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1
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Meta-analysis of the Efficacy of the Anatomical Center and High Hip Center Techniques in the Treatment of Adult Developmental Dysplasia of the Hip. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7256664. [PMID: 36082152 PMCID: PMC9448599 DOI: 10.1155/2022/7256664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022]
Abstract
Background. In total hip arthroplasty for the treatment of adult developmental dysplasia of the hip, there is considerable controversy regarding the placement of the acetabular cup, anatomic center, and upward in acetabular reconstruction. This article explores the efficacy of the anatomical center technique and high hip center technique in the treatment of adult developmental dysplasia of the hip. Method. By searching for articles in the Cochrane Library, PubMed, CNKI, and Wanfang databases, we collected the literature on the treatment of adult developmental dysplasia of the hip by anatomical center and high hip center technology and screened the literature according to the inclusion and exclusion criteria. The Cochrane risk of bias assessment tool was used to assess the risk of bias of randomized controlled trials, the quality of the literature in retrospective cohort studies was assessed using the Newcastle–Ottawa scale, and the RevMan 5.4 software was used to analyze the extracted outcome indicators. Results. Nine studies were finally included, including one prospective cohort study, eight retrospective cohort studies, two high-quality studies, and six moderate-quality studies. The meta-analysis results showed that the reconstruction of the acetabulum in two positions was significantly different in terms of operation time (
, 95% CI: -45.25-28.74,
), intraoperative blood loss (
, 95% CI: -108.57-75.19,
), postoperative drainage volume (
, 95% CI: -140.56-301.66,
), time to ground (
, 95% CI: -1.37-0.0,
), Harris score (
, 95% CI: -0.91-0.82,
), lower limb length difference (
, 95% CI: -0.22-0.64,
), WOMAC score (
, 95% CI: -4.89-2.41,
), postoperative complications (
, 95% CI: -0.06-0.02,
), Trendelenburg sign (
, 95% CI: -0.02-0.05,
), limb lengthening (
, 95% CI: 0.61-1.09,
), prosthesis wear (
, 95% CI: 0-0.02,
), and prosthesis loosening (
, 95% CI: -0.02-0.04,
). Conclusions. The high hip center technique can reduce operative time, intraoperative blood loss, and downtime. The anatomical center technique is superior to the high hip center technique in terms of limb lengthening. Compared with acetabular anatomical reconstruction, there was no significant difference in postoperative drainage, lower limb length difference, postoperative complications, Trendelenburg sign, and prosthesis survival or wear. For DDH patients who are not severely shortened in the lower limbs and have severe acetabular bone defects, joint surgeons can choose to reconstruct the acetabulum in the upper part to simplify the operation, reduce the trauma of the patient, and accelerate the recovery of the patient, and they can choose to adjust the length of the neck and the angle of the neck shaft to maintain the moment arm of the abductor muscle. A ceramic interface or a highly cross-linked polyethylene interface minimizes the effect of hip response forces. To further evaluate the efficacy of the anatomical center technique and the high hip center technique in the treatment of adult developmental dysplasia of the hip, more large-sample, high-quality, long-term follow-up randomized controlled trials are still needed for verification.
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Sukur E, Senel A, Ozdemir U, Akman YE, Azboy İ, Ozturkmen Y. Cementless modular total hip arthroplasty with subtrochanteric transverse shortening osteotomy for high hip dislocations. J Orthop Surg Res 2022; 17:139. [PMID: 35246184 PMCID: PMC8896094 DOI: 10.1186/s13018-022-03025-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Performing a total hip arthroplasty for a high hip dislocation is technically demanding and presents several challenges, with appropriate evaluation of the bone morphology of the hip and proper implant selection being critical for successful outcomes. Objective The purpose of our study was to evaluate the clinical and radiographic outcomes of cementless modular total hip arthroplasty for the treatment of high hip dislocations with sub-trochanteric transverse shortening osteotomy. Methods Sixty-eight hips with a high hip dislocation, were treated using a sub-trochanteric transverse shortening osteotomy and cementless modular total hip arthroplasty, retrospectively reviewed. Hip function was assessed using the Harris hip score, with hip abduction strength evaluated using the Trendelenburg test. Radiographic assessment included the measurement of leg length discrepancy, identification of implant loosening, localization of the hip center, and union at the osteotomy site. Results The mean follow-up period was 12.9 (range 5.2–16.8) years. The mean Harris hip score improved from a pre-operative score of 48.6 ± 3.6 to 82.4 ± 4.2 (p < 0.05). The hip was within the true acetabulum in all patients, postoperatively. Osteotomy union was achieved in 67 of the 68 hips (98.5%) in a mean latency of 12.5 ± 0.6 weeks. The mean length of femoral shortening was 66.5 ± 4.5 mm, with a mean pull-down length of the proximal part of 35.5 ± 3.5 mm. Conclusion For the treatment of high hip dislocations with satisfactory clinical outcomes, the modular stem offers an adjustable anteversion angle to restore sufficient rotational stability and the transverse osteotomy provides sufficient compression pressure across the osteotomy site to facilitate union. Trial registration It was a retrospective study and approved by Istanbul Research and Training Hospital institutional Ethics Review Board (772-05/02/2016).
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Affiliation(s)
- Erhan Sukur
- Departments of Orthopaedics and Traumotology, Sakarya University Training and Research Hospital, 54050, Sakarya, Turkey.
| | - Ahmet Senel
- Departments of Orthopaedics and Traumotology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ugur Ozdemir
- Departments of Orthopaedics and Traumotology, Sakarya University Training and Research Hospital, 54050, Sakarya, Turkey
| | - Yunus Emre Akman
- Departments of Orthopaedics and Traumotology, Ortopedkliniken Mälarsjukhuset, Eskilstuna, Sweden
| | - İbrahim Azboy
- Departments of Orthopaedics and Traumotology, Medipol University Hospital, Istanbul, Turkey
| | - Yusuf Ozturkmen
- Departments of Orthopaedics and Traumotology, Istanbul Training and Research Hospital, Istanbul, Turkey
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3
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Peng YW, Shen JM, Zhang YC, Sun JY, Du YQ, Zhou YG. Jumbo cup in hip joint renovation may cause the center of rotation to increase. World J Clin Cases 2021; 9:6300-6307. [PMID: 34434996 PMCID: PMC8362550 DOI: 10.12998/wjcc.v9.i22.6300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Utilizing the large jumbo cup in revision total hip arthroplasty is an effective approach to cure many lacunar and segmental peripheral bone defects. However, with the use of the jumbo cup, the center of the hip joint may become elevated relative to the primary acetabulum, and the diameter of the large cup is greater.
AIM To study the height and the significance of the elevation of the hip joint center.
METHODS Eighty-eight patients matched the criteria for this condition and were included in the study. The center height of the hip joint was measured relative to the opposite normal hip joint. The diameter of the jumbo cup was measured and checked according to operation notes, and the diameter of the jumbo cup was measured with a prosthesis label. Then, the horizontal and vertical centers of rotation were measured on the surgical side and opposite side. The average center height of the hip joint on the renovated side and the opposite side and the position of the hip cup relative to the teardrop were compared using a paired t-test.
RESULTS Radiometric analysis showed that the average hip joint center was elevated by 7.6 mm. The rotational center height delta of the renovated hip was 7.6 ± 5.6 mm, and there was an obvious difference between the two groups (P = 0.00). The difference in horizontal distance was 0.5 ± 5.1 mm (-11.5 -14.0 mm), and there was no obvious difference between the two groups (P = 0.38). According to the foreign standard, the rotational center height delta of the renovated hip was 7.5 ± 6.2 mm, and there was a significant difference between the two groups (P = 0.00). There was no obvious difference between the domestic and foreign standards (P > 0.05) between the two groups.
CONCLUSION The application of the jumbo cup elevates the rotational center of the hip joint, but it is feasible and effective to use the jumbo cup.
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Affiliation(s)
- Ya-Wen Peng
- Department of Orthopedics, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Jun-Min Shen
- Department of Orthopedics, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Yan-Chao Zhang
- Department of Orthopedics, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Jing-Yang Sun
- Department of Orthopedics, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Yin-Qiao Du
- Department of Orthopedics, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Yong-Gang Zhou
- Department of Orthopedics, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
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Sonohata M, Nakashima T, Kitajima M, Kawano S, Eto S, Mawatari M. Total hip arthroplasty using hydroxyapatite-coated cementless cup for rapidly destructive coxarthrosis: Minimum 10-year follow-up. J Orthop Sci 2021; 26:225-229. [PMID: 32273140 DOI: 10.1016/j.jos.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 03/07/2020] [Accepted: 03/12/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND Performing total hip arthroplasty (THA) as early as possible is recommended for rapidly destructive coxarthrosis (RDC) as it causes pain that becomes progressively more severe. However, acetabular bone loss remains an issue in THA. Special devices, such as a Kerboull-type plate, may be used for acetabular bone defects, but the procedure is highly invasive and often the patients are elderly, further complicating matters. We retrospectively investigated the clinical and radiographic results of THA using conventional hydroxyapatite-coated cementless cup in RDC. METHODS A total of 32 patients (35 hips) with RDC were enrolled in the study with a minimum 10-year follow-up. All THAs were performed using conventional hydroxyapatite-coated cementless cup. All patients were evaluated clinically according to the Harris hip score (HHS). Acetabular bone deficiency was classified according to the American Academy of Orthopaedic Surgeons (AAOS) classification. RESULTS Eleven hips (31%) were AAOS type III, and none were type IV. Total HHS significantly improved from 36.5 to 79.4 (p < 0.01). Two cups exhibited loosening. The overall implant-associated survival rate after 10 years was 91.4%. CONCLUSIONS Clinical results of THA using conventional cementless implants for patients with RDC were acceptable. Thus, THA using conventional cementless implant is an effective and safe surgery for patients with RDC, minimizing surgical stress.
