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Caylak R, Goksen A, Ors C, Togrul E. Iliopsoas Tenotomy Does Not Negatively Affect Hip Flexion Strength in Crowe 3 and 4 Hips Undergoing Total Hip Arthroplasty. J Arthroplasty 2025; 40:1265-1270. [PMID: 39477042 DOI: 10.1016/j.arth.2024.10.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 10/16/2024] [Accepted: 10/20/2024] [Indexed: 11/22/2024] Open
Abstract
BACKGROUND In total hip arthroplasty (THA), even if there is a dislocated hip, restoring the anatomical center of rotation increases long-term survival and hip function. Even with a shortening osteotomy, the procedure is still challenging due to soft-tissue tension. Therefore, soft tissue releases such as iliopsoas tenotomy may be necessary. In our study, we aimed to examine the effects of iliopsoas tenotomy on hip flexion and abduction strength in patients who underwent THA with shortening osteotomy for Crowe 3 and 4 hip dysplasia by using a hand dynamometer for measurement. METHODS The present study examined 27 patients who underwent THA with shortening osteotomy in unilateral Crowe 3 and 4 hips. The patients' hip flexion and abduction strengths were measured with a hand dynamometer preoperatively and in the first year postoperatively. RESULTS The average flexion strength of the operated side was less than the nonoperated side before surgery. It also decreased further in the first six weeks. But the strength increased in the 12th week and reached the same level as the non-operated side in the sixth month. The average abduction strength was less than the nonoperated side before the surgery, and it decreased further in the 6th week after surgery. However, the strength increased during follow-ups and reached the non-operated side strengths in the twelfth week. CONCLUSIONS In conclusion, during THA procedures for highly dislocated hips, releasing the iliopsoas tendon at the level of the minor trochanter to facilitate distalization of the hip center of rotation does not adversely affect hip flexion and abduction strengths. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Remzi Caylak
- Private Acibadem Ortopedia Hospital Hip Surgery Department, Seyhan Adana, Turkey
| | - Aysenur Goksen
- Tarsus University Faculty of Health Sciences Physiotherapy and Rehabilitation Department, Tarsus Mersin, Turkey
| | - Cagrı Ors
- Private Acibadem Ortopedia Hospital, Knee and Sport Surgery Department, Seyhan Adana, Turkey
| | - Emre Togrul
- Private Acibadem Ortopedia Hospital Hip Surgery Department, Seyhan Adana, Turkey
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Tikhilov RM, Volykhin RD, Bilyk SS, Kovalenko AN, Dzhavadov AA, Shubnyakov II. Primary total hip arthroplasty using custom-made acetabular implants in patients with high hip dislocation : surgical technique and results. Bone Jt Open 2025; 6:41-50. [PMID: 40306669 DOI: 10.1302/2633-1462.65.bjo-2024-0255.r1] [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] [Indexed: 05/02/2025] Open
Abstract
Aims Despite good results of using uncemented press-fit cups in patients with high hip dislocations (type C as per the Hartofilakidis classification), there are reports of loosening of these components. To improve the results on the acetabular side in patients with high hip dislocations, we used custom-made acetabular implants (CMAIs). The aim of this study was to evaluate the outcomes after total hip arthroplasty (THA) using CMAIs in patients with high hip dislocation. Methods We retrospectively analyzed the results of primary THA using the CMAIs in 58 hips (52 patients) from November 2017 to December 2019. All surgeries were performed using the femoral shortening osteotomy technique described by Paavilainen. Type C1 and C2 dislocations were observed in nine and 49 hips, respectively. The presence of various complications, functional results using the Oxford Hip Score (OHS), patient satisfaction, radiological parameters, and positioning of CMAIs were assessed. Results The mean follow-up period, including radiological follow-up for all 58 hips, was 5.2 years (4.2 to 6.3; SD 0.71). Patients demonstrated statistically significant improved functional outcomes according to the OHS (preoperatively 16.9 and postoperatively 38.5; p < 0.001). Four hips were revised: two hips due to dislocations, the cause of which was impingement of the greater trochanter due to malposition of the distally advanced greater trochanter after osteotomy. One hip was due to nonunion of the distally advanced greater trochanter after osteotomy, and one hip due to pain resulting from iliopsoas impingement caused by contact of the CMAI flange with the iliopsoas muscle. There were no radiological signs of loosening of the CMAIs. Any deviation of the CMAIs from the planned position was noted. Conclusion This preliminary study demonstrated that CMAIs may offer good bone fixation in patients with high hip dislocation; however, further biomechanical studies are needed to evaluate the use of CMAIs in terms of osseointegration, additional screw fixation, and to determine the effect of deviation of CMAIs from the planned position on clinically relevant complications.
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Affiliation(s)
- Rashid M Tikhilov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Rodion D Volykhin
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Stanislav S Bilyk
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Anton N Kovalenko
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Alisagib A Dzhavadov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Igor I Shubnyakov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
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Zhao R, Wang Y, Liu T, Ren H, Zhao R, Feng Z, Li P, Yang S, Lu J, Fan M, Ji Q, Zhang G. Measure Subtrochanteric Osteotomy in Unilateral Crowe-IV Dysplasia-Surgical Technique. Orthop Surg 2025; 17:962-970. [PMID: 39832726 PMCID: PMC11872374 DOI: 10.1111/os.14330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 11/30/2024] [Accepted: 12/01/2024] [Indexed: 01/22/2025] Open
Abstract
OBJECTIVE Determining the optimal osteotomy length for patients with unilateral Crowe-IV developmental dysplasia of the hip undergoing subtrochanteric osteotomy remains challenging due to the significant variability in pelvic and spinal alignment. Incorrect osteotomy length, compounded by pelvic or spinal tilt, can adversely affect postoperative gait and long-term outcomes. Therefore, this study could introduce a method to calculate the osteotomy length for patients with unilateral Crowe-IV developmental dysplasia of the hip, correcting spinal and pelvic tilt, and improving patient gait. METHODS This is a retrospective study that included 28 patients with unilateral Crowe-IV developmental dysplasia of the hip collected from June 2019 to June 2020, who underwent total hip arthroplasty with measured subtrochanteric osteotomy technique. The average follow-up period was 4.3 years (last follow-up). Harris scores, pelvic tilt angles represented by iliac obliquity angle (IO) and sacral obliquity angle (SO), and postoperative complications were recorded. Statistical analysis was performed using independent sample t-tests for normally distributed data and the Mann-Whitney U test for non-normally distributed data. RESULTS Postoperatively, pelvic tilt angles improved significantly. The comparison of preoperative and postoperative 3-month IO angles (8.77° ± 3.31° vs. 5.28° ± 2.29°, p = 0.00), and postoperative 3-month and last follow-up (5.28° ± 2.29° vs. 2.88° ± 1.39°, p = 0.00) showed statistically significant differences. Similarly, the comparison of preoperative and postoperative 3-month SO angles (9.56° ± 3.1° vs. 5.81° ± 2.78°, p = 0.00), and postoperative 3-month and last follow-up (5.81 °± 2.78° vs. 3.59° ± 1.72°, p = 0.00) showed statistically significant differences. Harris scores significantly improved from preoperative to 1-year postoperative (47.35 ± 12.32 vs. 80.5 ± 7.81, p = 0.00), and from 1-year postoperative to last follow-up (80.5 ± 7.81 vs. 90.78 ± 2.86, p = 0.00) with statistical significance. There were no significant differences in adverse event rates between the two groups. CONCLUSION Total hip arthroplasty combined with measurement subtrochanteric osteotomy technique improves pelvic tilt and Harris scores in Crowe-IV developmental dysplasia patients. This technique may serve as a guideline for determining resection length.
