addressed during acetabular reconstruction. The purpose of this study was to assess the short-term clinical results of total hip arthroplasty in patients with severe acetabular protrusions secondary to rheumatoid arthritis. METHODS From January 2011 to November 2014, 18 patients (20 hips) with severe acetabular protrusions secondary to rheumatoid arthritis underwent total hip arthroplasties using a non-cement impaction and auto-bone-grafting method with resection of the femoral head to treat the acetabular protrusion. The Harris hip scoring system was used to evaluate hip function during follow-up; X-rays were taken to assess the extent of prosthesis loosening and bone graft healing. RESULTS The operation time ranged from 55 to 131 min, averaging 89.5 ± 8.1 min. The blood loss was 165-480 mL (295 ± 10.9 mL). No blood vessel or nerve damage and no acetabular or femoral fracture occurred. The follow-up duration was 4.5 ± 1.7 years. Postoperative X-rays revealed autologous bone graft/acetabular fusion at 4.5 months post-surgery. The Harris hip scores increased significantly, from 55.3 ± 9.5 to 92.2 ± 12.7, after the operation (P < 0.01). The distance from the center of the femoral head to Kohler's line increased from 19.87 ± 3.9 mm to 21.5 ± 3.5 mm after the operation (P < 0.01). During follow-up, no hip acetabular prosthesis loosening was evident. CONCLUSIONS For patients with protrusio acetabuli secondary to rheumatoid arthritis, the use of a cementless, trabecular, metal modular cup allowing peripheral press fitting and restoration of bone stock via impacted autologous bone grafting are both technically straightforward and appear to yield satisfactory short-term results.
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Affiliation(s)
- Ping Zhen
- Department of Orthopedics, The Second Affiliated Hospital of Lanzhou University, Lanzhou, 730030 Gansu People’s Republic of China
- Department of Orthopaedics, Lanzhou General Hospital of PLA, No. 333 South Binhe Road, Lanzhou, 730050 Gansu People’s Republic of China
| | - Xusheng Li
- Department of Orthopaedics, Lanzhou General Hospital of PLA, No. 333 South Binhe Road, Lanzhou, 730050 Gansu People’s Republic of China
| | - Shenghu Zhou
- Department of Orthopaedics, Lanzhou General Hospital of PLA, No. 333 South Binhe Road, Lanzhou, 730050 Gansu People’s Republic of China
| | - Hao Lu
- Department of Orthopaedics, Lanzhou General Hospital of PLA, No. 333 South Binhe Road, Lanzhou, 730050 Gansu People’s Republic of China
| | - Hui Chen
- Department of Orthopaedics, Lanzhou General Hospital of PLA, No. 333 South Binhe Road, Lanzhou, 730050 Gansu People’s Republic of China
| | - Jun Liu
- Department of Orthopaedics, Lanzhou General Hospital of PLA, No. 333 South Binhe Road, Lanzhou, 730050 Gansu People’s Republic of China
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Gouin F, Crenn V, Tabutin J; Société française de chirurgie de la hanche et du genou (SFHG). Subperitoneal approach in revision arthroplasty for acetabular component protrusion: Analysis of practices within the French Hip and Knee Society (SFHG). Orthop Traumatol Surg Res 2017; 103:27-31. [PMID: 27876582 DOI: 10.1016/j.otsr.2016.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 10/03/2016] [Accepted: 10/25/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The complications related to revision for acetabular component protrusion with material migrating into the intrapelvic region remain rare but potentially serious. Today, the literature reports no epidemiological data on the subperitoneal approach (SPA) in revision total hip arthroplasty (RTHA) for protrusion. Therefore we conducted a retrospective study on a large revision arthroplasty database to answer the following questions: (1) What is the frequency of this approach in this population? (2) What are the factors related to this procedure? (3) Is morbidity and mortality of the SPA higher than for an isolated conventional approach? HYPOTHESIS Major protrusions with material in the superomedial quadrant (SMQ) have a higher probability of being operated using a SPA. MATERIAL AND METHODS This multicenter retrospective