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Affiliation(s)
- Motoki Sonohata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan.
| | - Takema Nakashima
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Masaru Kitajima
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Shunsuke Kawano
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Shuichi Eto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
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Grottoli CF, Cingolani A, Zambon F, Ferracini R, Villa T, Perale G. Simulated Performance of a Xenohybrid Bone Graft (SmartBone ®) in the Treatment of Acetabular Prosthetic Reconstruction. J Funct Biomater 2019; 10:E53. [PMID: 31766685 PMCID: PMC6963854 DOI: 10.3390/jfb10040053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/15/2019] [Accepted: 11/20/2019] [Indexed: 02/06/2023] Open
Abstract
Total hip arthroplasty (THA) is a surgical procedure for the replacement of hip joints with artificial prostheses. Several approaches are currently employed in the treatment of this kind of defect. Overall, the most common method involves using a quite invasive metallic support (a Burch-Schneider ring). Moreover, valid alternatives and less invasive techniques still need to be supported by novel material development. In this work, we evaluated the performance of SmartBone®, a xenohybrid bone graft composed of a bovine bone matrix reinforced with biodegradable polymers and collagen, as an effective support in acetabular prosthesis reconstruction. Specifically, the material's mechanical properties were experimentally determined (E = ~1.25 GPa, Ef = ~0.34 GPa, and Et = ~0.49 GPa) and used for simulation of the hip joint system with a SmartBone® insert. Moreover, a comparison with a similar case treated with a Burch-Schneider ring was also conducted. It was found that it is possible to perform THA revision surgeries without the insertion of an invasive metal support and it can be nicely combined with SmartBone®'s osteointegration characteristics. The material can withstand the loads independently (σmax = ~12 MPa) or be supported by a thinner titanium plate in contact with the bone in the worst cases. This way, improved bone regeneration can be achieved.
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Affiliation(s)
| | - Alberto Cingolani
- Industrie Biomediche Insubri SA, 6805 Mezzovico-Vira, Switzerland; (C.F.G.); (A.C.)
| | - Fabio Zambon
- Politecnico di Milano, Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “G. Natta”, 20133 Milan, Italy; (F.Z.); (T.V.)
| | - Riccardo Ferracini
- Department of Surgical Sciences and Integrated Diagnostics, University of Genova, Largo R. Benzi 10, 16132 Genova, Italy;
- IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132 Genova, Italy
| | - Tomaso Villa
- Politecnico di Milano, Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “G. Natta”, 20133 Milan, Italy; (F.Z.); (T.V.)
| | - Giuseppe Perale
- Industrie Biomediche Insubri SA, 6805 Mezzovico-Vira, Switzerland; (C.F.G.); (A.C.)
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, 1200 Vienna, Austria
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Chang CH, Hu CC, Chen CC, Mahajan J, Chang Y, Shih HN, Kwon YM. Revision Total Hip Arthroplasty for Paprosky Type III Acetabular Defect With Structural Allograft and Tantalum Trabecular Metal Acetabular Cup. Orthopedics 2018; 41:e861-e867. [PMID: 30371922 DOI: 10.3928/01477447-20181023-02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/28/2018] [Indexed: 02/03/2023]
Abstract
There are several surgical options for addressing Paprosky type III acetabular defects during revision total hip arthroplasty. In physiologically young and active patients, using structural bone graft to restore bone defects and provide adequate initial support for the revision acetabular component is one such option. This study reports the mid-term results of using a structural allograft accompanied by a trabecular metal-coated hemispherical cup for Paprosky type III defects. A retrospective analysis was performed of the data collected for 20 consecutive hips in 20 patients (mean age, 56.2 years; range, 43-68 years) with minimum 3-year follow-up (mean, 5.4 years; range, 3.3-10.3 years) who had a structural allograft accompanied by a trabecular metal-coated hemispherical cup for Paprosky type III defects. Only 1 hip had cup migration, which was less than 3 mm in vertical and less than 5° in inclination and recognized as loosening without symptoms. All grafts showed good incorporation with trabecular bridging over the graft and host bone. The mean modified Harris hip score showed significant improvement, from 29.7 (range, 11-52) preoperatively to 84.1 (range, 77-91) at the latest follow-up (P<.05). The use of a structural allograft combined with a tantalum trabecular metal acetabular cup in acetabular revision for Paprosky type III defects had a satisfactory mid-term clinical result. This is a viable option for patients with large acetabular shelf defects. [Orthopedics. 2018; 41(6):e861-e867.].
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7
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Eachempati KK, Malhotra R, Pichai S, Reddy AVG, Podhili Subramani AK, Gautam D, Bollavaram VR, Sheth NP. Results of trabecular metal augments in Paprosky IIIA and IIIB defects. Bone Joint J 2018; 100-B:903-908. [DOI: 10.1302/0301-620x.100b7.bjj-2017-1604.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The advent of trabecular metal (TM) augments has revolutionized the management of severe bone defects during acetabular reconstruction. The purpose of this study was to evaluate patients undergoing revision total hip arthroplasty (THA) with the use of TM augments for reconstruction of Paprosky IIIA and IIIB defects. Patients and Methods A retrospective study was conducted at four centres between August 2008 and January 2015. Patients treated with TM augments and TM shell for a Paprosky grade IIIA or IIIB defect, in the absence of pelvic discontinuity, and who underwent revision hip arthroplasty with the use of TM augments were included in the study. A total of 41 patients with minimum follow-up of two years were included and evaluated using intention-to-treat analysis. Results There were 36 (87.8%) patients with a Paprosky IIIA defect and five (12.2%) patients with a Paprosky IIIB defect. The mean age was 56.7 years (28 to 94). There were 21 (51.2%) women and 20 (48.8%) men. The mean follow-up was 39.4 months (12 to 96). One (2%) patient died after eight years. No failures were noted in the series. The mean survivorship was 100% at the time of latest follow-up. Conclusion The results of this multicentre study showed encouraging short- and mid-term results for the use of TM augments in the management of Paprosky grade IIIA and IIIB defects. Cite this article: Bone Joint J 2018;100-B:903–8.
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Affiliation(s)
- K. K. Eachempati
- Department of Orthopaedics, Max Cure Hospitals, Hyderabad, India
| | - R. Malhotra
- Department of Orthopaedics, All India
Institute of Medical Sciences, New Delhi, India
| | - S. Pichai
- Asian Joint Reconstruction Institute, Chennai, India
| | | | | | - D. Gautam
- Department of Orthopaedics, All India
Institute of Medical Sciences, New Delhi, India
| | - V. R. Bollavaram
- Department of Orthopaedics, Max Cure Hospitals, Hyderabad, India
| | - N. P. Sheth
- Department of Orthopaedic Surgery, University
of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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8
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Bombaci H, Simsek B, Soyarslan M, Murat Yildirim M. Determination of the hip rotation centre from landmarks in pelvic radiograph. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:470-473. [PMID: 29029869 PMCID: PMC6197315 DOI: 10.1016/j.aott.2017.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/08/2017] [Accepted: 09/19/2017] [Indexed: 11/02/2022]
Abstract
OBJECTIVE The hip rotation centre (HRC) is an important reference point in cases of total hip arthroplasty (THA). The aim of this study is to investigate the reference points in the Turkish population that enable the identification of the HRC in standard pelvic radiographs. METHODS The pelvic radiographs of 50 women and 50 men were examined. The mean age was 46.2 (range; 18-91). Patients with deformity of the hip joint and non-standard pelvic radiograph due to hip flexion contracture were excluded from the study. The pelvic height (PH), the distance between the HRC and teardrop (HRC-Td), and the HRC and the line tangent tuber ischiadicums (HRC-TI) were measured. The ratio of HRC-Td and HRC-TI to PH were calculated. The first is called "the horizontal-HRC ratio" and the second, "the vertical-HRC ratio". RESULTS Mean PH was 239 (±13.58) mm in males and 225 (±12.52) in females (p < 0.0001). The distances of HRC-TI were 71 (±6.35) and 65 (±6.72) mm (p < 0.0001) and the distance of HRC-Td were 34 (±3.73) and 30 (±4.05) mm (p = 0.0007), respectively. The vertical-HRC ratios were 30.01% (±2.05) for males, 29.10% (±2.35) for females, the horizontal-HRC ratio, 14.25% (±1.42) and 13.69% (±1.38), respectively (p > 0.05). CONCLUSION Although the quantitative values obtained in the present study differ between the genders, the ratios ("vertical-HRC" and "horizontal-HRC") are comparable in both sexes. The results show that these proposed ratios can be used in THA planning, regardless of gender in the Turkish population LEVEL OF EVIDENCE: Level IV, diagnostic study.