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Affiliation(s)
- Runkai Zhao
- Department of Orthopedic SurgeryThe General Hospital of the People's Liberation ArmyBeijingChina
| | - Yiming Wang
- Department of Orthopedic SurgeryThe General Hospital of the People's Liberation ArmyBeijingChina
| | - Te Liu
- Department of Orthopedic SurgeryThe General Hospital of the People's Liberation ArmyBeijingChina
| | - Haichao Ren
- Department of Orthopedic SurgeryThe General Hospital of the People's Liberation ArmyBeijingChina
| | - Runzhi Zhao
- Department of Orthopedic SurgeryThe Army Medical UniversityChongqingChina
| | - Zeyu Feng
- Department of Orthopedic SurgeryThe General Hospital of the People's Liberation ArmyBeijingChina
| | - Pengcheng Li
- Department of Orthopedic SurgeryThe General Hospital of the People's Liberation ArmyBeijingChina
| | - Shuai Yang
- Department of Orthopedic SurgeryThe General Hospital of the People's Liberation ArmyBeijingChina
| | - Juntao Lu
- Department of Orthopedic SurgeryThe General Hospital of the People's Liberation ArmyBeijingChina
| | - Menglin Fan
- Harbin Medical University Cancer HospitalHarbinChina
| | - Quanbo Ji
- Department of Orthopedic SurgeryThe General Hospital of the People's Liberation ArmyBeijingChina
| | - Guoqiang Zhang
- Department of Orthopedic SurgeryThe General Hospital of the People's Liberation ArmyBeijingChina
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Rai A, Nema SK, Madegowda A, Chouhan D, Garg AK. Similar Outcomes between Monoblock and Modular Femoral Stems in Total Hip Arthroplasty with Shortening Osteotomy for Dysplastic Hips at Five Years: A Systematic Review with Meta-analysis. Hip Pelvis 2025; 37:1-16. [PMID: 40012143 PMCID: PMC11885793 DOI: 10.5371/hp.2025.37.1.1] [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: 01/02/2024] [Revised: 02/02/2024] [Accepted: 02/15/2024] [Indexed: 02/28/2025] Open
Abstract
We aimed to examine the outcomes of arthritic congenital dislocation of hip in adults after subtrochanteric shortening derotation osteotomy (SSDO) with cementless hip arthroplasty at a minimum follow-up period of five years. Bibliographic databases were searched and isolated studies were divided into three groups (1, 2, and 3) based on the femoral stem type (modular, monoblock, or mixed). We pooled 931 hips/737 patients from 20 studies. The mean difference in the Harris hip score (HHS) before and after the operation was 47.55 (95% confidence interval [CI] 43.16, 51.94). On subgroup analysis the mean differences of 46.59 (95% CI 41.67, 51.51), 48.24 (95% CI 41.37, 55.11), and 47.30 (95% CI 43.85, 50.75), respectively in HHS were noted in groups 1, 2, and 3. The incidence of uncontrolled proximal femur fractures was comparable at 7.9% and 4.2% in groups 1 and 2; however, it was 0% and 16.6% for controlled fractures. The incidences of nonunion, dislocation, nerve paralysis, heterotopic ossification and revision due to any cause were 0.3%, 6.5%, 1.7%, 2.1%, and 7.9% for group 1 and 1.9%, 4.3%, 1.6%, 5.6%, and 7.4% for group 2. Similar improvements in functional outcome for both monoblock and modular stems can be expected. An increased incidence of controlled proximal femur fractures was observed with use of modular stems. The nonunion at the SSDO site was sporadic.
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Affiliation(s)
- Alok Rai
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Raipur, India
| | - Sandeep Kumar Nema
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Raipur, India
| | - Arkesh Madegowda
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Raipur, India
| | - Dushyant Chouhan
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Raipur, India
| | - Ankit Kumar Garg
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Raipur, India
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El-Ganzoury I, Ghazavi MT, Özden VE, Moreta J, Chaar O, Atipiboosin V, Bilgen ÖF, Inoue D, Liu P, Qin Y, Younis AS. Is There a Limit to Lengthening in Patients Who Have Crowe IV Developmental Dysplasia of the Hip Undergoing Total Hip Arthroplasty? J Arthroplasty 2025; 40:S132-S135. [PMID: 39447929 DOI: 10.1016/j.arth.2024.10.079] [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: 10/26/2024] Open
Affiliation(s)
| | - Mohammad T Ghazavi
- Department of Orthopedic Surgery, Scarborough Health Network, Toronto, Ontario, Canada
| | - Vahit Emre Özden
- Department of Orthopaedics and Traumatology, Acibadem Mehmet Ali Aydınlar University, İstanbul, Turkey; International Joint Center (IJC) Acibadem Maslak Hospital, Istanbul, Turkey
| | - Jesus Moreta
- Department of Orthopedic Surgery, Hospital San Juan De Dios, Santurtzi, Bilbao, Spain
| | - Oussama Chaar
- Burjeel Orthopaedic Institute, Abu Dhabi's Orthopaedic Institute, Abu Dhabi, United Arab Emirates
| | - Vorawit Atipiboosin
- Faculty of Medicine, Department of Orthopedics, Khonkaen University, Khonkaen, Thailand
| | - Ömer F Bilgen
- Department of Orthopaedics and Traumatology, Private Medicabil Hospital, Bursa, Turkey
| | - Daisuke Inoue
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Peilai Liu
- Department of Orthopaedics Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yanguo Qin
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, Jilin, China
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Hernigou P, Homma Y, Bastard C, Yoon BC, Lachaniette CHF. Subtrochanteric shortening osteotomy in adult sickle cell disease patients with cemented total hip arthroplasty for hip deformities secondary to childhood osteonecrosis: is healing a challenge? INTERNATIONAL ORTHOPAEDICS 2025; 49:407-419. [PMID: 39706872 PMCID: PMC11762774 DOI: 10.1007/s00264-024-06394-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Accepted: 12/12/2024] [Indexed: 12/23/2024]
Abstract
