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Mortazavi SMJ, Hosseini-Monfared P, Atilla B, Bilgen OF, Gahramanov A, Kreuzer S, Razzaghof M, Shubnyakov I, Zagra L. Is There a Difference in the Outcome of Total Hip Arthroplasty Performed for Patients Who Have Developmental Dysplasia when the Acetabular Component Is Positioned in the Anatomical Position Versus the High Hip Center? J Arthroplasty 2025; 40:S145-S147. [PMID: 39461541 DOI: 10.1016/j.arth.2024.10.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 10/10/2024] [Accepted: 10/14/2024] [Indexed: 10/29/2024] Open
Affiliation(s)
| | | | - Bülent Atilla
- Faculty of Medicine, Orthopaedics and Traumatology Department, Hacettepe University, Ankara, Turkiye
| | - Omer Faruk Bilgen
- Department of Orthopedic Surgery, Uludağ University, Nilüfer, Bursa, Turkiye
| | | | - Stefan Kreuzer
- Memorial Bone and Joint Research Foundation, Houston, Texas
| | - Mohammadreza Razzaghof
- Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Igor Shubnyakov
- Vreden National Medical Research Centre of Traumatology and Orthopaedics, St. Petersburg, Russian Federation
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
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Murylev V, Muzychenkov A, Elizarov P, Kukovenko G, Alekseev S, Zhuchkov AG, Erokhin NE. Long-term functional results of revision hip replacement using Burch-Schneider cages. J Orthop 2023; 37:53-58. [PMID: 36974092 PMCID: PMC10039112 DOI: 10.1016/j.jor.2023.02.008] [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: 11/28/2022] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction One of the most common and effective treatments for end-stage hip osteoarthritis is total hip arthroplasty (THA). According to the WHO, 1.5 million, more than 500,000, and approximately 100,000 THAs are performed annually in the world, in the USA, and in Russia, respectively. The use of Burch-Schneider cages has progressively increased since their introduction in 1975, with more than 125,000 cages being implanted by 2006. This design for revision surgery remains valid today.The objectives were to conduct a retrospective analysis of anti-protrusion cages in revision THA and evaluate long-term functional results. Methods Fifty-eight revision surgeries were performed at Botkin Hospital from 2003 to 2020 with anti-protrusion Burch-Schneider cages because of aseptic loosening of the acetabular component. The average age of the examined patients was 61.2 (±12.9) years. The maximum follow-up duration was 17 years. The average follow-up duration was 10.5 (±4.1) years. We used the functional Harris, WOMAC, SF-36, and FJS-12 scales to evaluate functional results. The patients were distributed into the following groups according to the Paprosky classification: 2C, 3A, and 3B. Results Group 2C showed good functional results, with a Harris score of 87 (±6.9), an FJS-12 score of 63.2 (±4.8), a WOMAC score of 175 (±16.7), and an Oxford Hip score of 39.06 (±9.1). Group 3A also showed good functional scores, with a Harris score of 78 (±7.1), an FJS-12 score of 61.2 (±5.1), a WOMAC score of 168 (±17.1), and an Oxford Hip score of 42.12 (±8.7). Group 3B showed satisfactory functional results, with a Harris score of 70 (±5.9), an FJS-12 score of 58.9 (±4.4), a WOMAC score of 166 (±18.1), and an Oxford Hip score of 48.4 (±9.4).Among patients who underwent revision surgery using Burch-Schneider rings, 16 needed to undergo repeat revision surgery. Periprosthetic infection occurred in 5 patients, aseptic loosening in 7, and periprosthetic fracture in 3. Conclusions The anti-protrusion Burch-Schneider system is a necessary and up-to-date element of THA and can be used with great efficacy in revision THA. Despite the rapid development of technologies and the appearance of new, highly efficient devices, there is still room for systems such as Burch-Schneider rings. However, there are relatively few indications for their use, with the main indications for the use of anti-protrusion systems being conditions related to bone defects of the acetabular roof and bone mass loss of the acetabular floor.
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Affiliation(s)
- Valeriy Murylev
- I.M.Sechenov First Moscow State Medical University (Sechenov University), Department of Traumatology, Orthopedics and Disaster Surgery, Moscow, 119991, Russian Federation
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
| | - Alexey Muzychenkov
- I.M.Sechenov First Moscow State Medical University (Sechenov University), Department of Traumatology, Orthopedics and Disaster Surgery, Moscow, 119991, Russian Federation
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
| | - Pavel Elizarov
- I.M.Sechenov First Moscow State Medical University (Sechenov University), Department of Traumatology, Orthopedics and Disaster Surgery, Moscow, 119991, Russian Federation
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
| | - Grigoriy Kukovenko
- I.M.Sechenov First Moscow State Medical University (Sechenov University), Department of Traumatology, Orthopedics and Disaster Surgery, Moscow, 119991, Russian Federation
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
| | - Semyon Alekseev
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
| | - Alexander G. Zhuchkov
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
| | - Nicolay E. Erokhin
- I.M.Sechenov First Moscow State Medical University (Sechenov University), Department of Traumatology, Orthopedics and Disaster Surgery, Moscow, 119991, Russian Federation
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
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Femoral Head Autograft to Manage Acetabular Bone Loss Defects in THA for Crowe III Hips by DAA: Retrospective Study and Surgical Technique. J Clin Med 2023; 12:jcm12030751. [PMID: 36769400 PMCID: PMC9918157 DOI: 10.3390/jcm12030751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Introduction: The pathologic anatomy of Crowe III is characterized by the erosion of the superior rim of acetabulum, with a typical bone defect in its supero-lateral portion. The performance of a total hip arthroplasty requires the management of the acetabular bone defect, and femoral head autograft can be a valid option to optimize implant coverage. Material and Methods: In all, eight Crowe III patients (nine hips), seven of which having unilateral hip affected, and one with bilateral involvement by secondary osteoarthritis in DDH; maximum limb length discrepancy (LLD) of 3.5 cm in unilateral patients. All were operated on by direct anterior approach. Patients were evaluated in terms of clinical, surgical, and radiological (center-edge, horizontal coverage, cup inclination) parameters. Results: Cup placement was implanted with a mean of 39.5 ± 7.5°. Stem alignment showed average 1.5 ± 2.3° in valgus. LLD showed an overall average preoperative of -29.5 ± 10.5 mm at the affected side, with a significant improvement to -2.5 ± 6.4 mm (p = 0.023). The mean initial coverage evaluated like a percentage of the horizontal bone host was 52.1 ± 7.1%, while the mean final coverage at the last post-operative X-ray from femoral autograft bone was 97.0 ± 4.5% with an average improvement of 44.5%. Average CE improved from -9.5 ± 5.2° (CE I) to the immediate post-operative (CE II) of 40.6 ± 8.2°. At the final follow up, CE III showed a mean of 38.6 ± 6.2°, with an average decrease of 2.0°. Discussion: Acetabular bone defect in Crowe III DDH patients undergoing THA by DAA, can be efficiently managed by massive autograft femoral head, which allowed an adequate and long-lasting coverage of the implant, with cup positioning at the native acetabulum.
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4
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Bari YA, Chilmi MZ, Arianto HF, Soetojo BW. Morselized bone autograft for high placement of acetabular component closure with hip arthroplasty revision after 3-years screws and cup loosening: A case report. Int J Surg Case Rep 2022; 101:107789. [PMID: 36459851 PMCID: PMC9712815 DOI: 10.1016/j.ijscr.2022.107789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/20/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Aseptic loosening in high placement of the acetabular component seriously affects the hip and femoral head loads. Surgery revision is highly recommended with defect closure in previous place. CASE PRESENTATION A-40-year-old man came with chief complaint of right groin pain and noticeable leg length discrepancy gait. The first hip arthroplasty through pseudo-acetabulum cup was done three years ago after neglected femoral head necrosis due to eight years of unknown hip dislocation in vehicle accident. On hip x-ray there is a screws and cup loosening, without any sign of infection from blood or from soft tissue which undergoes pathological and mold examination. The patient than assessed with periprosthetic aseptic loosening of hip dextra and simple total hip arthroplasty revision using true acetabulum location was done. The pseudo-acetabulum area closed with morselized bone autograft. One weeks after surgery, the wound healed properly. Hence, the patient sent to the rehabilitation. CLINICAL DISCUSSION Hip arthroplasty revision of aseptic loosening in high placement acetabular component should perform by returning to anatomical acetabular position. Cancellous morselized bone autograft (MBA) was used to closed the defect formed by previous procedure. CONCLUSION Revision of hip arthroplasty combined with morselized bone autograft can be considered for high placement acetabular component defect closure to provide better stability and strength in weight loads transfer.