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9
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Shoji T, Yamasaki T, Izumi S, Murakami H, Mifuji K, Sawa M, Yasunaga Y, Adachi N, Ochi M. Factors affecting the potential for posterior bony impingement after total hip arthroplasty. Bone Joint J 2017; 99-B:1140-1146. [DOI: 10.1302/0301-620x.99b9.bjj-2016-1078.r2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 05/09/2017] [Indexed: 11/05/2022]
Abstract
Aims Our aim was to evaluate the radiographic characteristics of patients undergoing total hip arthroplasty (THA) for the potential of posterior bony impingement using CT simulations. Patients and Methods Virtual CT data from 112 patients who underwent THA were analysed. There were 40 men and 72 women. Their mean age was 59.1 years (41 to 76). Associations between radiographic characteristics and posterior bony impingement and the range of external rotation of the hip were evaluated. In addition, we investigated the effects of pelvic tilt and the neck/shaft angle and femoral offset on posterior bony impingement. Results The range of external rotation and the ischiofemoral length were significantly lower, while femoral anteversion, the ischial ratio, and ischial angle were significantly higher in patients with posterior bony impingement compared with those who had implant impingement (p < 0.05). The range of external rotation positively correlated with ischiofemoral length (r = 0.49, p < 0.05), and negatively correlated with ischial length (r = -0.49, p < 0.05), ischial ratio (r =- 0.49, p < 0.05) and ischial angle (r = -0.55, p < 0.05). The range of external rotation was lower in patients with posterior pelvic tilt (p < 0.05) and in those with a high offset femoral component (p < 0.05) due to posterior bony impingement. Conclusion Posterior bony impingement after THA is more likely in patients with a wider ischium and a narrow ischiofemoral space. A high femoral offset and posterior pelvic tilt are also risk factors for this type of impingement. Cite this article: Bone Joint J 2017;99-B:1140–6.
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Affiliation(s)
- T. Shoji
- Graduate School of Biomedical Sciences,
Hiroshima University,
1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - T. Yamasaki
- Graduate School of Biomedical Sciences,
Hiroshima University,
1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - S. Izumi
- Graduate School of Biomedical Sciences,
Hiroshima University,
1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - H. Murakami
- Graduate School of Biomedical Sciences,
Hiroshima University,
1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - K. Mifuji
- Graduate School of Biomedical Sciences,
Hiroshima University,
1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - M. Sawa
- Graduate School of Biomedical Sciences,
Hiroshima University,
1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - Y. Yasunaga
- Hiroshima Prefectural Rehabilitation Center, 295-3
Taguchi, Saijo-town, Higashi-hiroshima, 739-0036, Japan
| | - N. Adachi
- Graduate School of Biomedical Sciences,
Hiroshima University,
1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - M. Ochi
- Graduate School of Biomedical Sciences,
Hiroshima University,
1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
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10
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Uchiyama K, Inoue G, Takahira N, Takaso M. Revision total hip arthroplasty - Salvage procedures using bone allografts in Japan. J Orthop Sci 2017; 22:593-600. [PMID: 28595799 DOI: 10.1016/j.jos.2017.01.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/06/2017] [Accepted: 01/17/2017] [Indexed: 11/15/2022]
Abstract
Total hip arthroplasty (THA) and hemiarthroplasty have improved hip joint function of patients suffering from hip disease or trauma with excellent clinical results and long-term survivorship. Conversely, there has been an increase in the number of revision surgeries after THA and hemiarthroplasty due to bone deficiency. The reconstruction of deficient bone remains a challenging problem following THA. While performing revision surgery, we have previously classified the preoperative bone deficiency using X-ray, CT and three-dimensional CT imaging according to location and severity of the deficiencies. We then predicted the shape and amount of the required bone allograft and the type of implant. Due to the accepted reconstruction methods of bone deficiency following revision surgeries, it is important to pre-operatively assess the site and size of the bone deficiency to be repaired in the revision THA (re-THA). Bone allograft makes it possible to repair massive bone deficiency, recover bone stock, and improve long-term implant stability. Performing bone allograft will require a bone bank for harvesting, treating, and storing bone in Japan.
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Affiliation(s)
- Katsufumi Uchiyama
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan.
| | - Gen Inoue
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan.
| | - Naonobu Takahira
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan.
| | - Masashi Takaso
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan.
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11
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Total hip arthroplasty without femoral osteotomy in patients who had high and low dislocation due to developmental dysplasia of the hip. Hip Int 2017; 26:193-8. [PMID: 26916655 DOI: 10.5301/hipint.5000330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Various surgical techniques and outcome results have been reported after primary total hip arthroplasty for the treatment of patients dysplastic hips. Low failure and complication rates have been reported when the acetabular component has been placed in the true acetabulum. The current study reports the results of primary total hip arthroplasty in patients with high and low dislocation for whom the acetabular component was placed in the true acetabulum without femoral or trochanteric osteotomy. METHODS 26 primary total hip replacements were performed on 22 patients. The mean duration of follow-up was 8.9 years.There were 4 men and 18 women. 17 hips were classified as type B (low dislocation) and 9 as type C (high dislocation), according to the classification system of Hartofilakidis et al. Acetabular components were placed in the true acetabulum without osteotomy for all patients. RESULTS At the time of final follow-up (mean 8.9 years) the average Harris Hip Score was 85 points. Femoral head autograft was used in 9 hips to supplement acetabular coverage. In 8 patient linear calcar fracture. 7 fixed with Dall-Mile cable and 1 fixed with a side plate. On radiologic evaluation, 2 incidents of asymptomatic osteolysis, 1 of acetabular loosening, 1 graft resorption, and 1 impingement (correlated with physical examination) were identified. 2 patients had neuropraxia and were treated medically. There were no early or late infections. Only 1 patient with acetabular loosening required revision surgery. CONCLUSIONS Although it is surgically difficult to place the acetabular component in the true acetabulum without femoral or trochanteric osteotomy, at the final follow-up we report favourable results. Long-term follow-up is needed to verify our results.
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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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Yıldız F, Kılıçoğlu ÖI, Dikmen G, Bozdağ E, Sünbüloğlu E, Tuna M. Biomechanical comparison of oblique and step-cut osteotomies used in total hip arthroplasty with femoral shortening. J Orthop Sci 2016; 21:640-6. [PMID: 27292115 DOI: 10.1016/j.jos.2016.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 03/26/2016] [Accepted: 04/24/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Various types of shortening osteotomies and prosthesis are used for femoral reconstruction in total hip arthroplasty of the high hip dislocation. This biomechanical study investigates whether step-cut osteotomies result in better stability than oblique osteotomies and cylindrical femoral stems enhance stability of the osteotomy more than conical stems, and which osteotomy and prosthesis type maintain the stability better after cyclical loading. METHODS Oblique and step-cut shortening osteotomies were compared under axial and rotational forces, using synthetic femur models and conical or cylindrical femoral prostheses. The models underwent cyclic loading for 10,000 cycles at 3 Hz (100-1000 N axial bending or 0.5-10 Nm torque). After the completion of cyclic loading, the models were loaded until failure. Stiffness values before and after cyclical loading, and failure loads were the outcome parameters. Relative displacements at the osteotomy sites were also measured using 3-Dimensions Digital Imaging Correlation System. RESULTS The mean failure load was significantly higher in conical prosthesis groups under axial forces. In torsion tests, the mean stiffness of conical prosthesis groups after cyclical loading was higher in oblique osteotomies. The other parameters were similar between the groups. CONCLUSIONS According to the results of the study, although some individual statistically significant parameters were obtained, step-cut osteotomies, which are technically challenging procedures, were not found biomechanically superior to oblique osteotomies, with neither conical nor cylindrical prostheses.
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Affiliation(s)
- Fatih Yıldız
- Department of Orthopedics and Traumatology, Bezmialem Vakıf University School of Medicine, Istanbul, Turkey.
| | - Önder I Kılıçoğlu
- Department of Orthopedics and Traumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Göksel Dikmen
- Department of Orthopedics and Traumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Ergun Bozdağ
- Department of Biomechanics, Istanbul Technical University, Istanbul, Turkey
| | - Emin Sünbüloğlu
- Department of Biomechanics, Istanbul Technical University, Istanbul, Turkey
| | - Meral Tuna
- Department of Biomechanics, Istanbul Technical University, Istanbul, Turkey
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Tuncay I, Yıldız F, Bilsel K, Uzer G, Elmadağ M, Erden T, Bozdağ E. Biomechanical Comparison of 2 Different Femoral Stems in the Shortening Osteotomy of the High-Riding Hip. J Arthroplasty 2016; 31:1346-1351. [PMID: 26795256 DOI: 10.1016/j.arth.2015.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We hypothesized that a rectangular cross-sectional femoral stem may produce more initial stability of the transverse subtrochanteric femoral shortening osteotomy rather than a circular cross-sectional stem. METHODS Twenty, fourth-generation, synthetic femur models were inserted with either circular or rectangular cross-sectional femoral stems after 3 cm of transverse subtrochanteric shortening. Half of the models were tested with axial bending and the other half with torsional loads. After the femora underwent cyclic loading, they were loaded until failure. Outcome parameters were stiffness values before and after cyclical loading, failure loads/torques, and displacements at the osteotomy sites. RESULTS In axial bending tests, the results were not significantly different between the groups. Under rotational forces, the mean stiffness value before cyclical loading and failure torque of the cylindrical stems was significantly higher than that of rectangular cross-sectional stems (11.8 ± 1.2 vs 7.1 ± 2.8 Nm/degree; P = .009 and 136.9 ± 60.2 vs 27.1 ± 17.5 Nm; P = .027 Nm, respectively). The mean amounts of displacements at the osteotomy sites were not significantly different between the groups in any direction in both axial and rotational tests. CONCLUSIONS According to the results of the study, using straight, cylindrical femoral stems can increase rotational stability of the transverse osteotomy more than the rectangular cross-sectional stems although the latter one has the advantages of rectangular geometrical design.