PURPOSE Hip deformity is frequent after childhood osteonecrosis in patients with sickle cell disease (SCD). When they are adults, they present a challenge as candidates for total hip arthroplasty (THA) because of abnormal bone development, their relative youth, and also because of their disease. Performing subtrochanteric osteotomy associated with THA is technically challenging, and healing of osteotomies has never been reported in this population with frequent osteonecrotic bone, whether using cemented or uncemented arthroplasties. METHODS We retrospectively analyzed 59 cemented THA with femoral corrective osteotomies (subtrochanteric shortening and transverse derotational osteotomy) performed on hip deformities between 1984 and 2018 in 59 sickle cell adult patients. The patient's age at the onset of osteonecrosis was an average of 8.4 years (6 to 10 years), and at the time of the THA was 28.6 years (19 to 41 years). All the patients had a minimum followup period of six years. Endocrinopathy was frequently associated to SCD Data and consequences were evaluated on bone union. The mechanical variables, such as the length of the resected femur, limb lengthening, the location of the osteotomy site, the size of the stem bridging the osteotomy, and any complications, were also analyzed. RESULTS The average length of the resected femoral segment was 38.4 mm. The length of the femoral stem (bridging the osteotomy) was average 13 cm. The mean osteotomy union time was 10.6 months. Twenty-four osteotomies healed in six months, six in nine months, and 29 in twelve months, while five required bone grafts at nine months. The union time of the osteotomy was average 10.6 months. Complications included four cases of transient nerve palsy, and five intraoperative femur perforations. No statistically significant relationship was found between osteotomy union time and mechanical variables. The severity of endocrinopathy associated with sickle cell disease prolonged the healing time. In three cases, cement leakage into the osteotomy gap occurred without resulting in non-healing. CONCLUSION Cemented THA, combined with a subtrochanteric femoral shortening with transverse derotational osteotomy, has a long union time but is effective for adult hip deformities of patients with sickle cell patients.
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Davulcu CD, Ozsahin MK, Kayaalp ME, Celayir A, Akbaba D, Unlu MC. Rectangular femoral stems can successfully accommodate the medullary canal in patients with severe hip dysplasia operated on with total hip arthroplasty and a shortening osteotomy: A morphometric study. Acta Orthop Belg 2024; 90:581-587. [PMID: 39869860 DOI: 10.52628/90.4.13095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2025]
Abstract
The current study aimed to objectively evaluate the fit of a rectangular, tapered stem to the severely dysplastic hips on the basis of the proximal femoral anatomy and the dimensional properties of the stem. It was hypothesized that the stem size planned with accordance to the diaphyseal canal width alone can accommodate the distal femur successfully with no sizing mismatch. Forty-six patients (53 hips) suffering from secondary osteoarthritis due to hip dysplasia scheduled for total hip arthroplasty (THA) with a subtrochanteric transverse shortening osteotomy were included. All hips were Crowe type 4. All patients underwent preoperative computed tomography imaging. Height of femoral head center (HCH) was determined. Medullary canal diameter measurements at different levels were made. These were made at a level (1) 35% of HCH above the lesser trochanter (DT +35), (2) 70% of HCH below the lesser trochanter (DT -70), and (3) at the level of isthmus (Di). Medullary canal flare indices were calculated from the individual parameter ratios. Similar measurements were carried out for the different sizes of the femoral stem. The mean DT +35 was 41.9 ± 6.4 mm, the mean DT-70 was 17.3 ± 2.2 mm, and the mean Di was 12.8 ± 1.9 mm. In all femurs, the width of the isthmus was wider than that of the corresponding femoral stem isthmus. The femoral stem sizes established with respect to the diaphyseal width of the femur were all compatible with the isthmus width of the femur. Tapered and rectangular stems can accommodate the proximal femur above and below the osteotomy level in Crowe type IV hip dyplasia patients, thereby constituting a viable option as the femoral stem in this patient group with technically demanding difficulties.
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Turgut N, Erdem M, Erdem AC, Bayam L, Batar S, Sağlam N, Gülabi D. Is step-cut shortening osteotomy a better choice than transverse osteotomy for total hip arthroplasty for Crowe type III-IV hip dysplasia? Orthop Traumatol Surg Res 2024; 110:103883. [PMID: 38583704 DOI: 10.1016/j.otsr.2024.103883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/22/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Total hip arthroplasty for developmental hip dysplasia is a challenging surgery due to anatomic abnormalities. Crowe III and Crowe IV hip dysplasia generally necessitates a subtrochanteric shortening osteotomy. Transverse and step-cut osteotomy are the most common procedures for shortening of femur although there is still no consensus which one is a superior method. The objective of this study was to demonstrate whether transverse or step-cut osteotomy is superior in hips who undergo arthroplasty for high riding hip dysplasia. HYPOTHESIS Our hypothesis was that higher rates of union would be achieved in patients with Crowe III-IV hip dysplasia when the step-cut osteotomy was performed compared to transverse osteotomies. MATERIAL AND METHODS A total of 99 hips from 90 patients (9 bilateral, 81 unilateral; 79 female, 11 male), each with a minimum follow-up duration of two years, were included in this study. The hips were classified as Crowe III (n=16) or IV (n=83). All hips were implanted cementless. Transverse or step-cut osteotomy was chosen for osteotomy type. The clinical and functional outcomes were assessed using the Harris Hip Score (HHS), limb length discrepancy (LLD), and limping. The complications and management of these were noted. The union rates were compared between osteotomy types. RESULTS The mean age at surgery was 48.8 (range, 21-79 years). The follow-up period was 64.3 months in average (range, 24 to 192 months). The mean Harris Hip Score before surgery was 35.6 (range, 18-50), and increased to 88.1 (range, 61-98) points at the most recent follow-up. The preoperative leg length discrepancy (LLD) measured 5.3cm (with a range of 3 to 6.8), while the postoperative LLD reduced to 0.8cm (with a range of 0 to 1.6). There were a total of 38 complications in 35 patients out of 99 cases, resulting in a complication rate of 38.4%. The most frequent complication observed was intraoperative femoral fractures, occurring in 13 cases. Residual limping was seen in 73.7% of all. Step-cut osteotomy was performed in 64 hips (35 CDH stem [Zimmer Biomet, Warsaw, IN, USA], 29 Wagner Cone stem [Zimmer Biomet, Warsaw, IN, USA]) and, transverse in 35 hips (22 CDH, 13 Wagner Cone). Six hips had nonunion problem and all of them were operated with a step-cut osteotomy (z-score: -7.12 and p<0.00001, Mann-Whitney U Test). CONCLUSION Transverse osteotomy may be a better option while performing a shortening subtrochanteric level osteotomy for total hip arthroplasty for Crowe III-IV hips. LEVEL OF EVIDENCE Level III; observational retrospective cohort study.