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Affiliation(s)
- Yunus Abdul Bari
- Department of Orthopedic and Traumatology, Universitas Airlangga Teaching Hospital, Surabaya, East Java, Indonesia,Corresponding author at: Department of Orthopedics, Universitas Airlangga Teaching Hospital, Jalan Dharmahusada Permai, East Java 60155, Indonesia.
| | - Mohammad Zaim Chilmi
- Department of Orthopedic and Traumatology, Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia
| | - Huda Fajar Arianto
- Department of Orthopedic and Traumatology, Universitas Airlangga Teaching Hospital, Surabaya, East Java, Indonesia
| | - Bagus Wibowo Soetojo
- Department of Orthopedic and Traumatology, Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia
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Cozzi Lepri A, Innocenti M, Galeotti A, Carulli C, Villano M, Civinini R. Trabecular titanium cups in acetabular revision arthroplasty: analysis of 10-year survivorship, restoration of center of rotation and osteointegration. Arch Orthop Trauma Surg 2022; 142:3523-3531. [PMID: 34782910 DOI: 10.1007/s00402-021-04243-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022]
Abstract
AIMS In case of severe bone loss, acetabular revision can be challenged using extra porous pure trabecular titanium (TT) revision cups designed to ensure enhanced iliac and ischiatic purchase. Aim of the study is to report on the clinical and radiological results of a TT acetabular component, evaluating functional outcome, restoration of the hip center of rotation and osteointegration. METHODS 85 patients, who underwent acetabular revision with a TT revision cup system between October 2009 and December 2018, were included in a retrospective study. Clinical outcome were assessed with Harris Hip Score (HHS). The hip rotation center was measured using the Pierchon method on the AP pelvis film. Loosening of the cup was determined according to the Kosashvili modification of Gill's criteria. Kaplan- Meier survivorship curve was performed. Results The mean follow-up was 6.12 years. The average HHS improved from 54.7 points to 89.7 points (p < 0.05). Two acetabular components (2.3%) were re-revised after a mean of 5.6 years, for aseptic loosening and for infection, with a progressive radiolucency and a > 5 mm vertical migration, respectively. The radiographic evaluation of the position of the hip rotation center revealed a statistically significant difference (p < 0.05) between the pre- and post-operative values. The hip rotation center was correctly restored within 5% of the reference Pierchon values in a percentage of 85.4% relative to horizontal parameters and within 8% in a percentage of 66.7% relative to vertical parameters. 5-year and 10-year survivorships were, respectively, 100% and 88%. CONCLUSIONS In case of severe bone loss, TT revision cup system allows for good restoration of center of rotation and osteointegration showing good 10-year survival rate.
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Affiliation(s)
- Andrea Cozzi Lepri
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy.
| | - Matteo Innocenti
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
| | - Alberto Galeotti
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
| | - Christian Carulli
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
| | - Marco Villano
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
| | - Roberto Civinini
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
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Singh A, Telagareddy K, Kumar P, Singh S, Singh RN, Singh PK. THA in patients with neglected acetabular fractures. SICOT J 2022; 8:37. [PMID: 36040232 PMCID: PMC9426301 DOI: 10.1051/sicotj/2022028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/12/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction: Total hip arthroplasty (THA) outcomes in patients with neglected acetabular fractures are less favourable compared to THA for osteoarthritis or inflammatory arthritis. These poorer clinical outcomes are largely due to an unexpected bone deficiency, and the procedure is more time-consuming and complicated for cases that require acetabular reconstruction and bone grafting. The clinical outcomes of THA in neglected acetabular fractures are not often studied. Methods: This study is a retrospective single surgeon series of THA for 51 neglected acetabular fractures in 49 patients treated with THA alone, open reduction and internal fixation with THA, or acetabular defect reconstruction THA. Our series aims to focus on the surgical technique and describe the functional and radiological outcomes of neglected acetabular fractures treated with different THA approaches by a single surgeon. Results: Using the Harris Hip score at the mean long-term follow-up, there was a clear improvement in 90% of patients in the present study. The long-term results are encouraging in terms of clinical improvement, radiographic restoration of acetabular bone stock, and the centre of restoration. Discussion: The series shows that with proper planning and reconstruction using structural bone grafting techniques, a neglected fracture-dislocation with loss of structural support can be satisfactorily treated using primary components alone. Bony reconstruction and use of primary cementless components ensure long-term survival and preserve bone stock for an easier revision of THA, if necessary, in the future.
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Affiliation(s)
- Ashish Singh
- Anup Institute of Orthopaedics and Rehabilitation, Patna, 800020 Bihar, India
| | | | - Purushotam Kumar
- Anup Institute of Orthopaedics and Rehabilitation, Patna, 800020 Bihar, India
| | - Sushil Singh
- Anup Institute of Orthopaedics and Rehabilitation, Patna, 800020 Bihar, India
| | | | - Pankaj Kumar Singh
- Anup Institute of Orthopaedics and Rehabilitation, Patna, 800020 Bihar, India
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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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Stirling P, Viamont-Guerra MR, Strom L, Chen AF, Saffarini M, Nover L, Laude F. Does Cup Position at the High Hip Center or Anatomic Hip Center in THA for Developmental Dysplasia of the Hip Result in Better Harris Hip Scores and Revision Incidence? A Systematic Review. Clin Orthop Relat Res 2021; 479:1119-1130. [PMID: 33539054 PMCID: PMC8051996 DOI: 10.1097/corr.0000000000001618] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 12/03/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND One goal of THA is to restore the anatomic hip center, which can be achieved in hips with developmental dysplasia by placing cups at the level of the native acetabulum. However, this might require adjuvant procedures such as femoral shortening osteotomy. Another option is to place the cup at the high hip center, potentially reducing surgical complexity. Currently, no clear consensus exists regarding which of these cup positions might offer better functional outcomes or long-term survival. QUESTION/PURPOSE We performed a systematic review to determine whether (1) functional outcomes as measured by the Harris hip score, (2) revision incidence, and (3) complications that do not result in revision differ based on the position of the acetabular cup (high hip center versus anatomic hip center) in patients undergoing THA for developmental dysplasia of the hip (DDH). METHODS We performed a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, including studies comparing the functional outcomes, revision incidence, and complications of primary THA in dysplastic hips with acetabular cups placed at the high hip center versus those placed at the anatomic hip center, over any time frame. The review protocol was registered with PROSPERO (registration number CRD42020168183) before commencement. Of 238 records, eight comparative, retrospective nonrandomized studies of interventions were eligible for our systematic review, reporting on 207 hips with cups placed at the high hip center and 268 hips with cups at the anatomic hip center. Risk of bias within eligible studies was assessed using the Risk Of Bias In Non-randomized Studies of Interventions tool. Due to low comparability between studies, data could not be pooled, so these studies were assessed without summary effects. RESULTS Six studies compared Harris hip scores, two of which favored high hip center cup placement and three of which favored anatomic hip center cup placement, although none of the differences between cohorts met the minimum clinically important difference. Five studies reliably compared revision incidence, which ranged from 2% to 9% for high hip center at 7 to 15 years and 0% to 5.9% for anatomic hip center at 6 to 16 years. Five studies reported intra- and postoperative complications, with the high hip center being associated with higher incidence of dislocation and lower incidence of neurological complications. No clear difference was observed in intraoperative complications between the high hip center and anatomic hip center. CONCLUSION No obvious differences could be observed in Harris hip score or revision incidence after THA for osteoarthritis secondary to DDH between cups placed at the anatomic hip center and those placed at the high hip center. Placement of the acetabular cup in the high hip center may lead to higher risk of dislocation but lower risk of neurologic complications, although no difference in intraoperative complications was observed. Surgeons should be able to achieve satisfactory functional scores and revision incidence using either technique, although they should be aware of how their choice influences hip biomechanics and the need for adjunct procedures and associated risks and operative time. These recommendations should be considered with respect to the several limitations in the studies reviewed, including the presence of serious confounding factors and selection biases, inconsistent definitions of the high hip center, variations in dysplasia severity, small sample sizes, and follow-up periods. These weaknesses should be addressed in well-designed future studies. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Patrick Stirling
- P. Stirling, L. Strom, M. Saffarini, L. Nover, ReSurg SA, Nyon, Switzerland
- P. Stirling, ReSurg UK, Herefordshire, UK
- M.-R. Viamont-Guerra, F. Laude, Ramsay Santé, Clinique du Sport Paris V, Paris, France
- M.-R. Viamont-Guerra, Hip Surgery Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
- A. F. Chen, Department of Orthopaedics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maria-Roxana Viamont-Guerra