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Affiliation(s)
- Ibrahim Tuncay
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Fatih Yıldız
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Gökçer Uzer
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Elmadağ
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Tunay Erden
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ergun Bozdağ
- Department of Biomechanics, Faculty of Mechanical Engineering, İstanbul Technical University, İstanbul, Turkey
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Fernandez-Valencia JÁ, Gallart X, Tomás X, Piñeros D, García S, Riba J. Radiography versus multidetector computed tomography in assessing graft integration after acetabular reconstruction. J Orthop Surg (Hong Kong) 2015; 23:370-4. [PMID: 26715721 DOI: 10.1177/230949901502300324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To compare radiography with multidetector computed tomography (MDCT) in the evaluation of graft integration following acetabular reconstruction for failed total hip arthroplasty (THA). METHODS Records of 5 men and 6 women aged 60 to 78 (mean, 71.8) years who underwent acetabular reconstruction using structural allografts for severe acetabular deficiency secondary to aseptic loosening (n=9) or septic loosening (n=2) were reviewed. The mean survival time of the THA was 136.4 (range, 12-360) months. Acetabular defects were classified as IIC (n=2), IIIA (n=3), or IIIB (n=6). Structural allografts were fixed with impaction followed by a reinforcement ring (n=10), an antiprotrusio cage (n=2), and/or an oblong cup (n=1) with gentamicineloaded cement. Cup loosening, graft integration, and graft resorption were evaluated using radiography. In addition, graft integration was evaluated using MDCT. RESULTS At a mean follow-up of 4.2 (range, 2-11) years, the survival of the acetabular reconstruction was 90.9%. No patient had any signs of infection. One patient underwent reoperation 22 months later for dislocation secondary to abductor deficiency caused by nonunion of the trochanteric fracture. According to radiography, all patients had graft integration. One patient had definitive and another had possible cup loosening. Four patients had minor graft resorption. According to MDCT, graft integration was complete in only one patient, partial >50% in 3, partial <50% in 4, and absent in 2. CONCLUSION MDCT is more accurate than radiography in evaluating graft integration following acetabular reconstruction.
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Xu J, Li D, Ma RF, Barden B, Ding Y. Application of Rapid Prototyping Pelvic Model for Patients with DDH to Facilitate Arthroplasty Planning: A Pilot Study. J Arthroplasty 2015; 30:1963-70. [PMID: 26129852 DOI: 10.1016/j.arth.2015.05.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/13/2015] [Accepted: 05/15/2015] [Indexed: 02/01/2023] Open
Abstract
Total hip arthroplasty (THA) is challenging in cases of osteoarthritis secondary to developmental dysplasia of the hip (DDH). Acetabular deficiency makes the positioning of the acetabular component difficult. Computer tomography based, patient-individual three dimensional (3-D) rapid prototype technology (RPT)-models were used to plan the placement of acetabular cup so that a surgeon was able to identify pelvic structures, assess the ideal extent of reaming and determine the size of cup after a reconstructive procedure. Intraclass correlation coefficients (ICCs) were used to analyze the agreement between the sizes of chosen components on the basis of preoperative planning and the actual sizes used in the operation. The use of the 3-D RPT-model facilitates the surgical procedures due to better planning and improved orientation.
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Affiliation(s)
- Jie Xu
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Deng Li
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruo-fan Ma
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bertram Barden
- Department of Orthopaedic Surgery, Düren Hospital, Academic Hospital of University of RWTH Aachen, Düren, Germany
| | - Yue Ding
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Radiographic Determination of Hip Rotation Center and Femoral Offset in Japanese Adults: A Preliminary Investigation toward the Preoperative Implications in Total Hip Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2015; 2015:610763. [PMID: 26576428 PMCID: PMC4631857 DOI: 10.1155/2015/610763] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/29/2015] [Accepted: 10/07/2015] [Indexed: 12/02/2022]
Abstract
The values of hip rotation center (HRC) and femoral offset (FO) evaluated according to Caucasian anatomical landmarks have been regarded as a useful reference also for Japanese patients in total hip arthroplasty (THA). In a strict sense, however, since there can be racial differences among their anatomical morphologies, it is clinically important to reconsider those parameters for the Japanese. In the present study, in order to investigate correlations among hip and pelvic morphometric parameters, frontal radiographs were taken from 98 Japanese adults (60 males and 38 females) without acetabular dysplasia and arthropathy in the standing position. Their mean age was 62.0 ± 16.7 years. The horizontal position of HRC was significantly correlated with the pelvic width in both genders (P = 0.0026 and 0.0010 for the males and the females, resp.). The vertical position of HRC was significantly correlated with the teardrop-sacroiliac distance in the males (P = 0.0003) and with the pelvic cavity height in the females (P = 0.0067). However, in both genders, there were no correlations among FO and the other parameters analyzed in this study. Our present findings might contribute to theoretical implications of an appropriate HRC position for Japanese OA patients in THA.
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Kaku N, Tabata T, Tsumura H. Influence of cup-center-edge angle on micro-motion at the interface between the cup and host bone in cementless total hip arthroplasty: three-dimensional finite element analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:1271-7. [DOI: 10.1007/s00590-015-1697-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/21/2015] [Indexed: 11/24/2022]
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Does rotational acetabular osteotomy affect subsequent total hip arthroplasty? Arch Orthop Trauma Surg 2015; 135:407-15. [PMID: 25577240 DOI: 10.1007/s00402-015-2154-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Rotational acetabular osteotomy (RAO) has been used successfully in patients with developmental dysplasia of the hip (DDH). However, some patients are forced to undergo total hip arthroplasty (THA) because of the progression of osteoarthritis. We evaluated the effect of previous RAO on the outcome of THA performed for degenerative arthritis secondary to DDH, comparing outcomes for patients with THA and prior RAO versus outcomes for patients with THA and no prior RAO. MATERIALS AND METHODS At an average follow-up point of 8.2 years (range 7-11 years), we compared outcomes in dysplastic hips for 22 hips (group R) in patients who underwent THA after successful RAO with outcomes for a well-matched control group of 30 hips in patients who underwent primary THA (group C) during the same period. RESULTS Both groups had similar midterm results. No acetabular or femoral components exhibited loosening or revision in either group. Harris hip scores (HHSs) at the most recent follow-up had not been compromised by RAO, and there were no significant differences in intraoperative blood loss and operative time between the two groups. Although there was a tendency toward superolateral placement of the acetabular component in group R, there were no significant differences in the mean steady-state linear and volumetric wear rates between the two groups. There were no infections, dislocations, intraoperative fractures, damaged nerves, or deep vein thromboses in either group. CONCLUSIONS Our midterm results demonstrated that RAO does not lead to higher revision rates, compromised HHSs, or shortened survivorship in eventual THA for DDH.
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20
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Xue E, Su Z, Chen C, Wong PKC, Wen H, Zhang Y. An intraoperative device to restore femoral offset in total hip arthroplasty. J Orthop Surg Res 2014; 9:58. [PMID: 25037492 PMCID: PMC4223551 DOI: 10.1186/s13018-014-0058-7] [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: 11/25/2013] [Accepted: 06/27/2014] [Indexed: 11/24/2022] Open
Abstract
Background Leg length discrepancy (LLD) after total hip arthroplasty (THA) can lead to unsatisfactory outcome. Our objective was to design and evaluate a simple and reliable intraoperative device (Length-offset Lever) to minimize leg length discrepancy. Methods This device was used in 51 patients undergoing primary total hip replacements. The leg length discrepancy was measured pre- and postoperatively based on plain radiographs. Results Preoperative radiographic leg length discrepancy averaged 13.5 ± 6.2 mm. Leg length discrepancy showed significant improvement, with a postoperative average of 4.1 ± 2.3 mm (p < 0.0001). There were no complications associated with this device. Conclusions The ‘Length-offset Lever’ is a useful intraoperative tool to restore anatomic femoral offset and height of femoral head.
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Affiliation(s)
| | | | | | | | | | - Yu Zhang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou 325000, Zhejiang, China.
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Muratli KS, Karatosun V, Uzun B, Celik S. Subtrochanteric shortening in total hip arthroplasty: biomechanical comparison of four techniques. J Arthroplasty 2014; 29:836-42. [PMID: 24095585 DOI: 10.1016/j.arth.2013.09.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/31/2013] [Accepted: 09/02/2013] [Indexed: 02/01/2023] Open
Abstract
Safe reduction of the femoral head into the true acetabulum requires a certain amount of femoral shortening in patients with high dislocation of the hip. In subtrochanteric shortening applications, to reduce complications it is necessary to maintain a stable fixation at the osteotomy line. The purpose of this study is to investigate frequently used methods from a biomechanical point of view. Four osteotomy groups were created with composite femurs to investigate subtrochanteric osteotomies; transverse, oblique, z-subtrochanteric and double Chevron. All loading tests were carried out with two implant types both with and without strut graft and cable fixation. No single inherent feature increasing the stability of the investigated osteotomy types was found. Additionally graft application did not have a significant contribution to stability.
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Affiliation(s)
- Kivanc S Muratli
- Department of Orthopaedics and Traumatology Baskent University School of Medicine, Zubeyde Hanim Research and Medical Center, Izmir, Turkey
| | - Vasfi Karatosun
- Department of Orthopaedics and Traumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Bora Uzun
- Department of Biomechanics, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Salih Celik
- Department of Biomechanics, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Gustke KA, Levering MF, Miranda MA. Use of jumbo cups for revision of acetabulae with large bony defects. J Arthroplasty 2014; 29:199-203. [PMID: 23993345 DOI: 10.1016/j.arth.2012.11.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 10/12/2012] [Accepted: 11/16/2012] [Indexed: 02/01/2023] Open
Abstract
Several methods of treatment are available for acetabular revision associated with bone loss. Jumbo cups (minimum diameter of 62 mm in women, 66 mm in men, or 10 mm larger than the normal contralateral acetabulum) are often useful for large defects. The purpose of this study is to report a large jumbo cup series with an average 10-year follow-up. A total of 196 jumbo cups in 186 patients with a minimum of 2-year follow-up were available for review. Harris hip score improved from 44 preoperatively to 72 postoperatively. Survivorship was 98% at 4 years and 96% at 16 years. Five revisions and two resection arthroplasties were performed for failure. In conclusion, porous jumbo cup acetabular revision with supplemental screw fixation provides good to excellent intermediate- and long-term outcomes.