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Affiliation(s)
- Necmettin Turgut
- Başkent University, Adana Dr. Turgut Noyan Research and Training Centre, Department of Orthopedics and Traumatology, Adana, Turkey.
| | - Mehmet Erdem
- Sakarya University Faculty of Medicine, Department of Orthopedics and Traumatology, Sakarya, Turkey
| | - Ahmet Can Erdem
- Bezmialem Vakıf University Faculty of Medicine Department of Orthopedics and Traumatology, İstanbul, Turkey
| | - Levent Bayam
- İstanbul Medipol University, Department of Orthopedics and Traumatology, İstanbul, Turkey
| | - Suat Batar
- Ümraniye Training and Research Hospital, University of Health Sciences, Department of Orthopedics and Traumatology, İstanbul, Turkey
| | - Necdet Sağlam
- Ümraniye Training and Research Hospital, University of Health Sciences, Department of Orthopedics and Traumatology, İstanbul, Turkey
| | - Deniz Gülabi
- Marmara University Faculty of Medicine, Department of Orthopedics and Traumatology, İstanbul, Turkey
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Tikhilov RM, Dzhavadov AA, Ziganshin DR, Zakhmatov NS, Alekberov RR, Shubnyakov II. Cementless Total Hip Arthroplasty With Paavilainen Femoral Shortening Osteotomy Can Provide Good Results at 10 Years in Patients Who Have Crowe IV Developmental Dysplasia of the Hip. J Arthroplasty 2024; 39:2316-2322. [PMID: 38614357 DOI: 10.1016/j.arth.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND The aim of this study was to present the clinical and radiologic results of primary total hip arthroplasty (THA) using the femoral shortening osteotomy technique described by Paavilainen in patients who have Crowe IV developmental dysplasia of the hip. METHODS We retrospectively analyzed the results of primary THA using the Paavilainen technique in 335 hips. The mean follow-up was 10.2 years. The degree of limp, leg-length discrepancy, and patient satisfaction were assessed. The Oxford Hip Score was used to examine functional outcomes. A number of radiographic parameters were also assessed. RESULTS The most common reason for revision surgery was nonunion of the distally advanced greater trochanter. This complication was observed in 22 hips (6.5%). The 10-year survival for acetabular components, it was 97.3%, and for femoral components was 98.7% with aseptic loosening as the end point, and 85.9% with reoperation for any reason as the end point. Patients demonstrated improved functional outcomes. The mean limb lengthening was 27.8 mm. Nonunion was more common if the contact length of the proximal femoral fragment with the lateral surface of the distal femoral fragment was less than 35 mm. CONCLUSIONS Cementless primary THA using the femoral shortening osteotomy technique described by Paavilainen in patients who have Crowe IV dysplasia of the hip demonstrates good clinical and radiologic postoperative results. If the contact between the fragments after osteotomy is less than 35 mm, there is a high risk of nonunion, and supplemental fixation may be warranted.
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Affiliation(s)
- Rashid M Tikhilov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Alisagib A Dzhavadov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Dinis R Ziganshin
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Nikita S Zakhmatov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Rauf R Alekberov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Igor I Shubnyakov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
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Lu Z, Chen Q, Lan Y, Xie S, Lin F, Feng E. Subtrochanteric Osteotomy in Direct Anterior Approach Total Hip Arthroplasty for Crowe IV Dysplasia-Surgical Technique and Literature Review. Orthop Surg 2024; 16:766-774. [PMID: 38296797 PMCID: PMC10925515 DOI: 10.1111/os.13996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024] Open
Abstract
For Crowe IV dysplasia, the clinical efficacy and surgical technique of subtrochanteric osteotomy (SO) within the direct anterior approach total hip arthroplasty (DAA-THA) was a subject of debate. This study aimed to describe the surgical technique and clinical outcomes in 11 cases of SO in DAA-THA and to summarize the relevant literature on this topic. Between June 2016 and June 2023, we retrospectively evaluated patients diagnosed with Crowe IV hip dysplasia at our institution. Criteria identified 11 patients who underwent SO during DAA-THA. Comprehensive data encompassing demographic information, radiological data, prosthetic implant type, and surgical intricacies were collected. In addition, an exhaustive review of existing case series literature was undertaken utilizing the PubMed databases. There were no revisions, deaths, dislocations, or infections. One hip (9.09%) had an intraoperative proximal split fracture, two hips (18.2%) had lower limb deep vein thrombosis, and one hip (9.09%) had symptoms of femoral nerve injury. Radiological data showed improved bilateral femoral offset, leg length discrepancy, and anatomical acetabular. During the mean follow-up of 2.18(1.06-2.46) years, patients demonstrated enhanced functional outcomes, with average changes of 25.2 in the Harris hip score and 47 in the WOMAC score. Reviewing the literature, most studies have favored S-ROM prostheses and transverse osteotomy techniques. Intraoperative fractures were notably frequent, with rates peaking at 25%. Nonunion and nerve injury were secondary common complications. SO via DAA-THA may offer satisfactory clinical and radiographic outcomes, but the literature review underscores the need for heightened awareness of intraoperative fracture risk. Proximal detachment of the vastus intermedius plays a pivotal role in SO exposure through the DAA.