- P. Stirling, L. Strom, M. Saffarini, L. Nover, ReSurg SA, Nyon, Switzerland
- P. Stirling, ReSurg UK, Herefordshire, UK
- M.-R. Viamont-Guerra, F. Laude, Ramsay Santé, Clinique du Sport Paris V, Paris, France
- M.-R. Viamont-Guerra, Hip Surgery Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
- A. F. Chen, Department of Orthopaedics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Louise Strom
- P. Stirling, L. Strom, M. Saffarini, L. Nover, ReSurg SA, Nyon, Switzerland
- P. Stirling, ReSurg UK, Herefordshire, UK
- M.-R. Viamont-Guerra, F. Laude, Ramsay Santé, Clinique du Sport Paris V, Paris, France
- M.-R. Viamont-Guerra, Hip Surgery Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
- A. F. Chen, Department of Orthopaedics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Antonia F. Chen
- P. Stirling, L. Strom, M. Saffarini, L. Nover, ReSurg SA, Nyon, Switzerland
- P. Stirling, ReSurg UK, Herefordshire, UK
- M.-R. Viamont-Guerra, F. Laude, Ramsay Santé, Clinique du Sport Paris V, Paris, France
- M.-R. Viamont-Guerra, Hip Surgery Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
- A. F. Chen, Department of Orthopaedics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mo Saffarini
- P. Stirling, L. Strom, M. Saffarini, L. Nover, ReSurg SA, Nyon, Switzerland
- P. Stirling, ReSurg UK, Herefordshire, UK
- M.-R. Viamont-Guerra, F. Laude, Ramsay Santé, Clinique du Sport Paris V, Paris, France
- M.-R. Viamont-Guerra, Hip Surgery Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
- A. F. Chen, Department of Orthopaedics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Luca Nover
- P. Stirling, L. Strom, M. Saffarini, L. Nover, ReSurg SA, Nyon, Switzerland
- P. Stirling, ReSurg UK, Herefordshire, UK
- M.-R. Viamont-Guerra, F. Laude, Ramsay Santé, Clinique du Sport Paris V, Paris, France
- M.-R. Viamont-Guerra, Hip Surgery Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
- A. F. Chen, Department of Orthopaedics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Frederic Laude
- P. Stirling, L. Strom, M. Saffarini, L. Nover, ReSurg SA, Nyon, Switzerland
- P. Stirling, ReSurg UK, Herefordshire, UK
- M.-R. Viamont-Guerra, F. Laude, Ramsay Santé, Clinique du Sport Paris V, Paris, France
- M.-R. Viamont-Guerra, Hip Surgery Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
- A. F. Chen, Department of Orthopaedics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Hamrayev AJ, Buyukkuscu MO, Misir A, Gursu SS. The fate of femoral head autograft in acetabular reconstruction in dysplastic hips at midterm. J Orthop Surg (Hong Kong) 2021; 28:2309499020957109. [PMID: 32996378 DOI: 10.1177/2309499020957109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate the acetabular cup and graft survival in patients who underwent total hip arthroplasty (THA) with the diagnosis of dysplastic hip osteoarthritis and received a femoral head autograft due to acetabular coverage deficiency. METHODS Between January 2005 and December 2016, 83 hip prostheses of 80 patients who underwent THA using femoral head autografts and were followed up for at least 2 years were retrospectively evaluated. Seventy-four hips of the remaining 71 patients (57 female (80%)) were included. Mean patient age at surgery was 51 ± 16 (range 18-76) years. The mean follow-up duration was 76 ± 25 (range 25-161) months. Acetabular inclination and graft thickness, contact length, percentage of coverage, and graft resorption were examined on postoperative and final follow-up radiographs. The presence of a radiolucent area around the acetabular and femoral components indicating loosening was also evaluated. RESULTS The mean postoperative acetabular component inclination was 44 ± 5.1° (range 30-48°) with mean graft coverage of 34 ± 4.8% (range 24-46%). In all patients, autograft union with the pelvis was seen and the lateral overflow was remodeled. Fifteen patients (20%) underwent revision surgery due to aseptic acetabular component loosening in four, nontraumatic recurrent dislocations in eight, periprosthetic infection in one, acetabular component protrusion in one, and traumatic hip dislocation in one. CONCLUSION In patients with osteoarthritis secondary to developmental hip dysplasia, the use of femoral head autografts to eliminate acetabular coverage deficiency during THA achieves acceptable midterm postoperative radiological outcomes. Increased acetabular bone stock may be beneficial in possible future revision surgeries.
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Affiliation(s)
- Arif Jan Hamrayev
- Department of Orthopaedics and Traumatology, 147008Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Ozbey Buyukkuscu
- Department of Orthopaedics and Traumatology, 147020Health Science University Gaziosmanpasa Education and Research Hospital, Istanbul, Turkey
| | - Abdulhamit Misir
- Department of Orthopaedics and Traumatology, 147020Health Science University Gaziosmanpasa Education and Research Hospital, Istanbul, Turkey
| | - Sukru Sarper Gursu
- Department of Orthopaedics and Traumatology, 147008Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
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10
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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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11
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Shen J, Sun J, Ma H, Du Y, Li T, Zhou Y. High Hip Center Technique in Total Hip Arthroplasty for Crowe Type II-III Developmental Dysplasia: Results of Midterm Follow-up. Orthop Surg 2020; 12:1245-1252. [PMID: 32776482 PMCID: PMC7454156 DOI: 10.1111/os.12756] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/13/2020] [Accepted: 06/21/2020] [Indexed: 12/19/2022] Open
Abstract
Objectives We aimed to show the utility of high hip center technique used in patients with Crowe II–III developmental dysplasia of the hip at the midterm follow‐up and evaluated the clinical and radiographic results between different heights of hip center. Methods From December 2003 to November 2013, we retrospectively evaluated 69 patients (85 hips) with Crowe II–III dysplasia who underwent a high hip center cementless total hip arthroplasty. The patients were divided into two groups according to the height of hip center, respectively group A (≥ 22 mm and < 28 mm) and group B (≥28 mm). The survivorship outcomes and radiographic and clinical results, including the vertical and horizontal distances of hip center, femoral offset, abductor lever arm, cup inclination, leg length discrepancy, Trendelenburg sign, and limp were evaluated. Results The mean follow‐up time was 8.9 ± 1.8 years. The mean location of the hip center from the inter‐teardrop was 25.1 ± 1.6 mm vertically and 30.0 ± 3.8 mm horizontally in group A, and 33.1 ± 4.8 mm vertically and 31.4 ± 6.1 mm horizontally in group B. Eleven hips of group B showed a lateralization over 10 mm, and the same was shown in one hip in group A (P = 0.012). There were no statistically significant differences between two groups in postoperative femoral offset, abductor lever arm, leg length discrepancy and cup inclination. At the final follow up, the mean WOMAC and Harris hip score were significantly improved in both groups. Of the 85 hips, four hips in group A and three hips in group B showed a positive Trendelenburg sign. Additionally, four patients in group A and two patients in group B presented with a limp. No significant differences were shown regarding the Harris hip score, WOMAC score, Trendelenburg sign, and limp between two groups. One hip of group A was revised by reason of dislocation at 8.3 years after surgery. One hip of group B was diagnosed with osteolysis and underwent a revision at 8.1 years after surgery. The Kaplan–Meier implants survivorship rates at the final follow‐up for all‐causes revisions in group A and group B were similar (96.7% [95% confidence interval, 90.5%–100%] and 96.2% [95% confidence interval, 89.0%–100%], respectively). Conclusions The high hip center technique is a valuable alternative to achieve excellent midterm results for Crowe II–III developmental dysplasia of the hip. Further, between the groups with differing degrees of HHC, there were no significant differences in outcomes or survivorship in our study.
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Affiliation(s)
- Junmin Shen
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jingyang Sun
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Haiyang Ma
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yinqiao Du
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Tiejian Li
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yonggang Zhou
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Orthopedics, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
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12
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Mussa M, Dewan V, Isbister E. Two stage cementation and screw augmentation of large acetabular defects in low demand patients: Early results and surgical technique. J Orthop 2020; 18:23-27. [PMID: 32189878 PMCID: PMC7068009 DOI: 10.1016/j.jor.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 07/27/2019] [Accepted: 09/10/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The reconstruction of large acetabular defects in revision hip arthroplasty represents a challenge to the surgeon and increases the complexity of the case. There are different options to overcome the problem of acetabular deficiency. In the elderly low demand patients, the main objective of revision surgery is to provide pain relief, allow immediate full weight bearing, and an early return to function. METHODS This article presents our experience in acetabular revision surgery using a novel technique of two stage cementation and screw augmentation in low demand patients. We report on the surgical technique and present the early results in 10 patients. RESULTS There were 6 females and 4 males with average age of 83.8 years. Patients were followed up for an average of 18.1 months. All patients were pain free and full weight bearing at the time of the final follow up with radiographs showing maintenance of implant position. None of the patients underwent revision surgery and there were no radiographic signs of failure detected in the early follow-up period. CONCLUSION This is a suitable technique in the management of large acetabular defects in revision hip arthroplasty, especially in the low demand patient population. It is a simple cost-effective technique that reduces the complexity of the acetabular revision, operative time, and morbidity associated with prolonged complex revision surgery.