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23
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Kohlhof H, Ziebarth K, Gravius S, Wirtz DC, Siebenrock KA. [Operative treatment of congenital hip osteoarthritis with high hip luxation (Crowe type IV)]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2013; 25:469-82. [PMID: 24085352 DOI: 10.1007/s00064-013-0241-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 07/05/2013] [Accepted: 07/18/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of the therapy is mechanical and functional stabilization of high dislocated hips with dysplasia coxarthrosis using total hip arthroplasty (THA). INDICATIONS Developmental dysplasia of the hip (DDH) in adults, symptomatic dysplasia coxarthrosis, high hip dislocation according to Crowe type III/IV, and symptomatic leg length inequality. CONTRAINDICATIONS Cerebrospinal dysfunction, muscular dystrophy, apparent disturbance of bone metabolism, acute or chronic infections, and immunocompromised patients. SURGICAL TECHNIQUE With the patient in a lateral decubitus position an incision is made between the anterior border of the gluteus maximus muscle and the posterior border of the gluteus medius muscle (Gibson interval). Identification of the sciatic nerve to protect the nerve from traction disorders by visual control. After performing trochanter flip osteotomy, preparation of the true actetabulum if possible. Implantation of the reinforcement ring, preparation of the femur and if necessary for mobilization, resection until the trochanter minor. Test repositioning under control of the sciatic nerve. Finally, refixation of the trochanteric crest. POSTOPERATIVE MANAGEMENT During hospital stay, intensive mobilization of the hip joint using a continuous passive motion machine with maximum flexion of 70°. No active abduction and passive adduction over the body midline. Maximum weight bearing 10-15 kg for 8 weeks, subsequently, first clinical and radiographic follow-up and deep venous thrombosis prophylaxis until full weight bearing. RESULTS From 1995 to 2012, 28 THAs of a Crow type IV high hip-dislocation were performed in our institute. Until now 14 patients have been analyzed during a follow-up of 8 years in 2012. Mid-term results showed an improvement of the postoperative clinical score (Merle d'Aubigné score) in 86 % of patients. Good to excellent results were obtained in 79 % of cases. Long-term results are not yet available. In one case an iatrogenic neuropraxia of the sciatic nerve was observed and after trauma a redislocation of the arthroplasty appeared in another case. In 2 cases an infection of the THA appeared 8 and 15 months after index surgery. No pseudoarthrosis of the trochanter or aseptic loosening was noticed.
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Affiliation(s)
- H Kohlhof
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Siegmund-Freud-Str. 25, 53127, Bonn, Deutschland,
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Abolghasemian M, Drexler M, Abdelbary H, Sayedi H, Backstein D, Kuzyk P, Safir O, Gross AE. Revision of the acetabular component in dysplastic hips previously reconstructed with a shelf autograft: study of the outcome with special assessment of bone-stock changes. Bone Joint J 2013; 95-B:777-81. [PMID: 23723271 DOI: 10.1302/0301-620x.95b6.31346] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this retrospective study we evaluated the proficiency of shelf autograft in the restoration of bone stock as part of primary total hip replacement (THR) for hip dysplasia, and in the results of revision arthroplasty after failure of the primary arthroplasty. Of 146 dysplastic hips treated by THR and a shelf graft, 43 were revised at an average of 156 months, 34 of which were suitable for this study (seven hips were excluded because of insufficient bone-stock data and two hips were excluded because allograft was used in the primary THR). The acetabular bone stock of the hips was assessed during revision surgery. The mean implant-bone contact was 58% (50% to 70%) at primary THR and 78% (40% to 100%) at the time of the revision, which was a significant improvement (p < 0.001). At primary THR all hips had had a segmental acetabular defect > 30%, whereas only five (15%) had significant segmental bone defects requiring structural support at the time of revision. In 15 hips (44%) no bone graft or metal augments were used during revision. A total of 30 hips were eligible for the survival study. At a mean follow-up of 103 months (27 to 228), two aseptic and two septic failures had occurred. Kaplan-Meier survival analysis of the revision procedures demonstrated a ten-year survival rate of 93.3% (95% confidence interval (CI) 78 to 107) with clinical or radiological failure as the endpoint. The mean Oxford hip score was 38.7 (26 to 46) for non-revised cases at final follow-up. Our results indicate that the use of shelf autografts during THR for dysplastic hips restores bone stock, contributing to the favourable survival of the revision arthroplasty should the primary procedure fail.
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Affiliation(s)
- M Abolghasemian
- Mount Sinai Hospital, University of Toronto, 600 University Street, Suite 476, Toronto, Ontario M5G 1X5, Canada.
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Abolghasemian M, Samiezadeh S, Jafari D, Bougherara H, Gross AE, Ghazavi MT. Displacement of the hip center of rotation after arthroplasty of Crowe III and IV dysplasia: a radiological and biomechanical study. J Arthroplasty 2013; 28:1031-5. [PMID: 23541865 DOI: 10.1016/j.arth.2012.07.042] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 07/10/2012] [Accepted: 07/20/2012] [Indexed: 02/01/2023] Open
Abstract
To study the direction and biomechanical consequences of hip center of rotation (HCOR) migration in Crowe type III and VI hips after total hip arthroplasty, post-operative radiographs and CT scans of several unilaterally affected hips were evaluated. Using a three-dimensional model of the human hip, the HCOR was moved in all directions, and joint reaction force (JRF) and abductor muscle force (AMF) were calculated for single-leg stance configuration. Comparing to the normal side, HCOR had displaced medially and inferiorly by an average of 23.4% and 20.8%, respectively, of the normal femoral head diameter. Significant decreases in JRF (13%) and AMF (46.13%) were observed in a presumptive case with that amount of displacement. Isolated inferior displacement had a small, increasing effect on these forces. In Crowe type III and IV hips, the HCOR migrates inferiorly and medially after THA, resulting in a decrease in JRF, AMF, and abductor muscle contraction force.
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Affiliation(s)
- Mansour Abolghasemian
- Department of Orthopedic Surgery, Shafa Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Patel S, Sukeik M, Haddad FS. Initial implant stability predicts migration but not failure in cementless acetabular revision with bone grafting. J Arthroplasty 2013; 28:832-837. [PMID: 23489733 DOI: 10.1016/j.arth.2012.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 07/31/2012] [Accepted: 10/12/2012] [Indexed: 02/01/2023] Open
Abstract
Host bone contact of less than 50% is perceived but not proven to cause migration and loosening after acetabular revision. A prospective analysis of cementless acetabular revision cases with impaction grafting was performed to determine if this was an independent risk factor for these events. Sixty-two hips in 54 patients were assessed at a mean follow-up of 84.5 months (range 61-112) yielding a probability of 94.6% of retaining the acetabular component using revision for aseptic loosening as the end point. No single factor was independently causative for loosening, although Type III fixation was associated with migration (p=0.0159); subanalysis suggested that achieving host-bone contact in at least part of the dome and posterior column is important.
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Affiliation(s)
- Shelain Patel
- Department of Orthopaedic Surgery, University College Hospital, London NW1 2BU, UK
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27
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Al-Hajjar M, Fisher J, Williams S, Tipper JL, Jennings LM. Effect of femoral head size on the wear of metal on metal bearings in total hip replacements under adverse edge-loading conditions. J Biomed Mater Res B Appl Biomater 2013; 101:213-22. [PMID: 23281164 PMCID: PMC3746118 DOI: 10.1002/jbm.b.32824] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 06/24/2012] [Accepted: 08/05/2012] [Indexed: 12/12/2022]
Abstract
Metal-on-metal (MoM) bearings have shown low-wear rates under standard hip simulator conditions; however, retrieval studies have shown large variations in wear rates and mechanisms. High-wear in vivo has caused catastrophic complications and has been associated with steep cup-inclination angle (rotational malpositioning). However, increasing the cup-inclination angle in vitro has not replicated the increases in wear to the same extent as those observed in retrievals. Clinically relevant wear rates, patterns, and particles were observed in vitro for ceramic-on-ceramic bearings when microseparation (translational malpositioning) conditions were introduced into the gait cycle. In the present study, 28 and 36-mm MoM bearings were investigated under adverse conditions. Increasing the cup angle from 45° to 65° resulted in a significant increase in the wear rate of the 28 mm bearings. However, for the 36 mm bearings, head-rim contact did not occur under the steep cup-angle condition, and the wear rate did not increase. The introduction of microseparation to the gait cycle significantly increased the wear rate of the MoM bearings. Cup angle and head size did not influence the wear rate under microseparation conditions. This study indicated that high-in vivo wear rates were associated with edge loading due to rotational malpositioning such as high-cup-inclination angle and translational malpositioning that could occur due to several surgical factors. Translational malpositioning had a more dominant effect on the wear rate. Preclinical simulation testing should be undertaken with translational and rotational malpositioning conditions as well as standard walking cycle conditions defined by the ISO standard.