study included 260 cases of THA with endopelvic protrusion of material at least 15mm inside the Kohler line. The degree of protrusion was assessed on the AP pelvic X-ray with the construction of the SMQ. The reason for the subperitoneal approach, the duration of surgery, and the preoperative exams were also collected. RESULTS Nineteen procedures out of the 260 RTHAs included (7.8%) had a SPA in addition to the approach for the revision THA. The frequency of the SPA varied among centers (range: 1.7-50%). In four cases, the SPA was indicted to care for a vascular complication identified preoperatively. For one patient, the SPA was indicated intraoperatively. The other indications were either to extract the implant (n=7) or prevent a potential intraoperative assault of neurovascular structures (n=9). The cases presenting major protrusion on the AP X-ray with material in the SMQ were more often operated through the SPA (12/19; 63.2%) than cases with no SMQ involvement (4/241; 1.7%) (P<0.001). Vascular structures were explored with imaging in 15 out of 19 (88.9%) of the SPA cases versus 26 out of 177 (14.7%) of the revisions without the SPA (41 with no information in the non-SPA group) (P<0.001). Early mortality (before 45 days) of patients who had undergone the SPA (1/19; 5.3%) was not significantly different than for the patients who had not undergone the SPA (3/241; 1.2%) (P=0.26). Although the duration of surgery was longer in the SPA group (210±88 [range: 70-360] versus 169±52 [range: 60-300]; P=0.04), bleeding was not greater in the SPA group (1488±1770mL [range: 500-5000mL]) than in the non-SPA group (1343±987mL [range: 75-3500mL]; p>0.05). DISCUSSION Despite the limitations related to the retrospective and multicenter design of this study, to our knowledge it is the only one that examines SPA procedures within the context of severe material protrusion with THA. Based on these results, it seems preferable to plan for SPA every time there is an acetabular protrusion in the SMQ, after exploration with CT angiography. The SPA does not result in greater mortality or morbidity. LEVEL OF EVIDENCE IV, retrospective study.
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Saglam Y, Ozturk I, Cakmak MF, Ozdemir M, Yazicioglu O. Total hip arthroplasty in patients with ankylosing spondylitis: Midterm radiologic and functional results. Acta Orthop Traumatol Turc 2016; 50:443-7. [PMID: 27492583 PMCID: PMC6197352 DOI: 10.1016/j.aott.2016.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 01/10/2016] [Accepted: 01/24/2016] [Indexed: 02/06/2023]
Abstract
Introduction The aim of this study was to evaluate the clinical and radiological outcomes of total hip arthroplasty (THA) in patients with Ankylosing Spondylitis (AS). Patients and methods One hundred five hips of 61 AS patients (mean age: 41.3 ± 10.2 years) who underwent THA between 1997 and 2012 were included into the study. Dorr's classification of proximal femoral geometry, acetabular protrusio, bone ankylosis, acetabular protrusion, Brooker classification of heterotopic ossification (HO), Gruen and Charnley classifications of implant loosening were used in radiographic assessments. Patients were called back to return for an additional long-term follow-up for functional assessment. Results Cementless total hip arthroplasty was used in 83 hips (79%) and cemented TKA was used in 22 hips (21%). The overall rate of aseptic loosening was 7.6% at a mean follow-up of 5.4 years. Femoral loosening was statistically similar in cemented and cementless femoral components (14% vs. 8%, p = 0.089). Acetabular component loosening was statistically higher in patients with any degree of HO (p = 0.04). Regardless of the type of femoral implant (cemented or cementless), femoral component loosening was higher in Dorr's type C patients (p = 0.005). The average pre-operative HSS was 46.6 ± 16.3, and it improved to 80.7 ± 18.7 at last follow-up (p < 0.01). Conclusion Revision incidence was similar in between ankylosed and non-ankylosed hips. While complication rates are high, significant functional improvement can be achieved after THA in patients with AS.