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Affiliation(s)
- Mohamed Mussa
- The Royal Wolverhampton NHS Trust, Wolverhampton, UK
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13
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Moussa A, Rahman S, Xu M, Tanzer M, Pasini D. Topology optimization of 3D-printed structurally porous cage for acetabular reinforcement in total hip arthroplasty. J Mech Behav Biomed Mater 2020; 105:103705. [PMID: 32279849 DOI: 10.1016/j.jmbbm.2020.103705] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/07/2020] [Accepted: 02/16/2020] [Indexed: 01/12/2023]
Abstract
Aseptic loosening and mechanical failure of acetabular reinforcement components are among the main causes of their reduced service life. Current acetabular implants typically feature a structural solid layer that provides load bearing capacity, coated with a foam of uniform porosity to reduce stress shielding and implant loosening. This paper presents an alternative concept for a 3D printed cage that consists of a multifunctional fully porous layer with graded attributes that integrate both structural function and bone in-growth properties. The design comprises a hemispherical cup affixed to a superior flange with architecture featuring an optimally graded porosity. The methodology here presented combines an upscaling mechanics scheme of lattice materials with density-based topology optimization, and includes additive manufacturing constraints and bone ingrowth requirements in the problem formulation. The numerical results indicate a 21.4% reduction in the maximum contact stress on the bone surface, and a 26% decrease in the bone-implant interface peak micromotion, values that are indicative of enhanced bone ingrowth and implant long-term stability.
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Affiliation(s)
- Ahmed Moussa
- Department of Mechanical Engineering, McGill University, Montreal, Quebec, H3A0C3, Canada
| | - Shakurur Rahman
- Department of Mechanical Engineering, McGill University, Montreal, Quebec, H3A0C3, Canada
| | - Manman Xu
- Department of Mechanical Engineering, McGill University, Montreal, Quebec, H3A0C3, Canada
| | - Michael Tanzer
- Division of Orthopaedics, Department of Surgery, McGill University, Jo Miller Orthopaedic Research Laboratory, Montreal, Quebec, H3G1A4, Canada
| | - Damiano Pasini
- Department of Mechanical Engineering, McGill University, Montreal, Quebec, H3A0C3, Canada.
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14
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Theil C, Schmidt-Braekling T, Gosheger G, Moellenbeck B, Schwarze J, Dieckmann R. A single centre study of 41 cases on the use of porous tantalum metal implants in acetabular revision surgery. BMC Musculoskelet Disord 2019; 20:238. [PMID: 31113411 PMCID: PMC6530026 DOI: 10.1186/s12891-019-2626-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/14/2019] [Indexed: 12/21/2022] Open
Abstract
Background This study aims at investigating cup survival of porous tantalum revision cups and identifies risk factors for failure. Methods We retrospectively reviewed 41 patients treated between 2010 and 2012. Main indications were aseptic loosening in 83% and two-stage exchange after periprosthetic joint infection in 17% of cases. Mean follow-up period was 72 months. Femoral megaprostheses were used in 13% of cases. Most defects were classified as Paprosky 3b (29%). Function was assessed using the Harris Hip score. Results Aseptic cup survivorship was 80% at 104 months (95% Confidence Interval 67.4–92.4). Overall implant survival was 73%. Major bone loss defects (Paprosky types 2c to 3b) were associated with a significantly higher rate of failure than minor defects (P = 0.002). There were eight cases of aseptic loosening (19.5%) and two of infection (4.9%). Previous surgeries, indication for acetabular revision, patient-related risk factors and use of megaprostheses did not significantly influence implant survival. The Harris Hip Score improved from a median of 40 (Interquartile range 31–45) to 82 (interquartile range 65–88) postoperative (P < 0.0001). Conclusions In summary, the use of porous tantalum metal implants in acetabular revision surgery achieves good to excellent short- term and mid-term functional results and an acceptable complication rate relative to the extent of defect and previous surgery. However, one should be aware of potential limitations of the implants in addressing large defects and discontinuity.
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Affiliation(s)
- Christoph Theil
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Tom Schmidt-Braekling
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Burkhard Moellenbeck
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Jan Schwarze
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Ralf Dieckmann
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
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15
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Berninger MT, Hungerer S, Friederichs J, Stuby FM, Fulghum C, Schipp R. Primary Total Hip Arthroplasty in Severe Dysplastic Hip Osteoarthritis With a Far Proximal Cup Position. J Arthroplasty 2019; 34:920-925. [PMID: 30755380 DOI: 10.1016/j.arth.2019.01.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/28/2018] [Accepted: 01/14/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Developmental hip dysplasia is the most common cause of secondary hip osteoarthritis. Due to severe acetabular bone deficiency, cup positioning in total hip arthroplasty (THA) of dysplastic hips remains a surgical challenge. The aim was to analyze the functional outcome of far proximal cup positions in primary THA. METHODS Fifty patients (61 hips) with THA for severe dysplastic osteoarthritis and a far proximal cup position were included. Patients were divided according to the heights of the implanted cups with increasing vertical distance from the interteardrop line (group A: 55-65 mm, group B: 65-75 mm, group C: >75 mm). Functional outcome was assessed at latest follow-up (38 ± 16 months) by Lower Extremity Functional Score, Tegner Activity Score, and Harris Hip Score (HHS). Patients answered a Patient Satisfaction Questionnaire. Leg length discrepancy was estimated radiographically. RESULTS The Lower Extremity Functional Score significantly decreased in C (45.3 ± 25) compared to A (66.7 ± 15.3) and B (67.9 ± 9.9). The Tegner Activity Score significantly increased in all subgroups from preoperative to postoperative (2.2 ± 1.3 to 4.1 ± 1.4; P < .05). The mean overall HHS was 89.3 ± 14.7 (A: 89.5 ± 14.3, B: 94.3 ± 6.5, C: 78.3 ± 22.1). The HHS domains of activity of daily life and gait were significantly reduced in C (P < .05). Patients described a high satisfaction level with the surgery. No significant differences were found with regard to preoperative and postoperative leg lengthening (P = .881). Neither dislocations, impingement problems nor neurologic complications were observed. CONCLUSION Primary THA without any concomitant surgical interventions with a far proximal cup position offers a safe and effective treatment option in severe dysplastic hip osteoarthritis.
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MESH Headings
- Acetabulum/surgery
- Adult
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/rehabilitation
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Female
- Hip Dislocation/surgery
- Hip Dislocation, Congenital/complications
- Hip Dislocation, Congenital/surgery
- Hip Prosthesis
- Humans
- Male
- Middle Aged
- Osteoarthritis, Hip/etiology
- Osteoarthritis, Hip/surgery
- Recovery of Function
- Retrospective Studies
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Markus T Berninger
- Department of Trauma Surgery, BG Trauma Center Murnau, Murnau, Germany; Endogap, Joint Replacement Institute, Garmisch-Partenkirchen Medical Center, Garmisch-Partenkirchen, Germany
| | - Sven Hungerer
- Department of Trauma Surgery, BG Trauma Center Murnau, Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University Salzburg and BG Trauma Center Murnau, Murnau, Germany
| | - Jan Friederichs
- Department of Trauma Surgery, BG Trauma Center Murnau, Murnau, Germany
| | - Fabian M Stuby
- Department of Trauma Surgery, BG Trauma Center Murnau, Murnau, Germany
| | - Christian Fulghum
- Endogap, Joint Replacement Institute, Garmisch-Partenkirchen Medical Center, Garmisch-Partenkirchen, Germany
| | - Rolf Schipp
- Endogap, Joint Replacement Institute, Garmisch-Partenkirchen Medical Center, Garmisch-Partenkirchen, Germany
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16
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Aprato A, Olivero M, Branca Vergano L, Massè A. Outcome of cages in revision arthroplasty of the acetabulum: a systematic review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:24-31. [PMID: 30714995 PMCID: PMC6503392 DOI: 10.23750/abm.v90i1-s.8081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIM OF THE WORK To investigate the clinical, radiological and functional outcomes of acetabular revisions with acetabular reinforcement rings and cages. METHODS A comprehensive literature study of international databases was performed. Inclusion criteria were cementless revisions, use of reinforcement rings, radiological and clinical follow-up, availability of full text in English, publication between January 1990 and July 2018. In a second further analysis, we selected only studies describing patients with more severe acetabular defects (AAOS 3, AAOS 4, Paprosky III). Data extracted included mean follow-up period, radiographic follow-up, functional scores, implant failures and survival rate. RESULTS We included in our review 1327 acetabular revisions described in 28 articles. The most commonly used reinforcement rings were Burch-Schneider ring, the Muller ring and the Ganz ring. Mean follow-up for all patients together was 8.8 years. Clinical or radiological signs of loosening were reported in 191 patients, 83 patients needed further acetabular revision for aseptic loosening and 41 patients received additional surgeries for septic loosening. The mean value of the Harris Hip Score reported at the last follow-up was 76.3. Nineteen articles fulfilled the criteria for further analysis about high-grade acetabular bone defects. We analyzed 649 revisions with mean follow-up period of 8.2 years. Clinical or radiological loosening was reported in 90 patients, additional acetabular revision was performed in 39 patients and 25 patients needed further surgeries for deep infection. CONCLUSION Acetabular revisions with cages are characterized by good survival rates and functional scores with a mean follow-up period of 8 years.