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Affiliation(s)
- Mazen Al-Hajjar
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
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28
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Kiliçoğlu Oİ, Türker M, Akgül T, Yazicioğlu O. Cementless total hip arthroplasty with modified oblique femoral shortening osteotomy in Crowe type IV congenital hip dislocation. J Arthroplasty 2013; 28:117-25. [PMID: 22868069 DOI: 10.1016/j.arth.2012.06.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 11/16/2011] [Accepted: 06/15/2012] [Indexed: 02/01/2023] Open
Abstract
Midterm results of cementless total hip arthroplasty in patients with Crowe type IV congenital dislocation of the hip were evaluated. A modified oblique subtrochanteric shortening osteotomy was used in all patients. A cylindrical femoral stem was used in all patients to stabilize the osteotomy. Mean follow-up was 82 months in 20 hips of 16 patients. Mean Merle D'Aubigné pain score increased from 2.52 to 5.65 points, function score improved from 4.0 to 5.3 points, and mobility score improved from 3.95 to 5.35. Mean greater trochanter height relative to the estimated hip center was 6.8 ± 2.0 cm preoperatively and -1 ± 0.2 cm postoperatively. Complications were dislocations in 3 patients, which were successfully managed without redislocation and fracture of greater trochanter in 3 patients, which healed uneventfully in 2 but with residual Trendelenburg gait in one. Total hip arthroplasty with modified oblique subtrochanteric shortening osteotomy is an effective technique for the treatment for Crowe type IV hip dislocation.
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Affiliation(s)
- Onder İ Kiliçoğlu
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul,Turkey
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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: 0.7] [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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30
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Bagaria V, Deshpande S, Kuthe A, Rasalkar DD, Paunipagar BK, Madhugiri TS. Radiographic study of the hip joint to determine anthropometric parameters for Indian population. Eur J Radiol 2012; 81:312-6. [DOI: 10.1016/j.ejrad.2010.12.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 12/17/2010] [Indexed: 10/18/2022]
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Deirmengian GK, Zmistowski B, O'Neil JT, Hozack WJ. Management of acetabular bone loss in revision total hip arthroplasty. J Bone Joint Surg Am 2011; 93:1842-52. [PMID: 22005871 DOI: 10.2106/jbjs.j.01197] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Most acetabular revisions can be managed with a hemispherical component with screw fixation. Areas of segmental bone loss that preclude acetabular component stability may be managed with structural allograft or second-generation porous metal augments. Acetabular cages have a limited application but can be a useful tool in the management of massive bone loss and pelvic discontinuity.
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Affiliation(s)
- Gregory K Deirmengian
- Rothman Institute of Orthopaedics, Thomas Jefferson University Medical School, 925 Chestnut Street, Philadelphia, PA 19107, USA
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Kawanabe K, Akiyama H, Goto K, Maeno S, Nakamura T. Load dispersion effects of acetabular reinforcement devices used in revision total hip arthroplasty: a simulation study using finite element analysis. J Arthroplasty 2011; 26:1061-6. [PMID: 21676579 DOI: 10.1016/j.arth.2011.04.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 04/14/2011] [Indexed: 02/01/2023] Open
Abstract
Several types of acetabular reinforcement devices are used to prevent the collapse of grafted bone in revision total hip arthroplasty. However, it remains unclear how the stress is reduced by different devices. We used finite element analysis to evaluate 4 types of acetabular reinforcement devices: Kerboull-type device, Burch-Schneider anti-protrusio cage, Mueller ring, and Ganz ring. The control was a socket fixed with bone cement without any reinforcement devices. The stress distribution on the inner surface of each socket was calculated by binarization image processing. For all 4 reinforcement devices, the stress was reduced to less than one-half of that in the control. All the devices were useful for preventing the collapse of bulk bone grafts applied to load-bearing defects.
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Affiliation(s)
- Keiichi Kawanabe
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
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Ogawa H, Ito Y, Shinozaki M, Matsumoto K, Shimizu K. Subtrochanteric transverse shortening osteotomy in cementless total hip arthroplasty achieved using a modular stem. Orthopedics 2011; 34:170. [PMID: 21410120 DOI: 10.3928/01477447-20110124-24] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
It is challenging to reconstruct normal hip motion after a high hip dislocation. Although total hip arthroplasty (THA) with shortening osteotomy is a solution for high hip dislocation, osteotomy nonunion is a major complication. To improve the rate of osteotomy union, subtrochanteric transverse shortening osteotomy was performed using a modular-type stem, S-ROM, that can be fixed to both the proximal and distal parts of the femur individually with a stepped proximal sleeve and polished distal flutes with fins, respectively. The stem can facilitate union of the osteotomy by maintaining rigid rotational stability and generating compression pressure between bone parts of the femur even in simple transverse osteotomy. Moreover, transverse osteotomy is technically simple and minimizes the damage of the periosteum at the osteotomy. In our series, this procedure was performed on 6 hips in 6 patients with high hip dislocation. The mean follow-up period was 8.1 years. Osteotomy union was achieved in all patients for a mean of 8.8 weeks. This procedure is a good option for surgical treatment of high hip dislocation.
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Affiliation(s)
- Hiroyasu Ogawa
- Department of Orthopedic Surgery, Gifu University, Graduate School of Medicine, Gifu, Japan.
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Revisions of extensive acetabular defects with impaction grafting and a cement cup. Clin Orthop Relat Res 2011; 469:562-73. [PMID: 20931308 PMCID: PMC3018199 DOI: 10.1007/s11999-010-1618-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 09/24/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Loosening of acetabular components often leads to bony defects. Management of extensive acetabular bone loss in hip revision arthroplasty can be a tremendous challenge. QUESTIONS/PURPOSES We asked whether a reconstruction with impacted bone grafts will provide a durable and pain-free function in extensive acetabular defects. We specifically determined the (1) survival rates with the end point of revision for any reason, aseptic revision, and radiographic loosening; (2) visual analog scale (VAS) pain score, Harris hip score (HHS), and the Oxford Hip Questionnaire score (OHQS); (3) number of repeat revisions; (4) complications; and (5) radiographic loosening, wear, and radiolucencies. PATIENTS AND METHODS We retrospectively followed 25 patients (27 hips) with extensive acetabular defects. No patient was lost to followup. Two patients died during followup. Minimum followup was 3 years (mean, 8.8 years; range, 3-14.1 years). RESULTS Three patients (three hips) underwent repeat revision surgery and another two patients (two hips) had radiographically loose hips. The 10-year survival rate was 88% (95% confidence interval, 74.2%-100%) with the end point acetabular revision for any reason and 95% (95% confidence interval, 86.0%-100%) with the end point acetabular revision for aseptic loosening. The mean HHSs were 55 points before surgery and 72 points postoperatively. CONCLUSIONS Acetabular reconstruction with impaction bone grafting and a cemented cup is a reliable technique with a 10-year survival rate of 88% in patients with extensive acetabular deficiencies. LEVEL OF EVIDENCE Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.
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35
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Uchiyama K, Takahira N, Fukushima K, Yamamoto T, Moriya M, Itoman M. Radiological evaluation of allograft reconstruction in acetabulum with Ganz reinforcement ring in revision total hip replacement. J Orthop Sci 2010; 15:764-71. [PMID: 21116894 DOI: 10.1007/s00776-010-1549-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 08/25/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND In revision total hip replacement (THR), cages and rings are commonly used for the reconstruction of bone defects that are due to mechanical loosening of the acetabular cup and migration of the femoral head prosthesis. The purpose of this study was to evaluate the radiological results of the use of Ganz reinforcement rings with bone allografts in acetabular revision THR. METHODS We reviewed 30 hips of 28 patients who underwent allograft reconstruction of the acetabulum with a Ganz reinforcement ring in revision THR. The average postoperative follow-up period was 8 years. The position of the acetabular socket was measured on anteroposterior radiographs. Loosening of the acetabular component was defined as a change in the cranial or central direction of the cup or a change in the cup inclination angle at the time of last follow-up. In cases of segmental bone defects in weight-bearing areas, we used two or three strut screws prior to incorporation of the Ganz reinforcement ring to act as struts for the ring. Kaplan-Meier survivorship analysis was performed. The end point was revision surgery done because of defined loosening of the acetabular component at the time of the last follow-up. RESULTS All five acetabular components (16.7%) defined as showing aseptic loosening were type D defects (cranio-central defects), but no patient needed revision surgery during the follow-up period. Nine revision surgeries with strut screws for type D acetabular bone defects were performed. The calculated Kaplan-Meier survival rate at 5 years was 96.0%, and the rate at 10 years was 80.2%, using defined loosening of the acetabular component as the end point. CONCLUSIONS Allograft reconstruction of the acetabulum with a Ganz reinforcement ring is a useful technique for revision THR. Occasionally, a special technique (the strut screw technique) was required for the reconstruction of type D bone defects.
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Affiliation(s)
- Katsufumi Uchiyama
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
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Dua A, Kiran K, Malhotra R, Bhan S. Acetabular reconstruction using fresh frozen bone allograft. Hip Int 2010; 20:143-9. [PMID: 20544647 DOI: 10.1177/112070001002000203] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2009] [Indexed: 02/04/2023]
Abstract
The success of total hip arthroplasty has led to a move toward operating on a wider and younger population. All implants have a finite useful life, and bone loss is associated with all major causes of failure. The use bone allograft, either morselized or structural has the aim of reconstituting the bone stock. We retrospectively reviewed the clinical and radiological results of 72 acetabular reconstructions both primary and revision, done at our institute between May 1999 and October 2004 with a minimum follow-up of one year. The Harris Hip Score (HHS) was calculated and follow-up radiographs were evaluated for graft incorporation; evidence of loosening and migration. Preoperatively 28 acetabular defects were type III (AAOS), 18 were type II, 16 were type I and 10 were type IV. 60 reconstructions were done using cementless acetabular prostheses, and the remaining twelve had cemented implants. Patients were followed up for an average of 30.69 months (range 12 - 64 months). The mean preoperative HHS was 36.13 points which improved to a mean of 81.6 points (range 61 to 91) at final follow-up. None of the patients required reoperation. Dislocation was the commonest complication (8 hips). Short and medium term results were encouraging with the use of this technique.