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Affiliation(s)
- Yavuz Saglam
- Biruni University Hospital, Orthopedics and Traumatology Department, Istanbul, Turkey.
| | - Irfan Ozturk
- Istanbul University, Istanbul Faculty of Medicine, Orthopedics and Traumatology Department, Istanbul, Turkey
| | - Mehmet Fevzi Cakmak
- Istanbul University, Istanbul Faculty of Medicine, Orthopedics and Traumatology Department, Istanbul, Turkey
| | - Mustafa Ozdemir
- Istanbul University, Istanbul Faculty of Medicine, Orthopedics and Traumatology Department, Istanbul, Turkey
| | - Onder Yazicioglu
- Istanbul University, Istanbul Faculty of Medicine, Orthopedics and Traumatology Department, Istanbul, Turkey
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Epinette JA, Mertl P, Combourieu B, Goncalves H, Blairon A, Ehlinger M, Tabutin J. Outcomes and prognostic factors in revision hip arthroplasty for severe intra-pelvic cup protrusion: 246 cases. Orthop Traumatol Surg Res 2015; 101:S257-63. [PMID: 26320392 DOI: 10.1016/j.otsr.2015.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/21/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The outcome of revision total hip arthroplasty (THA) for intra-pelvic cup protrusion is unclear. Hence, we conducted a large retrospective study to clarify the surgical strategy (hip lever arm and cup mechanical fixation) and the outcomes of reconstruction for severe intra-pelvic cup protrusion. HYPOTHESIS We hypothesized that restoration of the anatomic hip centre in such acetabular revisions decreased the risk of recurrent loosening. MATERIAL AND METHODS The study included 246 THA procedures (in 220 patients), with a follow-up of 5.2 ± 4.9 years (1-24.2) after the index surgery. Bone loss was estimated using the SOFCOT classification (grade III or IV in 80% of cases) and the Paprosky classification (IIIA or IIIB in 58% of cases). Quality of the reconstruction was assessed on X-rays according to the correction of the protrusion and position of the hip centre of rotation. RESULTS After a clinical follow-up of at least 5 years, with a mean of 9.9 ± 4.1 years (5-24 years), the mean Postel-Merle d'Aubigné score was 14.2 ± 3.1 and the mean Harris Hip Score was 78.0 ± 18.7. Cup protrusion was partially or completely corrected in every case and cup position was normal in 27 (11%) cases. The centre of rotation was within 10mm of the physiological position in 158 (64.2%) cases, acceptable in 77 (31.3%) cases, ascended in 9 (3.7%) cases, and worsened in 1 (0.4%) case. Revision for cup or cup and femoral failures was required in 24 (9.8%) cases. Cumulative survival rates with cup loosening as the endpoint were 88.5% after 5 years, 79.9% after 10 years, and 63.9% at last follow-up at 13.6 years. DISCUSSION Our hypothesis that restoration of anatomic hip centre decreased the risk of recurrent loosening was not verified: success or failure in restoring the normal centre of rotation did not correlate significantly with final cup status. Recurrent aseptic loosening was the cause of failure in 9.8% of cases. Ensuring long-term effective mechanical stability had a greater impact on global outcomes than restoring an ideal centre of rotation.
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Affiliation(s)
- J-A Epinette
- Clinique Médico-Chirugicale, 200, rue d'Auvergne, 62700 Bruay-Labuissière, France.
| | - P Mertl
- Service de Chirurgie Orthopédique et Traumatologique, CHU d'Amiens, Hôpital Nord, 1, place Victor-Pauchet, 80054 Amiens, France
| | - B Combourieu
- Hôpital Raymond-Poincaré, Département universitaire de Chirurgie Orthopédique et de Traumatologie, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - H Goncalves
- Hôpital Raymond-Poincaré, Département universitaire de Chirurgie Orthopédique et de Traumatologie, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - A Blairon
- Département universitaire de Chirurgie Orthopédique et de Traumatologie, Université Lille Nord de France, Hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille, France
| | - M Ehlinger
- Service de chirurgie orthopédique et de traumatologie, Hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - J Tabutin
- Service de Chirurgie Orthopédique et de Traumatologie, Centre Hospitalier de Cannes, 15, avenue des Broussailles, 06401 Cannes, France
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