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17
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Ueno T, Kabata T, Kajino Y, Ohmori T, Yoshitani J, Tsuchiya H. Three-Dimensional Host Bone Coverage Required in Total Hip Arthroplasty for Developmental Dysplasia of the Hip and Its Relationship With 2-Dimensional Coverage. J Arthroplasty 2019; 34:93-101. [PMID: 30342952 DOI: 10.1016/j.arth.2018.09.082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/03/2018] [Accepted: 09/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In total hip arthroplasty, the minimum host bone coverage required on the cup for stable fixation has been previously reported; however, the coverage was generally evaluated on a 2-dimensional (2D) image and 3-dimensional (3D) coverage has not been well described. METHODS We used postoperative computed tomography images to retrospectively measure 3D cup coverage in 151 hips with developmental dysplasia of the hip that underwent primary total hip arthroplasty. The aims were to (1) determine the minimum requirement of the 3D coverage for stable cup fixation; (2) evaluate the relationship between 2D and 3D coverage; and (3) identify the factors associated with 2D-3D discrepancy, defined as follows: 2D-3D discrepancy = 2D coverage-3D coverage. RESULTS All cups showed stable fixation as demonstrated by bone ingrowth with an average postoperative period of 48 months. The minimum 3D coverage was 61.2%, with a mean value of 77.1% ± 6.7% and maximum value of 97.6%. We found a significant positive but poor relationship between 3D and 2D coverage (bone coverage index; r = 0.30). Consequently, the 2D-3D discrepancy varied greatly, with a mean value of -1.6% ± 12.3% (range, -36.5% to 32.2%). Multiple linear regression analyses confirmed that lower cup center and anterior tilt of the pelvis relative to the computed tomography table were independent factors associated with increasing 2D-3D discrepancy. CONCLUSION This study showed that 2D coverage, measured on a projected image, carries a risk of overestimation, especially in hips with the aforementioned features.
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Affiliation(s)
- Takuro Ueno
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tamon Kabata
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yoshitomo Kajino
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takaaki Ohmori
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Junya Yoshitani
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
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Developmental Dysplasia Treated With Cementless Total Hip Arthroplasty Utilizing High Hip Center Reconstruction: A Minimum 13-Year Follow-up Study. J Arthroplasty 2018; 33:2899-2905. [PMID: 29803578 DOI: 10.1016/j.arth.2018.04.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/16/2018] [Accepted: 04/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The primary aim of this study was to determine the clinical outcomes at 13-year follow-up of patients diagnosed with developmental dysplasia of the hip and subsequently treated with total hip arthroplasty (THA). The secondary aim was to investigate the effect of hip center location on clinical outcomes and polyethylene wear. METHODS We reviewed data from a consecutive series of 104 patients (123 hips) from a single center. Patients were treated with THA with the high hip center (HHC) technique using cementless acetabular shells and highly cross-linked liners. Radiographs were collected preoperatively and through 13-year follow-up to assess degree of dysplasia (Crowe classification), component positioning, occurrence of bone resorption, and polyethylene wear. The Harris Hip Score (HHS) was administered at 4 and 13 years. RESULTS No patients were lost to follow-up, and one was revised for femoral loosening. Radiolucency was seen in 20% of patients and was not associated with HHC (P = .560). No patients developed osteolysis. The wear rate was low for all patients (mean: 3 ± 19 μm/y) and not associated with HHC (P = .852). The median 13-year HHS was 91.9 (interquartile range: 84.8-97.0). There was a statistically significant decline from the 4- to 13-year HHS (P < .001) for the Crowe II-IV group, although 82% of these patients remained above 80 points at 13 years. The nondysplastic and Crowe I group showed no longitudinal change in HHS (P = .243). CONCLUSION This cup design and highly cross-linked polyethylene liner combination demonstrates excellent clinical outcomes, similar to THA for primary osteoarthritis, through 13-year follow-up in patients with various degrees of developmental dysplasia of the hip and HHC reconstructions.
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19
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Cadossi M, Garcia FL, Sambri A, Andreoli I, Dallari D, Pignatti G. A 2- to 7-Year Follow-Up of a Modular Iliac Screw Cup in Major Acetabular Defects: Clinical, Radiographic and Survivorship Analysis With Comparison to the Literature. J Arthroplasty 2017; 32:207-213. [PMID: 27449716 DOI: 10.1016/j.arth.2016.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/10/2016] [Accepted: 06/11/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Inadequate acetabular bone stock is a major issue in total hip arthroplasty, and several treatment options are available. Stemmed cups have been used in this scenario with variable results. A novel modular polyaxial uncemented iliac screw cup (HERM-BS-Sansone cup-Citieffe s.r.l., Calderara di Reno, Bologna, Italy) has been recently introduced to overcome the drawbacks of stemmed cups. In this retrospective study, we report the results of this cup in patients with large acetabular bone defects at 2- to 7-year follow-up. METHODS We evaluated a consecutive series of 121 hips (118 revisions and 3 complex primary arthroplasties) treated with this novel cup at a mean follow-up of 46 months. Kaplan-Meier survival analysis was performed with implant revision for any reason as a primary end point. Further survival analysis was performed excluding septic failures. Clinical outcome was assessed with the Harris Hip Score. RESULTS There had been 7 reoperations: 1 for aseptic loosening, 5 for deep infection, and 1 for recurrent dislocation. In 5 cases, the cup was removed; estimated survival rate at 5-year follow-up with implant removal for any reason was 95.6% (95% confidence interval = 91-99), and 98.3% (95% CI = 96-100) excluding those failed for infection. Mean Harris Hip Score at latest follow-up was 77 points (range, 44-95; standard deviation = 11.9). CONCLUSION The present findings show the short-term efficacy of the iliac screw cup with respect to implant survival. A longer follow-up and a larger number of patients are necessary to confirm the encouraging preliminary results.
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Affiliation(s)
| | - Flávio Luís Garcia
- Ribeirão Preto Medical School (University of São Paulo), Ribeirão Preto, São Paulo, Brazil
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Kwong-Ting H, Kam-Yiu W. Use of Structural Bone Graft for Reconstruction of Acetabular Defects in Primary Total Hip Arthroplasty: A 13-year Experience. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2016. [DOI: 10.1016/j.jotr.2015.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background/Purpose The purpose of this study was to evaluate the clinical and radiographic outcomes of primary cementless total hip arthroplasty (THA) with acetabular defect reconstruction using structural bone grafts. Methods Between 2001 and 2012, 10 hips in eight patients with uncontained superolateral acetabular bone defects were reconstructed with femoral head grafts at the time of primary cementless THA. The mean age at surgery was 61.7 years. Patients were followed-up for a mean of 5.8 years for evaluation. Results With either revision or loosening as endpoints, the survival rate of the structural grafts was 100%. Significant improvements in clinical outcomes in terms of the Visual Analogue Scale for Pain (from 9.5 to 3.3, p = 0.005) and Harris Hip Score (from 32.7 to 73.9, p = 0.005) were noted. Conclusion Uncontained superolateral acetabular bone defects can be effectively reconstructed with structural bone grafts during primary THA, with excellent short- to midterm survival rate and significantly improved clinical outcomes.
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Affiliation(s)
- Ho Kwong-Ting
- Department of Orthopaedics and Traumatology, Princess Margaret Hospital, Hong Kong, China
| | - Wong Kam-Yiu
- Department of Orthopaedics and Traumatology, Princess Margaret Hospital, Hong Kong, China
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Chen M, Luo ZL, Wu KR, Zhang XQ, Ling XD, Shang XF. Cementless Total Hip Arthroplasty With a High Hip Center for Hartofilakidis Type B Developmental Dysplasia of the Hip: Results of Midterm Follow-Up. J Arthroplasty 2016; 31:1027-34. [PMID: 26712347 DOI: 10.1016/j.arth.2015.11.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 10/26/2015] [Accepted: 11/16/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Acetabular reconstruction in adults with Hartofilakidis type B developmental dysplasia of the hip is a major technical challenge. The purpose of this retrospective study was to evaluate hip function and radiographic outcomes regarding high hip center at midterm follow-up. METHODS From January 1, 2007 to December 31, 2009, 37 patients who had Hartofilakidis type B developmental dysplasia of the hip underwent a primary total hip arthroplasty using a high hip center technique. Functional, radiographic, and survivorship outcomes were evaluated. RESULTS Of the 37 patients, 31 patients (83.8%) were available for the mean follow-up of 6.1 years (range, 1.5-7.6 years). Thirty-one cementless cups were located at an average vertical distance of 38.1 ± 3.3 mm and at a mean horizontal distance of 35.5 ± 3.4 mm. The mean ratio of the height of the hip center was 2.4% (range, 2.0%-2.9%). The Harris Hip Scores were improved from 50.3 points (range, 38-63 points) preoperatively to 92.3 points (range, 85-100 points) at the final follow-up (P < .001). Four patients continued to present with Trendelenburg gait pattern at the last follow-up. With use of revision for any reason and aseptic loosening as the end point, the 5-year survival rates were 90.3% (95% CI, 79.9%-100%) and 93.3% (95% CI, 84.3%-100%), respectively. CONCLUSIONS The high hip center technique in conjunction with a cementless acetabular component seems to be a valuable alternative to achieve satisfactory midterm outcomes for Hartofilakidis type B developmental dysplasia of the hip.