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Affiliation(s)
- Aman Dua
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
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Khoury JI, Malkani AL, Adler EM, Markel DC. Constrained acetabular liners cemented into cages during total hip revision arthroplasty. J Arthroplasty 2010; 25:901-5. [PMID: 20620017 DOI: 10.1016/j.arth.2009.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 08/19/2009] [Indexed: 02/01/2023] Open
Abstract
The combination of acetabular bone loss and hip instability is challenging. Sixteen patients underwent revision total hip arthroplasty using constrained acetabular liners cemented into cages. The average follow-up was 28 months (range, 24-60 months). Clinical evaluation was obtained using the Harris hip score along with radiographic data. At latest follow-up, 13 patients were available for evaluation. Although the average postoperative Harris hip score was 62 points, which was better than the preoperative score of 27 points, the overall radiographic failure rate was 23%. The combination of poor acetabular bone stock and altered stresses from the increased constraint likely led to the poor outcome. We would only recommend use of a cemented, constrained acetabular liner in combination with a protrusio cage as a bail out or salvage procedure.
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Affiliation(s)
- John I Khoury
- Detroit Medical Center/Providence Hospital Orthopaedic Surgery Residency Program, Detroit, Michigan, USA
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Kurtz WB, Ecker TM, Reichmann WM, Murphy SB. Factors affecting bony impingement in hip arthroplasty. J Arthroplasty 2010; 25:624-34.e1-2. [PMID: 19559561 DOI: 10.1016/j.arth.2009.03.024] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 03/28/2009] [Indexed: 02/01/2023] Open
Abstract
Computer modeling of 10 patients' computed tomographic scans was used to study the variables affecting hip arthroplasty range of motion before bony impingement (ROMBI) including acetabular offset and height, femoral offset, height and anteversion, and osteophyte removal. The ROMBI was compared with the ROM before component impingement and the native hip ROM. The ROMBI decreased with decreased total offset and limb shortening. Acetabular offset and height had a greater effect on ROMBI than femoral offset and height. The ROMBI lost with decreased acetabular offset was not fully recoverable with an increase in femoral offset or osteophyte removal. Bony impingement increased and component impingement decreased with decreased acetabular offset and increased head diameter.
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Total hip arthroplasty using Kerboull-type acetabular reinforcement device for rapidly destructive coxarthrosis. J Arthroplasty 2010; 25:432-6. [PMID: 19369027 DOI: 10.1016/j.arth.2009.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Accepted: 03/16/2009] [Indexed: 02/01/2023] Open
Abstract
We studied 20 primary cemented total hip arthroplasties performed using Kerboull-type acetabular reinforcement device for rapidly destructive coxarthrosis. The average patient age at the time of surgery was 68.3 (range, 60-77) years. The mean follow-up period was 6.3 years (3.8-11.8). The mean preoperative Japanese Orthopedic Association hip score was 38.1 (16-70) vs 85.2 (70-93) at the latest follow-up. The radiographic outcome in 20 hips showed no migration or aseptic loosening. A partial radiolucent line at the cement-bone interface was noted in 2 hips (10%), but no progression occurred. There were no major complications. No patient required repeated surgery. The use of Kerboull-type acetabular reinforcement device for rapidly destructive coxarthrosis provided satisfactory 3-year to 11-year clinical and radiographic results.
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40
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Foucher KC, Hurwitz DE, Wimmer MA. Relative importance of gait vs. joint positioning on hip contact forces after total hip replacement. J Orthop Res 2009; 27:1576-82. [PMID: 19514072 DOI: 10.1002/jor.20935] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Implant loosening is a common indication for total hip replacement (THR) revision. High contact forces and implant twisting moments are thought to be associated with implant loosening. Relationships between joint positioning and hip forces, or outcomes, have been investigated through in vivo and in vitro modalities. Relationships between hip forces and gait are less understood, despite repeated findings that gait following a THR does not fully return to normal. We tested the hypothesis that gait parameters would be better predictors of implant force (peak contact forces and peak twisting moment during walking) than joint positioning parameters. Subjects underwent gait analysis, hip force modeling, and measurement of clinical radiographs 1 year after successful THR surgery. Gait parameters were consistently more influential in determining hip forces. Alone, gait explained as much as 67% of the variation in force, compared to a maximum of 33% by joint geometry. Combinations of gait and joint positioning parameters together explained up to 86% of the variation in hip force parameters. Results suggest that gait may provide a valuable postoperatively modifiable target to improve hip loads and potentially reduce the risk for implant loosening.
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Affiliation(s)
- Kharma C Foucher
- Department of Orthopedic Surgery, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, Illinois 60612, USA.
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41
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Landor I, Vavrik P, Jahoda D, Pokorny D, Tawa A, Sosna A. The Long Oblique Revision component in revision arthroplasty of the hip. ACTA ACUST UNITED AC 2009; 91:24-30. [DOI: 10.1302/0301-620x.91b1.20906] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Migration of the acetabular component may give rise to oval-shaped bone defects in the acetabulum. The oblong implant is designed to fill these defects and achieve a stable cementless anchorage with no significant bone loss. We prospectively reviewed 133 oblong long oblique revision components at a mean follow-up of 9.74 years (0.6 to 14). All had been used in revisions for defects of type IIB to IIIB according to Paprosky. Aseptic loosening was the reason for revision in 11 cases (8.3%) and deep infection in seven (5.3%). The probability of implant survival over a 12-year follow-up estimated by the Kaplan-Meier method gave a survival rate of 0.85% respectively 0.90% when deep infection was excluded as the endpoint. Our study supports the use of these components in defects from IIB to IIIA. The main precondition for success is direct contact of more than half of the surface of the implant with the host acetabular bone.
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Affiliation(s)
- I. Landor
- 1st Orthopaedic Clinic, Medical Faculty Charles, University, Prague V Úvalu 84, 150 05 Prague 5, Czech Republic
| | - P. Vavrik
- 1st Orthopaedic Clinic, Medical Faculty Charles, University, Prague V Úvalu 84, 150 05 Prague 5, Czech Republic
| | - D. Jahoda
- 1st Orthopaedic Clinic, Medical Faculty Charles, University, Prague V Úvalu 84, 150 05 Prague 5, Czech Republic
| | - D. Pokorny
- 1st Orthopaedic Clinic, Medical Faculty Charles, University, Prague V Úvalu 84, 150 05 Prague 5, Czech Republic
| | - A. Tawa
- 1st Orthopaedic Clinic, Medical Faculty Charles, University, Prague V Úvalu 84, 150 05 Prague 5, Czech Republic
| | - A. Sosna
- 1st Orthopaedic Clinic, Medical Faculty Charles, University, Prague V Úvalu 84, 150 05 Prague 5, Czech Republic
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42
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Buttaro MA, Comba F, Pusso R, Piccaluga F. Acetabular revision with metal mesh, impaction bone grafting, and a cemented cup. Clin Orthop Relat Res 2008; 466:2482-90. [PMID: 18704610 PMCID: PMC2584278 DOI: 10.1007/s11999-008-0442-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2007] [Accepted: 07/23/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Impaction grafting is controversial in the presence of segmental and cavitary acetabular defects and requires the use of supplemental devices to close segmental defects. This approach, however, would allow treating combined deficiencies that could not be managed with impacted cancellous bone alone. We raised the following two questions: (1) What is the survival rate in patients with combined deficiencies reconstructed with metal mesh, impaction grafting and a cemented cup and (2) can metal mesh prevent cup migration? We evaluated 23 cavitary uncontained acetabular defects in revision hip arthroplasty. Preoperative diagnoses were aseptic loosening (19 hips) and second-stage reimplantations after resection for infection (four hips). The preoperative Merle D'Aubigné-Postel score averaged 7.4 points. Two patients had reoperations for mechanical failure at 6 and 24 months. The survival rate with further revision as an end point was 90.8% at an average of 36 months (range, 24-56 months; 95% confidence interval, 68.1-97.6). Metal mesh did not prevent cup migration: migration occurred in all patients, averaging 5.1 mm (range, 2-25 mm). Another three patients with severe combined defects had asymptomatic mesh rupture with 3- to 15-mm migration. Postoperative functional score averaged 16.2 points. Metal mesh, impaction grafting, and a cemented cup should be considered for reconstruction of medium uncontained acetabular defects, but not for severe combined deficiencies. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Martín A. Buttaro
- Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Potosí 4215, C1199ACK Buenos Aires, Argentina
| | - Fernando Comba
- Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Potosí 4215, C1199ACK Buenos Aires, Argentina
| | - Rodolfo Pusso
- Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Potosí 4215, C1199ACK Buenos Aires, Argentina
| | - Francisco Piccaluga
- Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Potosí 4215, C1199ACK Buenos Aires, Argentina
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Abeyta PN, Namba RS, Janku GV, Murray WR, Kim HT. Reconstruction of major segmental acetabular defects with an oblong-shaped cementless prosthesis: a long-term outcomes study. J Arthroplasty 2008; 23:247-53. [PMID: 18280420 DOI: 10.1016/j.arth.2007.01.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2006] [Accepted: 01/28/2007] [Indexed: 02/01/2023] Open
Abstract
A retrospective outcomes study was performed on 25 consecutive acetabular reconstructions of major segmental defects by using an oblong-shaped cementless implant. All patients had combined acetabular defects (type III) as defined by the American Academy of Orthopaedic Surgeons classification of acetabular bone deficiency. Long-term follow-up was performed at an average of 11 years postoperatively. Clinical and radiographic outcomes were measured. Failures were defined by component revision or clear radiographic evidence of loosening. Six patients died before final evaluation, and 4 patients did not have complete radiographic data, leaving 14 patients (15 hips) for final analysis. At final follow-up, only 3 of the implants had failed and were revised. There was 1 case of a well-functioning implant with circumferential radiolucency; otherwise, there was no evidence of loosening among the remaining implants.