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Affiliation(s)
- Zhiming Lu
- Department of Arthrosis SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Qinghuang Chen
- Department of OrthopedicAnxi County HospitalQuanzhouChina
| | | | | | | | - Eryou Feng
- Department of Arthrosis SurgeryFujian Medical University Union HospitalFuzhouChina
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Masson JB, Foissey C, Bertani A, Pibarot V, Rongieras F. Transverse subtrochanteric shortening osteotomy with double tension-band fixation during THA for Crowe III-IV developmental dysplasia: 12-year outcomes. Orthop Traumatol Surg Res 2023; 109:103684. [PMID: 37704103 DOI: 10.1016/j.otsr.2023.103684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/02/2023] [Accepted: 04/14/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND When performing total hip arthroplasty in patients with severe developmental dysplasia, shortening the femur facilitates reduction while also preventing sciatic or crural nerve injury and excessive length of the operated limb. No consensus exists about the optimal type of implant and best internal fixation procedure, two parameters that directly govern the risk of the most common intraoperative and postoperative complications (diaphyseal fractures, dislocation, non-union). To minimise these risks, we developed a technique combining a transverse subtrochanteric shortening osteotomy, a long ovoid-profiled, cementless stem anchored in the metaphysis, and double tension-band wiring for internal fixation. The primary objective of this study was to evaluate the outcomes of this technique with emphasis on (i) complications and femoral implant survival, (ii) clinical outcomes (functional scores and lower-limb length inequality [LLLI]), and time to healing. HYPOTHESIS Our technique is associated with low rates of intraoperative and postoperative complications. MATERIAL AND METHODS This single-centre retrospective cohort study included patients who underwent THA with a transverse subtrochanteric shortening osteotomy and fixation using double tension-band wiring to treat severe (Crowe III or IV) developmental hip dysplasia. The femoral implant was a long, ovoid, cementless stem fully coated with hydroxyapatite. We collected the intraoperative and postoperative complications, survival, LLLI, functional scores (Harris Hip Score [HHS] and Forgotten Joint Score [FJS]), patient satisfaction, and radiographic outcomes. RESULTS The study included 31 hips in 25 patients. Two patients (2/31 hips, 6.5%) were lost to follow-up, leaving 29 hips for the analysis of postoperative outcomes. Mean follow-up was 13.7±4.2 years (range, 5.8-18.3 years). The four intraoperative complications (4/31, 12.9%) consisted fracture of the diaphysis (2/31, 6.5%), fracture of the greater trochanter (1/31, 3.2%), and sciatic nerve injury followed by a full recovery (1/29, 3.4%). The 8 (8/29, 27.5%) postoperative complications consisted of dislocation (2/29, 6.9%), stem subsidence (2/29, 6.9%), and non-union (4/29, 13.8%). Femoral implant survival at last follow-up was 87.1% (95% CI, 76.1-99.7). The mean HHS increased from 39.6±12.0 (range, 14-61) before surgery to 81.7±13.2 (range, 48-100) at last follow-up (p<0.01). The FJS at last follow-up indicated that the joint was forgotten in 14/29 (48.2%) cases and caused only acceptable symptoms in 9/29 (31.0%) of cases. Clinically significant (≥ 1cm) LLLI was present in 8/29 (27.6%) patients postoperatively compared to 19/29 (65.5%) preoperatively. The mean LLLI decreased from 20.8±19.7mm (range, 0-60mm) to 5.0±7.3mm (range, 0-30mm). Mean time to healing was 4.3±2.4 months (range, 2-11 months). CONCLUSION Regarding these complex procedures, this technique was associated with low rates of intraoperative fractures and early postoperative complications. However, femoral stem survival was shorter than in earlier studies and the non-union rate was high, despite satisfactory functional and clinical outcomes. LEVEL OF EVIDENCE IV
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Affiliation(s)
| | - Constant Foissey
- Hôpital de la Croix Rousse, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - Antoine Bertani
- Hôpital Édouard-Herriot, 5, place d'Arsonval, 69008 Lyon, France
| | - Vincent Pibarot
- Hôpital Édouard-Herriot, 5, place d'Arsonval, 69008 Lyon, France
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Mimendia I, Lakhani K, Núñez JH, Barro V, Guerra-Farfán E, Collado D, Hernández A. Total hip arthroplasty associated with transverse subtrochanteric shortening osteotomy and conical stem fixation in Crowe type IV hip dysplasia. Musculoskelet Surg 2023; 107:367-372. [PMID: 36869994 DOI: 10.1007/s12306-023-00779-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 02/26/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Total hip arthroplasty (THA) in high-dislocated hip dysplasia is a surgical challenge, presenting difficulties in the biomechanical reconstruction of the hip. The purpose of the present study is to analyze clinical and radiological outcomes of a series of patients with Crowe type IV hip dysplasia who underwent a THA with transverse subtrochanteric shortening osteotomy and conical stem fixation in our Hip surgery unit. METHODS This non-interventional retrospective study included all patients diagnosed with Crowe type IV hip dysplasia who underwent a THA using a subtrochanteric shortening osteotomy and uncemented conical stem fixation between January 1, 2008, and December 31, 2015. Demographic, clinical and radiologic data were analyzed, including Harris Hip Score and Oxford Hip Score. RESULTS Seventeen hips in 13 patients were included in the final analysis. All patients were women and mean age was 39 years (range 35-45). Mean follow-up was 5.6 years (range 1-8). Average length of the osteotomy was 3.4 cm (range 3-4.5) and mean lowering of the center of rotation was 5.67 cm (range 3.8-9.1). Mean time for bone union was 5.5 months. No nerve palsy or non-union was detected at the end of follow-up period. CONCLUSION The use of cementless conical stem fixation associated with a transverse subtrochanteric shortening osteotomy for treating Crowe type IV hip dysplasia permits to correct the rotational alterations of the femur and provides good stability of the osteotomy, with very low risk of nerve palsy and non-union rates.
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Affiliation(s)
- I Mimendia
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - K Lakhani
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
- Traumatology and Rehabilitation, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebrón, 119., 08035, Barcelona, Spain.
| | - J H Núñez
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - V Barro
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - E Guerra-Farfán
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - D Collado
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - A Hernández
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
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Cicek H, Tuhanioğlu Ü, Ogur HU, Seyfettinoglu F, Kilicarslan K. Percutaneous Partial Tenotomy of ITB for Secondary Genu Valgum Developing After Total Hip Arthroplasty ın Patients wıth Crowe Type-Iv Dysplasia. Indian J Orthop 2023; 57:666-672. [PMID: 37128561 PMCID: PMC10147883 DOI: 10.1007/s43465-023-00832-7] [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: 12/27/2020] [Accepted: 01/20/2023] [Indexed: 02/18/2023]
Abstract
Background The aim of this study was to make a prospective evaluation of the effect on the clinical results of percutaneous iliotibial band partial tenotomy (PITP) applied to cases of genu valgum which developed following total hip prosthesis for Crowe Type IV dysplastic hip. Methods The study consists of 33 patients with unilateral crowe type IV dysplastic hip osteoarthritis who developed iatrogenic ipsilateral genu valgum after total hip arthroplasty. The patients were randomly separated into 2 groups of Group 1 (n = 16) where percutaneous iliotibial band tricut partial tenotomy was applied (PITP) and Group 2 (n = 17) where no treatment was applied. Pre and postoperative measurements were taken of the Harris Hip Score (HHS), the Lysholm-Gilquist Knee Score (LGS), Visual Analog Score (VAS), ipsilateral knee Q angle, and the spina ilica anterior superior medial malleolus distance (SIAS-MM). Results In both Group 1 and Group 2, a statistically significant increase was seen in the values of SIAS-MM (p < 0.001), Q angle (p < 0.001) and HSS (p < 0.001) from preoperative to postoperative. A statistically significant decrease was determined in LGS (p < 0.001, p < 0.003). In Group 1, a statistically significant decrease in the Q angle was determined at the final follow-up after PITP compared to the early postoperative period (p < 0.001). The HSS values for Group 1 were statistically significantly high in the early postoperative period and at the final follow-up (p < 0.001). Conclusion PITP application improves knee and hip clinical scores in the early postoperative period and hip clinical scores in the mid-term follow-up.