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Affiliation(s)
- Min Chen
- Department of Orthopaedics, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Zheng-Liang Luo
- Department of Orthopaedics, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Ke-Rong Wu
- Department of Orthopaedics, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Xiao-Qi Zhang
- Department of Orthopaedics, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Xiao-Dong Ling
- Department of Orthopaedics, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Xi-Fu Shang
- Department of Orthopaedics, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui Province, China
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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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Nawabi DH, Meftah M, Nam D, Ranawat AS, Ranawat CS. Durable fixation achieved with medialized, high hip center cementless THAs for Crowe II and III dysplasia. Clin Orthop Relat Res 2014; 472:630-6. [PMID: 23884804 PMCID: PMC3890163 DOI: 10.1007/s11999-013-3187-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A high hip center total hip arthroplasty (THA) for dysplasia allows more complete socket coverage by native bone at the expense of abnormal hip biomechanics. Despite poor results with cemented components, intermediate-term results with cementless cups at a high hip center have been promising, but there are few reports at long-term followup without bone graft. QUESTIONS/PURPOSES The purpose of this study was to examine (1) survivorship; 2) radiographic results; and 3) hip scores at a minimum of 10 years for patients treated with high hip center cementless THA for Crowe II and III dysplasia without bone graft. METHODS We reviewed charts and radiographs of 32 patients with Crowe II or III dysplasia who were treated with high hip center cementless THA; at a mean followup of 12 years (range, 10-21 years), 23 patients (27 hips) were available for review. We sought to medialize cups to the inner table to achieve bony coverage of > 75%. At final followup, the WOMAC and Harris hip scores were recorded. Radiographic analysis including computerized wear evaluation was performed. Radiographic parameters were compared with a control group of 23 patients with Crowe I dysplasia who had cementless cups placed at an anatomic hip center; among the high hip center reconstructions, we also compared wear between those in the superolateral and superomedial quadrants. RESULTS Kaplan-Meier survivorship for all-cause revisions was 97% (95% confidence interval, 79%-99%) in the high hip center group; this was no different from the anatomic hip center group. There were no revisions for acetabular loosening. Wear rates did not differ significantly between the high hip center and the control group, but lateralized high hip centers were associated with higher (p = 0.002) wear. Hip scores were excellent in both groups. CONCLUSIONS In Crowe II and III dysplasia, a high hip center cementless cup obviates the need for bone graft and provides durable fixation beyond 10 years. Medialization of these reconstructions seems important to decrease wear.
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Affiliation(s)
- Danyal H. Nawabi
| | - Morteza Meftah
| | - Denis Nam
| | - Amar S. Ranawat
| | - Chitranjan S. Ranawat
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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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Tikhilov RM, Shubnyakov II, Kovalenko AN, Totoyev ZA, Lyu B, Bilyk SS. THE STRUCTURE OF EARLY REVISIONS AFTER HIP REPLACEMENT. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2014. [DOI: 10.21823/2311-2905-2014-0-2-5-13] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Banerjee S, Issa K, Kapadia BH, Pivec R, Khanuja HS, Mont MA. Systematic review on outcomes of acetabular revisions with highly-porous metals. INTERNATIONAL ORTHOPAEDICS 2013; 38:689-702. [PMID: 24178061 DOI: 10.1007/s00264-013-2145-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/25/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of this study was to systematically review the literature and report the clinical and radiographic outcomes of highly-porous acetabular cups in revision settings. METHOD A literature search of four electronic databases of EMBASE, CINAHL-plus, PubMed, and SCOPUS yielded 25 studies reporting the outcomes of 2,083 revision procedures with highly-porous acetabular components. There was lack of high quality evidence (level I and level II studies) and only two studies with level III evidence, while the remainder were all level IV studies. In addition, a majority of the studies had small sample sizes and had short to mid-term follow-up. The mean age of the patients was 65 years (range, 58-72 years) and the mean follow-up was 3.6 years (range, two to six years). Outcomes evaluated were aseptic survivorship, Harris hip scores, migration rates, incidence of peri-acetabular radiolucencies and radiographic restoration of the hip centre. RESULTS The mean aseptic survivorship was 97.2% (range, 80-100%). The Harris hip scores improved from a mean pre-operative score of 42 points, (range, 29-75 points), to a mean postoperative score of 79 points (range, 69-94 points). The mean incidence of cup migration and prevalence of peri-acetabular radiolucencies was 2.4% (range, 0-8.8%) and 4.6% (range, 0-19%), respectively, at final follow-up. The vertical hip centre-of-rotation was restored significantly from a mean of 39.2 mm (range, 27.6-50 mm) pre-operatively, to a mean of 24.1 mm (range, 7.4-47 mm), postoperatively. CONCLUSION The short-term clinical and radiographic results of highly-porous metals in revision hip arthroplasty are excellent with a low rate of loosening in the presence of both major and minor bone loss.
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Affiliation(s)
- Samik Banerjee
- Department of Orthopaedic Surgery, Rubin Institute for Advanced Orthopaedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
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Baghdadi YMK, Larson AN, Sierra RJ. Restoration of the hip center during THA performed for protrusio acetabuli is associated with better implant survival. Clin Orthop Relat Res 2013; 471:3251-9. [PMID: 23703532 PMCID: PMC3773116 DOI: 10.1007/s11999-013-3072-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 05/13/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acetabular protrusio is an uncommon finding in hip arthritis. Several reconstructive approaches have been used; however the best approach remains undefined. QUESTIONS/PURPOSES Our purposes in this study were to (1) describe the THA survivorship for protrusio as a function of the acetabular component, (2) evaluate survivorship of the cup as a function of restoration of radiographic hip mechanics and offset, and (3) report the long-term clinical results. METHODS One hundred twenty-seven patients (162 hips) undergoing primary THA with acetabular protrusio were retrospectively reviewed. The mean age of the patients at surgery was 66±13 years, and the mean followup was 10±6 years (range, 2-25 years).The cup fixation was uncemented in 107 (83 with bone graft) and cemented in 55 hips (14 with bone graft). Preoperative and postoperative radiographs were reviewed for restoration of hip mechanics and offset. RESULTS The THA survival from aseptic cup revision at 15 years was 89% (95% CI, 75%-96%) for uncemented compared with 85% (95% CI, 68%-94%) for cemented cups. The risk of aseptic cup revision significantly increased by 24% (hazards ratio, 1.24; 95% CI, 1.02-1.5) for every 1 mm medial or lateral distance away from the native hip center of rotation to the prosthetic head center. Harris hip scores were improved by mean of 27±20 points (n=123) with a higher postoperative score for uncemented bone grafted compared with solely cemented cups (81±16 versus 71±20 points). CONCLUSIONS Restoring hip center of rotation using an uncemented cup with or without bone graft was associated with increased durability in our series. There was a 24% increase in the risk of aseptic cup revision for every 1 mm medial or lateral distance away from the native hip center to the prosthetic head center. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yaser M. K. Baghdadi
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
| | - A. Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
| | - Rafael J. Sierra
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
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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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Ma W, Zhang X, Zhang Y. The Comparative Analysis of a Novel Acetabular Component against Hemispherical Component in Case of Extensive Acetabular Bone Defects — A Study of Finite Element Analysis. INT J ADV ROBOT SYST 2013. [DOI: 10.5772/54561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Wenhui Ma
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Xuemin Zhang
- Department of Orthopaedic Surgery, Hebei National Defence Construction Hospital, Shijiazhuang, Hebei Province, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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Optimized design for a novel acetabular component with three wings. A study of finite element analysis. J Surg Res 2013; 179:78-86. [DOI: 10.1016/j.jss.2012.08.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 08/08/2012] [Accepted: 08/20/2012] [Indexed: 02/01/2023]
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Reconstruction of the rotation center of the hip after oblong cups in revision total hip arthroplasty. J Orthop Traumatol 2012; 14:39-49. [PMID: 23160803 PMCID: PMC3585906 DOI: 10.1007/s10195-012-0217-8] [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: 02/23/2012] [Accepted: 10/21/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The preoperative bone defect and the reconstruction of the center of rotation of the hip are critical in acetabular revision surgery. Uncemented oblong cups are employed in order to manage these issues. We analyzed the clinical results and rates of revision of two different uncemented oblong cups, the reconstruction of the center of rotation of the hip, as well as the rate of radiological loosening and possible risk factors. MATERIALS AND METHODS Forty-five patients (46 hips) underwent acetabular revision surgery using two different uncemented oblong cups. We assessed the clinical results and the survival rate for revision and aseptic loosening. Intraoperative bone loss was classified according to Paprosky, and acetabular reconstruction was assessed according to Ranawat. The mean follow-up was 7.2 years (range 4-11 years). RESULTS There were four re-revisions (three due to aseptic loosening); the survival rate for re-revision due to aseptic loosening was 60.1 % at seven years. The mean distance between the center of the femoral head prosthesis and the approximate center of the femoral head improved from 21.5 to 10.2 mm. Thirteen cups showed radiological loosening; the survival rate for radiological loosening at seven years was 40.54 %. A smaller postoperative horizontal distance was correlated with cup loosening. CONCLUSIONS Although optimal acetabular reconstruction can be achieved by using oblong uncemented cups in revision hip surgery, the clinical and radiological results are not encouraging. Excessive medialization of the cup may increase the rate of loosening.