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Affiliation(s)
- Paul N Abeyta
- Department of Orthopaedic Surgery, University of California, and Kaiser Permanente Hospital, San Francisco 94143-0728, USA
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Park MS, Kim KH, Jeong WC. Transverse subtrochanteric shortening osteotomy in primary total hip arthroplasty for patients with severe hip developmental dysplasia. J Arthroplasty 2007; 22:1031-6. [PMID: 17920477 DOI: 10.1016/j.arth.2007.05.011] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 05/08/2007] [Indexed: 02/01/2023] Open
Abstract
Twenty-four total hip arthroplasties were performed on patients with Crowe grade 3 or 4 hip dysplasia using subtrochanteric shortening osteotomy with 2 kinds of femoral stems. The average age of the patients was 44.8 years, and their average length of follow-up was 4.7 years. Acetabular reconstruction with structural autograft was used in 11 hips. Radiologically, hip centers were nearly normalized by a vertical height of 10.6-mm elevation and a horizontal length of 1.7 mm as compared with uninvolved sites. Three osteotomy nonunions required revisions with bone graft. One acetabular revision was performed for migration. One postoperative dislocation was managed successfully with closed reduction and an abduction brace. However, no neurologic complication was noticed. The Harris hip score improved from 35.6 to 81.7. A cementless modular distal fluted femoral stem is a useful device in these patients.
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Affiliation(s)
- Myung-Sik Park
- Department of Orthopedics, Chonbuk National University Hospital and Research Institute of Clinical Medicine, Jeonju, Chonbuk, South Korea
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Radiographic comparison of cemented and uncemented total hip arthroplasty and hip resurfacing. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2007. [DOI: 10.1007/s00590-007-0228-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Paprosky WG, Sporer SS, Murphy BP. Addressing severe bone deficiency: what a cage will not do. J Arthroplasty 2007; 22:111-5. [PMID: 17570291 DOI: 10.1016/j.arth.2007.01.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2006] [Accepted: 01/19/2007] [Indexed: 02/01/2023] Open
Abstract
Managing severe acetabular bone loss in total hip arthroplasty revision can be a tremendous challenge. Osteolysis and migration of the acetabular component can lead to large uncontained defects. Traditionally, these deficiencies have been treated with allograft with or without the support of a cage. In severe cases, a majority of the cage support is via allograft instead of host bone. Sometimes, with remodeling and resorption of the allograft, the cage can lose structural support, leading to fatigue and failure. In these situations, trabecular metal has become a viable alternative. Deficiencies of acetabular bone can be independently addressed and reconstructed providing initial stability and, we believe, long-term biologic fixation to host bone.
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Affiliation(s)
- Wayne G Paprosky
- Department of Orthopaedic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois
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Tabutin J, Pelegri C, Cambas PM, Vogt F. [Fence grafting for acetabular reconstruction with a cementless cup]. ACTA ACUST UNITED AC 2006; 92:708-14. [PMID: 17124455 DOI: 10.1016/s0035-1040(06)75932-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Acetabular reconstruction is difficult after loss of bone stock and socket remodeling. Several techniques have been proposed ranging from a metal backing to allografting. We propose fence grafting. After explantation, the acetabulum is carefully cleaned of all interface tissue and precisely measured. If the vertical diameter is clearly greater than the anteroposterior diameter, a tricortical graft is harvested from the iliac crest and modeled to perfectly fit between the anterioinferior iliac spine and the residual posterior wall as well as the fundus medially. One or two oblique screws are inserted for stabilization. Any superior bone loss is filled by bone substitute (without mechanical value). The acetabulum is then reamed from the obturator foramen sparing the anterior and posterior columns. Residual bony defects are filled with cancellous bone. A hemispheric cup is then press fit and maintained with two or three screws. We performed this procedure in eight patients with SO.F.C.O.T. stage III acetabular loosening with segmentary bone loss and an oval acetabular cavity. Clinical follow-up was more than four years. The Postel-Merle-d'Aubigné score improved from 9.8 to 15.7 on average. Radiographically, there were no implant mobilization or migration and no circumferential lucent lines were observed. A nearly anatomic position was achieved in all cases except two (technical imperfection). At more than one-year follow-up, the grafts could not be distinguished from adjacent bone. For us, high-positioned or jumbo cups do not offer a satisfactory reconstruction option. There is a risk of compression with allografts from a head bank. We have not used the cemented metal-backed solution nor impacted grafts. The major drawback with fence grafting is the iliac harvesting (possible residual limping because of the extensive disinsertion of the gluteus medius. The reliable acetabular reconstruction is the major advantage. This technique is not simply an acetabular block widened laterally but it decreases the vertical dimension. This is a reliable but minute technique which allows true long-lasting reconstruction of the acetabulum.
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Affiliation(s)
- J Tabutin
- Centre Hospitalier de Cannes, 15, avenue Broussailles, 06401 Cannes Cedex.
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Girard J, Lavigne M, Vendittoli PA, Roy AG. Biomechanical reconstruction of the hip: a randomised study comparing total hip resurfacing and total hip arthroplasty. ACTA ACUST UNITED AC 2006; 88:721-6. [PMID: 16720762 DOI: 10.1302/0301-620x.88b6.17447] [Citation(s) in RCA: 168] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have compared the biomechanical nature of the reconstruction of the hip in conventional total hip arthroplasty (THA) and surface replacement arthroplasty (SRA) in a randomised study involving 120 patients undergoing unilateral primary hip replacement. The contralateral hip was used as a control. Post-operatively, the femoral offset was significantly increased with THA (mean 5.1 mm; -2.8 to 11.6) and decreased with SRA (mean -3.3 mm; -8.9 to 8.2). Femoral offset was restored within sd 4 mm in 14 (25%) of those with THA and in 28 (57%) of the patients receiving SRA (p < 0.001). In the THA group, the leg was lengthened by a mean of 2.6 mm (-6.04 to +12.9), whereas it was shortened by a mean of 1.9 mm (-7.1 to +2.05) in the SRA group, compared with the contralateral side. Leg-length inequality was restored within sd 4 mm in 42 (86%) of the SRA and 33 (60%) of the THA patients. The radiological parameters of acetabular reconstruction were similar in both groups. Restoration of the normal proximal femoral anatomy was more precise with SRA. The enhanced stability afforded by the use of a large-diameter femoral head avoided over-lengthening of the limb or increased offset to improve soft-tissue tension as occurs sometimes in THA. In a subgroup of patients with significant pre-operative deformity, restoration of the normal hip anatomy with lower pre-operative femoral offset or significant shortening of the leg was still possible with SRA.
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Affiliation(s)
- J Girard
- Department of Orthopaedics, The Maisonneuve-Rosemont Hospital, 5345 Boul L'Assomption, Suite 55, Montréal, Québec H1T 4B3, Canada
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Abstract
The surgical strategy for revision of the acetabular component is determined by available host bone stock. Contained (cavitary) bone loss is the most common pattern of bone loss and can be addressed by morsellized bone graft. If contact can be made with at least 50% host bone, conventional uncemented cups can be used. If, however, contact with 50% host bone cannot be achieved, a protective cage and a cemented cup is an acceptable option but with a significant complication rate. The use of trabecular metal, which provides a more favorable environment for bone graft remodeling and host bone ingrowth, has allowed us to address larger contained defects without resorting to a cage. For massive contained defects, a combination of a trabecular metal cup protected by a cage has been used.
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Affiliation(s)
- Allan E Gross
- Division of Orthopaedic surgery, Faculty of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Erdemli B, Yilmaz C, Atalar H, Güzel B, Cetin I. Total hip arthroplasty in developmental high dislocation of the hip. J Arthroplasty 2005; 20:1021-8. [PMID: 16376258 DOI: 10.1016/j.arth.2005.02.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2003] [Revised: 10/18/2004] [Accepted: 02/03/2005] [Indexed: 02/01/2023] Open
Abstract
In total hip arthroplasty for developmental high dislocations, placement of the implant cup in the true acetabulum and femoral-shortening osteotomy can produce satisfactory results. We performed total hip arthroplasties in 25 high dislocated hips (22 patients) between 1992 and 2000, placing all cups in the true acetabula and using noncemented components and performing a femoral-shortening osteotomy in 22 hips. The overall complication rate was 36%. At follow-up evaluation at an average of 5 years later, patients' mean scores had improved as follows: pain, from 2.3 to 5.7; function scores, from 2.3 to 4.5; mobility scores, from 2.3 to 4.4; Harris hip scores, from 37.8 to 95. We recommend both placing the cup in the true acetabulum to maximize host-bone contact with the implant and preserve as much host bone as possible and femoral-shortening osteotomy for a lower incidence of nerve injury than with aggressive soft-tissue release.
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Affiliation(s)
- Bülent Erdemli
- Department of Orthopedics and Traumatology, Ankara University Medical School, Ankara, Turkey
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