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Affiliation(s)
- Hakan Cicek
- Orthopaedi and Traumatology Department, Adana Şehir Training and Research Hospital, Adana, Turkey
| | - Ümit Tuhanioğlu
- Orthopaedi and Traumatology Department, Adana Medline Private Hospital, Yüreğir, Adana, Turkey
| | - Hasan Ulas Ogur
- Orthopaedi and Traumatology Department, Adana Şehir Training and Research Hospital, Adana, Turkey
| | - Firat Seyfettinoglu
- Orthopaedi and Traumatology Department, Adana Şehir Training and Research Hospital, Adana, Turkey
| | - Kasim Kilicarslan
- Orthopaedi and Traumatology Department, Ankara Şehir Training and Research Hospital, Adana, Turkey
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Liu Y, Zhang S, Li C, Ma M, Yang M, Guo R, Kong X, Chai W. Fixation by Autogenous Cortical Plate Technique on Sites of Subtrochanteric Shortening Osteotomy Contributes to Early Bone Union in Total Hip Arthroplasty for Crowe Type IV Developmental Dysplasia of the Hip. Ther Clin Risk Manag 2022; 18:1059-1067. [DOI: 10.2147/tcrm.s381885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/06/2022] [Indexed: 11/29/2022] Open
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Huang Z, Ling J, Zeng Z, Di Z, Zhang J, Tao K. Mid-Term Outcomes of Cemented Stem and Subtrochanteric Shortening Derotational Osteotomy in Total Hip Arthroplasty for Crowe IV Developmental Dysplasia. Orthop Surg 2022; 14:3178-3186. [PMID: 36250564 PMCID: PMC9732592 DOI: 10.1111/os.13515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 08/11/2022] [Accepted: 08/24/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Performing subtrochanteric osteotomy with cemented components in patients with Crowe IV developmental dysplasia of the hip (DDH) is technically challenging and not widely reported. This study aimed to evaluate the mid-term outcomes of cemented stem total hip arthroplasty (THA) with subtrochanteric femoral shortening and transverse derotational osteotomy in patients with Crowe IV DDH. METHODS Data collected from patients with Crowe IV DDH who underwent cemented stem THA with subtrochanteric femoral shortening and transverse derotational osteotomy between 2010 and 2018 were retrospectively evaluated. The cemented Lubinus SP II femoral component and the cementless CombiCup acetabular component were used together in all cases. These data, including Harris hip scores, limb length discrepancy (LLD), severity of limp, Trendelenburg test, bone union, length of the resected femur, limb lengthening, level of the osteotomy site, and length bridging the osteotomy site, as well as complications, were analyzed. A paired Student t-test was used to analyze continuous variables, categorical data were compared using Fisher's exact probability test, and correlation analysis was performed using Spearman's rank correlation coefficient. RESULTS Among 14 included patients (10 females and four males), the mean age was 60.4 years (range, 47-73). The mean follow-up period was 49.1 months, and no patient was lost to follow-up. The mean Harris hip score improved from 40.7 to 87.7. The mean LLD decreased from 52 to 12.7 mm. The mean length of the excised femoral segment was 38.4 mm, and the mean length of limb lengthening was 27.1 mm. The mean distance between the osteotomy site and the lesser trochanter was 21.1 mm after surgery. The mean length of the femoral stem bridging the osteotomy site was 97.6 mm. Finally, the mean osteotomy union time was 10.6 months. No statistically significant correlation was found between the osteotomy union time and these factors. No neurological deficits were noted. Delayed union was observed in one patient, and postoperative dislocation was observed in two patients. Cement leakage into the osteotomy gap was observed in one patient, however, no revisions were required, and no signs of loosening or migration were observed. CONCLUSIONS Cemented stem THA combined with subtrochanteric femoral shortening and transverse derotational osteotomy is safe and effective in treating patients with Crowe IV DDH. Rather than leading to nonunion, cement leakage may negatively affect bone healing.
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Affiliation(s)
- Zhe‐Yu Huang
- The Department of Orthopedics SurgeryNingbo No. 6 HospitalNingboChina
| | - Jing Ling
- The Department of Orthopedics SurgeryNingbo No. 6 HospitalNingboChina
| | - Zhi‐Min Zeng
- The Department of Orthopedics SurgeryNingbo No. 6 HospitalNingboChina
| | - Zheng‐Lin Di
- The Department of Orthopedics SurgeryNingbo No. 6 HospitalNingboChina
| | - Jun‐Hui Zhang
- The Department of Orthopedics SurgeryNingbo No. 6 HospitalNingboChina
| | - Kun Tao
- The Department of Orthopedics SurgeryNingbo No. 6 HospitalNingboChina
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Ibrahim FMF, Gameel S. Total cementless unconstrained hip arthroplasty in Crowe type IV hip dysplasia with subtrochentric derotation osteotomy. Acta Orthop Belg 2022; 88:517-524. [PMID: 36791705 DOI: 10.52628/88.3.7416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Developmental hip dysplasia is a common cause for secondary osteoarthritis and in the past it was considered impossible to do hip arthroplasty surgery for this group of patients. We aim at introducing our results and arthroplasty technique in management of such technically demanding and challenging cases. 22 patients with 25 hips suffer from hip dysplasia Crowe type IV were operated by total cementless unconstrained hip arthroplasty with subtrochentric derotation osteotomy without fixation of osteotomy site, The mean age group was 37.9. All patients were operated through lateral approach. The acetabular component is located in the true acetabulum. Postoperatively the patient can weight bear fully unaided within 3 months. The preoperative limb length discrepancy improved from a mean 46.36 mm to 7.3 mm. One case of stem subsidence occurred and underwent revision to cemented stem 1years later. The Harris hip score improved to 85.9 at end of follow up in comparison to38.09 preoperatively. The osteotomy site healed within 5.1months in average .No cases of osteotomy non union occurred. The mean follow up was 28.3 months. We concluded that hip arthroplasty in patients with hip dysplasia Crowe type IV is technically demanding surgery. Recreation of normal biomechanics and anatomy through implantation of acetabular component in the true acetabulum and femoral shortening and derotation offers the patient painless and adequately functioning hip.