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Dapuzzo MR, Sierra RJ. Acetabular considerations during total hip arthroplasty for hip dysplasia. Orthop Clin North Am 2012; 43:369-75. [PMID: 22819164 DOI: 10.1016/j.ocl.2012.05.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The wide spectrum of anatomic abnormalities that characterize hip dysplasia dictate the need for different reconstructive techniques when hip replacement is required. Multiple factors such as young age and high activity level of this patient population, coupled with the increased complexity of surgery, explain the somewhat elevated historical failure rate of hip arthroplasty in DDH and emphasize the need for careful analysis of each case and selection of the most appropriate reconstruction options. One particular problem specific to acetabular reconstruction is the deficient bone stock that may limit the ability to place the component fully on native bone at the true acetabular region. When standard techniques of reconstruction leave a significant portion of the component uncovered, the alternatives include acetabular augmentation with bone autograft, intentional high placement of the component, or medialization of the component with or without medial wall osteotomy. Uncemented sockets have provided promising midterm results with supplemental bone augmentation and are the authors' preferred method of treatment for hips with moderate dysplasia and anterolateral acetabular bone deficiency.
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Affiliation(s)
- Michele R Dapuzzo
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908, USA
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Yang S, Cui Q. Total hip arthroplasty in developmental dysplasia of the hip: Review of anatomy, techniques and outcomes. World J Orthop 2012; 3:42-8. [PMID: 22655221 PMCID: PMC3364316 DOI: 10.5312/wjo.v3.i5.42] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 02/20/2012] [Accepted: 05/13/2012] [Indexed: 02/06/2023] Open
Abstract
Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) presents many challenges to the reconstructive surgeon. The complex femoral and acetabular anatomy makes standard reconstruction technically challenging. Acetabular coverage can be improved by medialization of the component or augmentation of the deficient areas with bone graft. Femoral shortening osteotomies are considered in cases of severe dysplasia and frankly dislocated hips. Each patient’s unique anatomy dictates what options of reconstruction are available. The functional outcomes of THA in DDH are generally excellent, though higher rates of mechanical failure have been reported in this group. This article reviews the anatomy, classification, technical considerations, and outcomes of THA in patients with DDH.
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Patil N, Hwang K, Goodman SB. Cancellous impaction bone grafting of acetabular defects in complex primary and revision total hip arthroplasty. Orthopedics 2012; 35:e306-12. [PMID: 22385438 DOI: 10.3928/01477447-20120222-24] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The reconstruction of major acetabular bone defects during revision, conversion, and primary total hip arthroplasties (THAs) is challenging. We reviewed a consecutive series of 168 THAs (108 revisions, 8 conversions, and 52 primary THAs) performed by 1 surgeon (S.B.G.) between 1997 and 2008 using impaction bone grafting for acetabular reconstruction. Autograft, cancellous allograft croutons, and demineralized bone matrix were used to fill bone defects as needed. The acetabular bone deficiency was classified according to the American Academy of Orthopaedic Surgeons: type I, segmental deficiency with significant rim defect; type II, cavitary defects medially or posteriorly; type III, combined cavitary and segmental deficiency; type IV, pelvic discontinuity; and type V, arthrodesis. According to this method, 56 hips had type I, 31 hips had type II, 48 hips had type III, and 27 hips had type IV deficiencies. Of the 168 patients, 19 subsequently died of causes unrelated to the THA, and 11 were lost to follow-up. All patients had at least 2 years of follow-up. Average Harris Hip Score improved from 45.5±17.9 preoperatively to 81.1±16.5 postoperatively (P<.05) for revision THAs, from 40.0±11.3 preoperatively to 85.0±12.8 postoperatively (P<.05) for conversion THAs, and from 42.3±14.9 preoperatively to 85.0±12.0 postoperatively (P<.05) for primary THAs. All impaction grafted bone (allograft, autograft, or a combination) incorporated radiographically, thus restoring bone stock. Complications included 1 early infection, which was managed successfully with debridement and liner exchange, and 2 late infections that were managed successfully with staged revision. Two revisions required subsequent re-revision for late loosening. Two hip dislocations occurred, 1 of which required surgical treatment to place a constrained liner.
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Affiliation(s)
- Nilesh Patil
- Penn State Orthopedics, State College, Pennsylvania, 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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Affiliation(s)
- Scott M Sporer
- Department of Orthopaedic Surgery, Rush University Medical Center, 25 North Winfield Road, Suite 505, Winfield, IL 60190, USA
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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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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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Lerch M, Thorey F, von Lewinski G, Klages P, Wirth CJ, Windhagen H. An alternative treatment method to restore limb-length discrepancy in osteoarthritis with high congenital hip dislocation. Arch Orthop Trauma Surg 2009; 129:1593-9. [PMID: 19271228 DOI: 10.1007/s00402-009-0846-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Indexed: 10/21/2022]
Abstract
AIM The purpose of this study was to describe the rationale and to analyse the results of uncemented total hip arthroplasty (THA) in patients with osteoarthritis and congenital dislocation of the hip (CDH) prior to iliofemoral distraction. METHOD Twenty hips were followed-up for 5.8 years (1-12 years). First the THA components were implanted after soft tissue release. In the interval, iliofemoral distraction with an external distraction apparatus was conducted. The second surgery consisted of an open reduction. An iliofemoral distraction of 0.8 mm/day was monitored. The treatment time was 86 days (50-210 days). In 61 days (32-94 days) the hip joints were distracted for 51 mm (41-75 mm). RESULT The Harris Hip Score increased significantly by 47 points. The SF-36 health score showed a satisfying increase in all patients. CONCLUSION In experienced hands this method is a relatively safe procedure for limb-length equalization in patients with severe CDH.
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Affiliation(s)
- Matthias Lerch
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany.
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Symeonides PP, Petsatodes GE, Pournaras JD, Kapetanos GA, Christodoulou AG, Marougiannis DJ. The Effectiveness of the Burch-Schneider antiprotrusio cage for acetabular bone deficiency: five to twenty-one years' follow-up. J Arthroplasty 2009; 24:168-74. [PMID: 18534474 DOI: 10.1016/j.arth.2007.10.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Revised: 07/13/2007] [Accepted: 10/03/2007] [Indexed: 02/01/2023] Open
Abstract
From 1985 to 2001, the Burch-Schneider antiprotrusio cage (B-S APC) was implanted in 57 cases (55 patients) with massive acetabular deficiency. The B-S APC survived until the last review 5 to 21 years after operation in 89.5% of the cases, produced substantial pain relief, and increased range of hip motion and walking capacity. The 10.5% failure rate was due to aseptic loosening in 2 cases and mechanical failure in 4 cases. It appears that application of the B-S APC in extensive acetabular deficiency presents a durable solution provided that proper indications and technique are used.
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Affiliation(s)
- Panagiotis P Symeonides
- First Orthopaedic Department of the Aristotle University of Thessaloniki, Thessaloniki, Greece
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42
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Minimum ten-year results of a porous acetabular component for Crowe I to III hip dysplasia using an elevated hip center. J Arthroplasty 2009; 24:187-94. [PMID: 18534384 DOI: 10.1016/j.arth.2007.08.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Accepted: 08/02/2007] [Indexed: 02/01/2023] Open
Abstract
We conducted a retrospective study of the placement of porous-coated acetabular components using screws at more than 20 mm above the teardrop without structural bone graft for dysplastic hips to determine long-term outcome. Thirty hips (29 patients) were monitored for a mean of 15.2 years (range, 10.4-18.3 years) after surgery. Compared with 12 contralateral normal hips, the distance of the hip center from the teardrop was significantly high (26.8 +/- 4.8 and 13.4 +/- 2.7 mm P < .001); however, it was not laterally different (31. 5 +/- 5.1 and 31.7 +/- 5.0 mm). No acetabular components showed loosening. One metal shell was revised for wear and osteolysis. Morselized bone grafted in 25 hips was incorporated in all cases. Slight elevation of the hip center without lateralization in cementless cups fixed with screws was well tolerated for dysplastic hips.
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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: 68] [Impact Index Per Article: 4.0] [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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Sembrano JN, Cheng EY. Acetabular cage survival and analysis of factors related to failure. Clin Orthop Relat Res 2008; 466:1657-65. [PMID: 18299946 PMCID: PMC2505268 DOI: 10.1007/s11999-008-0183-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Accepted: 02/05/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED The reported results of acetabular cage reconstruction for pelvic deficiency are widely variable. Our primary question was: what is the survivorship of cage reconstruction with a primary end point of cage revision and secondary end points of radiographic loosening and any reoperation? Secondary questions were: which factors predict cage failure, and what is the functional outcome (SF-36, WOMAC, Harris hip score) of this reconstructive method? We reviewed 72 cage reconstructions in 68 patients. Minimum followup was 1.2 years (mean, 5.1 years; range, 1.2-10.7 years). Five-year cage revision-free survivorship was 87.8%. Five-year loosening-free and acetabular reoperation-free survivorships were 80.7% and 81.3%, respectively. No single preoperative factor (age, gender, severity of pelvic defect, degree of heterotopic ossification, difference in limb lengths and centers of rotation) or intraoperative factor (type of bone graft, type of cage, changes in limb length and center of rotation) predicted cage failure. Functional outcomes were 28.9 (SF-36 Physical Component), 52.4 (SF-36 Mental Component), 33.7 (WOMAC), and 44.2 (Harris). We judged these outcomes acceptable for this sometimes challenging problem. Future techniques for treating pelvic deficiency will need to be compared with these and other outcomes in the literature. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Jonathan N. Sembrano
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue S, R200, Minneapolis, MN 55454 USA
| | - Edward Y. Cheng
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue S, R200, Minneapolis, MN 55454 USA
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McMinn DJW, Daniel J, Ziaee H, Pradhan C. Results of the Birmingham Hip Resurfacing dysplasia component in severe acetabular insufficiency. ACTA ACUST UNITED AC 2008; 90:715-23. [DOI: 10.1302/0301-620x.90b6.19875] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The dysplasia cup, which was devised as an adjunct to the Birmingham Hip Resurfacing system, has a hydroxyapatite-coated porous surface and two supplementary neutralisation screws to provide stable primary fixation, permit early weight-bearing, and allow incorporation of morcellised autograft without the need for structural bone grafting. A total of 110 consecutive dysplasia resurfacing arthroplasties in 103 patients (55 men and 48 women) performed between 1997 and 2000 was reviewed with a minimum follow-up of six years. The mean age at operation was 47.2 years (21 to 62) and 104 hips (94%) were Crowe grade II or III. During the mean follow-up of 7.8 years (6 to 9.6), three hips (2.7%) were converted to a total hip replacement at a mean of 3.9 years (2 months to 8.1 years), giving a cumulative survival of 95.2% at nine years (95% confidence interval 89 to 100). The revisions were due to a fracture of the femoral neck, a collapse of the femoral head and a deep infection. There was no aseptic loosening or osteolysis of the acetabular component associated with either of the revisions performed for failure of the femoral component. No patient is awaiting a revision. The median Oxford hip score in 98 patients with surviving hips at the final review was 13 and the 10th and the 90th percentiles were 12 and 23, respectively.
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Affiliation(s)
- D. J. W. McMinn
- The McMinn Centre, 25 Highfield Road, Edgbaston, Birmingham B15 3DP, UK
| | - J. Daniel
- The McMinn Centre, 25 Highfield Road, Edgbaston, Birmingham B15 3DP, UK
| | - H. Ziaee
- The McMinn Centre, 25 Highfield Road, Edgbaston, Birmingham B15 3DP, UK
| | - C. Pradhan
- The McMinn Centre, 25 Highfield Road, Edgbaston, Birmingham B15 3DP, UK
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Type III acetabular defect revision with bilobed components: five-year results. Clin Orthop Relat Res 2008; 466:691-5. [PMID: 18264858 PMCID: PMC2505228 DOI: 10.1007/s11999-007-0079-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 11/12/2007] [Indexed: 01/31/2023]
Abstract
UNLABELLED Combined segmental and cavitary deficiencies of the acetabulum (American Academy of Orthopaedic Surgeons Type III) are a difficult problem that revision arthroplasty surgeons must tackle with increasing frequency. Porous-coated bilobed acetabular components are a reconstruction option that allows for increased host bone-prosthesis contact with restoration of the anatomic hip center without the use of a structural bone graft. Eleven consecutive Type III acetabular defects in 11 patients were revised with a porous-coated bilobed cup without a structural bone graft between January 1999 and January 2001 and prospectively followed. Average Harris hip scores improved from 36 preoperatively to 85 postoperatively. Radiographic analysis showed improvement in the average vertical displacement of the hip center. Average leg length discrepancies decreased from 34 mm preoperatively to 7 mm postoperatively. There have been no revisions performed or planned. Porous-coated bilobed acetabular components can provide good clinical and radiographic results at intermediate followup for treatment of Type III acetabular deficiencies. Bilobed components offer a viable option for reconstruction of Type III defects without the use of a structural bone graft or cement while maximizing the host bone-implant contact and restoring the native hip center. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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47
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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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Atilla B, Ali H, Aksoy MC, Caglar O, Tokgozoglu AM, Alpaslan M. Position of the acetabular component determines the fate of femoral head autografts in total hip replacement for acetabular dysplasia. ACTA ACUST UNITED AC 2007; 89:874-8. [PMID: 17673578 DOI: 10.1302/0301-620x.89b7.18417] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have reviewed 54 patients who had undergone 61 total hip replacements using bulk femoral autografts to augment a congenitally dysplastic acetabulum. There were 52 women and two men with a mean age of 42.4 years (29 to 76) at the time of the index operation. A variety of different prostheses was used: 28 (45.9%) were cemented and 33 (54.1%) uncemented. The graft technique remained unchanged throughout the series. Follow-up was at a mean of 8.3 years (3 to 20). The Hospital for Special Surgery hip score improved from a mean of 10.7 (4 to 18) pre-operatively to a mean of 35 (28 to 38) at follow-up. The position of the acetabular component was anatomical in 37 hips (60.7%), displaced less than 1 cm in 20 (32.7%) and displaced more than 1 cm in four (6.6%). Its cover was between 50% and 75% in 34 hips (55.7%) and less than 50% in 25 (41%). In two cases (3.3%), it was more than 75%. There was no graft resorption in 36 hips (59%), mild resorption in 21 (34%) and severe resorption in four (6%). Six hips (9.8%) were revised for aseptic loosening. The overall rate of loosening and revision was 14.8%. Overall survival at 8.3 years was 93.4%. The only significant factor which predicted failure was the implantation of the acetabular component more than 1 cm from the anatomical centre of rotation of the hip.
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Affiliation(s)
- B Atilla
- Department of Orthopaedics and Traumatology, Hacettepe University, Faculty of Medicine, 06100 Sihhiye, Ankara, Turkey
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Heller MO, Schröder JH, Matziolis G, Sharenkov A, Taylor WR, Perka C, Duda GN. [Musculoskeletal load analysis. A biomechanical explanation for clinical results--and more?]. DER ORTHOPADE 2007; 36:188, 190-4. [PMID: 17333071 DOI: 10.1007/s00132-007-1054-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Mechanical loading of the lower extremities due to muscle and joint contact forces plays an important role in orthopaedic and trauma surgery. Detailed, patient specific information on the in vivo forces and their distribution is, however, currently not readily available to the surgeon in clinical routine. The goal of this study was to elucidate the relationship between the position of the cup and the musculoskeletal loading conditions at the hip using validated analyses, and further, to evaluate the predictions of the biomechanical conditions against the results of a clinical study. The results indicate that restoring the anatomical hip centre to its anatomical mediolateral position could help to reduce joint loads and add to the longevity of the reconstruction. The routine use of validated analyses of musculoskeletal loading conditions, such as in the presented example using standardised pre-operative planning and sound intra-operative decision support systems, could contribute to securing a high standard in patient treatment.
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Affiliation(s)
- M O Heller
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin
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50
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Kawanabe K, Akiyama H, Onishi E, Nakamura T. Revision total hip replacement using the Kerboull acetabular reinforcement device with morsellised or bulk graft: results at a mean follow-up of 8.7 years. ACTA ACUST UNITED AC 2007; 89:26-31. [PMID: 17259411 DOI: 10.1302/0301-620x.89b1.18037] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We retrospectively evaluated 42 hips which had undergone acetabular reconstruction using the Kerboull acetabular reinforcement device between September 1994 and December 1998. We used autogenous bone chips from the ilium and ceramic particle morsellised grafts, even in large acetabular bone defects, in the early stages of the study. Thereafter, femoral head allograft was used as bulk graft in patients with large acetabular defects. Ceramic blocks and the patients' contralateral femoral head were also used as bulk graft. The mean follow-up period was 8.7 years (4.3 to 12). Survivorship analysis was performed using radiological failure of the acetabular component, irrespective of whether it was revised, or not, as the end-point. The survival rate of the morsellised graft group (25 hips) and the bulk graft group (17 hips) at ten years was 53% (95% confidence interval (CI) 42.5% to 63.5%) and 82% (95% CI 72.4% to 91.6%), respectively. The mid-term results of revision total hip replacement with the Kerboull device were better when bulk graft was used in any size of bone defect.
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Affiliation(s)
- K Kawanabe
- Department of Orthopaedic Surgery, Faculty of Medicine Kyoto University, Kyoto, Japan.
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