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Shen K, Feng E, Lin F, Weng Y, Chen J. Learning Curve of Total Hip Arthroplasty in Direct Anterior Approach without Requiring Corrective Osteotomy for Hip Dysplasia. Orthop Surg 2022; 14:840-850. [PMID: 35388599 PMCID: PMC9087452 DOI: 10.1111/os.13231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To explore the learning curve of total hip arthroplasty in direct anterior approach (DA-THA) without requiring corrective osteotomy for patients with unilateral developmental dysplasia of the hip (DDH) through the evaluation of clinical and radiographic results. METHOD From December 2015 to January 2021, we retrospectively evaluated a surgeon's first 100 patients with unilateral hip dysplasia (Crowe I-III) who underwent DA-THA. All procedures were performed by a fellowship-trained joint surgeon. Cementless hemispheric porous-coated acetabular cups and tapered cementless stems were used in all hips. The radiographic data, including leg length, the height of the center of rotation, femoral head offset, the cup anteversion and inclination angle, were measured. The cumulative sum analysis (CUSUM) and risk-adjusted cumulative sum analysis (RA-CUSUM) were used to determine the learning curve of DA-THA for each patient's operation time. By analyzing the operation time, complication rate, postoperative length of hospitalization and creatine kinase (before surgery and the third day after surgery), estimated blood loss, Harris score, radiographic data were compared between the different stages of the learning curve. RESULTS The mean follow-up time was 35.45 ± 16.82 months. The CUSUM method obtained the maximum turning point of the curve at 43 cases, which divided the learning curve into Learning Period and Mastery Period. The CUSUM learning curve was best modeled as a cubic curve with the equation: CUSUM (min) = 0.001x3 - 0.495x2 + 33.60x - 10.00, which had a higher R2 value of 0.967. The pre-operative data, creatine kinase, estimated blood loss and postoperative Harris scores of the two stages were not statistically significant (P > 0.05). The mean operation time was 118 min in the Learning Period and 87 min in the Mastery Period. Statistically significant differences were detected in the operation time (P < 0.001), postoperative length of hospitalization(P = 0.024), and postoperative leg length discrepancy (P = 0.012) between the two stages. The overall complication rates were 27.9% in the Learning Period and 12.3% in the Mastery Period (p = 0.049). The overall outliers of radiographic data were 34 cases in the Learning Period and 31 cases in the Mastery Period (79.07% vs 54.39%, P = 0.010). CONCLUSIONS The DA-THA is a valuable alternative to achieve satisfactory clinical results for mild-to-moderate DDH patients. Furthermore, accurate analysis of the learning curve of DA-THA for hip dysplasia by the CUSUM method showed that the surgeons need to finish about 43 cases to master the technique.
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Affiliation(s)
- Kaiwei Shen
- Department of Arthrosis Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Eryou Feng
- Department of Arthrosis Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Feitai Lin
- Department of Arthrosis Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Yan Weng
- Department of Arthrosis Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Jinhua Chen
- Medical Department of Fujian Medicine University Union Hospital, Fuzhou, China
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Abstract
Aims Adult patients with history of childhood infection pose a surgical challenge for total hip arthroplasty (THA) due to distorted bony anatomy, soft-tissue contractures, risk of reinfection, and relatively younger age. Therefore, the purpose of the present study was to determine clinical outcome, reinfection rate, and complications in patients with septic sequelae after THA. Methods A retrospective analysis was conducted of 91 cementless THAs (57 male and 34 female) performed between 2008 and 2017 in patients who had history of hip infection during childhood. Clinical outcome was measured using Harris Hip Score (HHS) and Modified Merle d’Aubigne and Postel (MAP) score, and quality of life (QOL) using 12-Item Short Form Health Survey Questionnaire (SF-12) components: Physical Component Score (PCS) and Mental Component Score (MCS); limb length discrepancy (LLD) and radiological assessment of the prosthesis was performed at the latest follow-up. Reinfection and revision surgery after THA for any reason was documented. Results There was significant improvement in HHS, Modified Merle d’Aubigne Postel hip score, and QOL index SF 12-PCS and MCS (p < 0.001) and there was no case of reinfection reported during the follow-up. The minimum follow-up for the study was three years with a mean of 6.5 (SD 2.3; 3 to 12). LLD decreased from a mean of 3.3 cm (SD 1) to 0.9 cm (SD 0.8) during follow-up. One patient required revision surgery for femoral component loosening. Kaplan-Meier survival analysis estimated revision-free survivorship of 100% at the end of five years and 96.9% (95% confidence interval 79.8 to 99.6) at the end of ten years. Conclusion We found that cementless THA results in good to excellent functional outcomes in patients with a prior history of childhood infection. There is an exceedingly low rate of risk of reinfection in these patients, even though complications are not uncommon. Cite this article: Bone Jt Open 2022;3(4):314–320.
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Affiliation(s)
- Rajesh Malhotra
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Sahil Batra
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Deepak Gautam
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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Takahashi D, Noyama Y, Shimizu T, Terkawi MA, Iwasaki N. Finite Element Analysis of Optimal Positioning of Femoral Osteotomy in Total Hip Arthroplasty With Subtrochanteric Shortening. Arthroplast Today 2022; 14:105-109. [PMID: 35252515 PMCID: PMC8891993 DOI: 10.1016/j.artd.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/22/2021] [Accepted: 01/15/2022] [Indexed: 11/09/2022] Open
Abstract
Background Total hip arthroplasty with femoral shortening is frequently recommended for patients with high hip dislocation. However, the possibility of postoperative rotational deviation of the stem presents a challenge for surgeons. We aimed to determine the optimal position for osteotomy in total hip arthroplasty under full weight-bearing and turning torque by using finite element analysis. Methods Four models of femoral osteotomy with 30-mm transverse shortening at 30% (model 30), 40% (model 40), 50% (model 50), and 60% (model 60) from the proximal end of the full length of the Exeter stem were constructed. Using finite element analysis, the constructs were first analyzed under an axial load of 1500 N and then with an added torsional load of 10°. Results The analyses under torsional loading conditions revealed that the maximum von Mises stress on the stem in each model occurred at the proximal end of the distal fragment and the distal side of the stem. The maximum stress values at the stem were 819 MPa (model 30), 825 MPa (model 40), 916 MPa (model 50), and 944 MPa (model 60). The maximum stress values at the osteotomy site of the medullary cavity side of the distal bone fragment were 761 MPa (model 30), 165 MPa (model 40), 187 MPa (model 50), and 414 MPa (model 60). Conclusions The osteotomy level should be around the proximal 40% of the full length of the Exeter stem, which is most suitable for rotation stability in the early postoperative period.
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Affiliation(s)
- Daisuke Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshihiro Noyama
- Department of Pharmaceutical Affairs Division, Teijin Nakashima Medical Company Limited, Okayama, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Mohamad Alaa Terkawi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Sukur E, Senel A, Ozdemir U, Akman YE, Azboy İ, Ozturkmen Y. Cementless modular total hip arthroplasty with subtrochanteric transverse shortening osteotomy for high hip dislocations. J Orthop Surg Res 2022; 17:139. [PMID: 35246184 PMCID: PMC8896094 DOI: 10.1186/s13018-022-03025-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Performing a total hip arthroplasty for a high hip dislocation is technically demanding and presents several challenges, with appropriate evaluation of the bone morphology of the hip and proper implant selection being critical for successful outcomes. Objective The purpose of our study was to evaluate the clinical and radiographic outcomes of cementless modular total hip arthroplasty for the treatment of high hip dislocations with sub-trochanteric transverse shortening osteotomy. Methods Sixty-eight hips with a high hip dislocation, were treated using a sub-trochanteric transverse shortening osteotomy and cementless modular total hip arthroplasty, retrospectively reviewed. Hip function was assessed using the Harris hip score, with hip abduction strength evaluated using the Trendelenburg test. Radiographic assessment included the measurement of leg length discrepancy, identification of implant loosening, localization of the hip center, and union at the osteotomy site. Results The mean follow-up period was 12.9 (range 5.2–16.8) years. The mean Harris hip score improved from a pre-operative score of 48.6 ± 3.6 to 82.4 ± 4.2 (p < 0.05). The hip was within the true acetabulum in all patients, postoperatively. Osteotomy union was achieved in 67 of the 68 hips (98.5%) in a mean latency of 12.5 ± 0.6 weeks. The mean length of femoral shortening was 66.5 ± 4.5 mm, with a mean pull-down length of the proximal part of 35.5 ± 3.5 mm. Conclusion For the treatment of high hip dislocations with satisfactory clinical outcomes, the modular stem offers an adjustable anteversion angle to restore sufficient rotational stability and the transverse osteotomy provides sufficient compression pressure across the osteotomy site to facilitate union. Trial registration It was a retrospective study and approved by Istanbul Research and Training Hospital institutional Ethics Review Board (772-05/02/2016).
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Affiliation(s)
- Erhan Sukur
- Departments of Orthopaedics and Traumotology, Sakarya University Training and Research Hospital, 54050, Sakarya, Turkey.
| | - Ahmet Senel
- Departments of Orthopaedics and Traumotology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ugur Ozdemir
- Departments of Orthopaedics and Traumotology, Sakarya University Training and Research Hospital, 54050, Sakarya, Turkey
| | - Yunus Emre Akman
- Departments of Orthopaedics and Traumotology, Ortopedkliniken Mälarsjukhuset, Eskilstuna, Sweden
| | - İbrahim Azboy
- Departments of Orthopaedics and Traumotology, Medipol University Hospital, Istanbul, Turkey
| | - Yusuf Ozturkmen
- Departments of Orthopaedics and Traumotology, Istanbul Training and Research Hospital, Istanbul, Turkey
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Zhang L. Total Hip Arthroplasty in Adult Patients with Sequelae After Childhood Hip Infection. PRINCIPLES OF PRIMARY TOTAL HIP ARTHROPLASTY 2022:121-125. [DOI: 10.1007/978-981-19-3606-7_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Ors C, Caylak R, Togrul E. Total Hip Arthroplasty With the Wagner Cone Femoral Stem in Patients With Crowe IV Developmental Dysplasia of the Hip: A Retrospective Study. J Arthroplasty 2022; 37:103-109. [PMID: 34547428 DOI: 10.1016/j.arth.2021.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study is to assess treatment of Crowe type IV hip dysplasia with the Wagner cone femoral stem combined with transverse subtrochanteric shortening osteotomy and augmenting the osteotomy site using the intercalary segment as a strut autograft. METHODS One hundred twenty-seven hips of 91 patients diagnosed with Crowe type IV hip dysplasia and treated with total hip arthroplasty using the Wagner cone stem combined with transverse subtrochanteric shortening osteotomy were retrospectively evaluated by clinical and radiographic outcomes as well as complications. RESULTS The mean follow-up was 8.4 years. The Harris Hip Score and the Western Ontario and McMaster University Osteoarthritis Index scores were significantly improved postoperatively (P = .000). Intraoperative femoral cracks were observed in 70 hips (55.1%) and all femurs healed smoothly. Femoral cracks did not have a significant effect on clinical outcomes, except for heterotopic ossifications (P = .032). The probability of 10-year survivorship of the components free of revision for any reasons as end point was 94.5%; when only the femoral components were considered the survivorship was of 96.9%. CONCLUSION Transverse subtrochanteric shortening and augmenting the osteotomy site using the intercalary segment of bone resected from the shortened femur with the Wagner cone stem is an effective and reliable technique in the management of total hip arthroplasty in Crowe type IV hip dysplasia. Stable and firm placing of the femoral component which leads to an increased frequency of intraoperative femoral cracks does not have an unfavorable effect on clinical and radiological outcomes.
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Affiliation(s)
- Cagri Ors
- Private Ortopedia Hospital, Knee and Sport Surgery Department, Seyhan, Adana, Turkey
| | - Remzi Caylak
- Private Ortopedia Hospital, Hip Surgery Department, Seyhan, Adana, Turkey
| | - Emre Togrul
- Private Ortopedia Hospital, Hip Surgery Department, Seyhan, Adana, Turkey
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Talwar J, Agarwal S, Agarwal S, Krishna LG, Rustagi A. Step-Cut Subtrochanteric Osteotomy Combined with Total Hip Arthroplasty for Neglected Traumatic Hip Dislocations. Clin Orthop Surg 2022; 14:205-212. [PMID: 35685975 PMCID: PMC9152891 DOI: 10.4055/cios21104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/07/2021] [Accepted: 11/07/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jatin Talwar
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Saumya Agarwal
- Department of Orthopaedics, Ravindra Nath Tagore Medical College, Udaipur, Rajasthan, India
| | - Sarang Agarwal
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Loveneesh G. Krishna
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ashish Rustagi
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Liu Y, Ma M, Yang M, Guo R, Kong X, Chai W. [A comparative study of three different fixation methods after subtrochanteric shortening osteotomy in total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of the hip]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1519-1524. [PMID: 34913306 DOI: 10.7507/1002-1892.202107121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the effectiveness of three different fixation methods after subtrochanteric shortening osteotomy (SSO) in total hip arthroplasty (THA) for Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods A clinical data of 63 patients (78 hips) with Crowe type Ⅳ DDH, who underwent THA with SSO between November 2014 and May 2019, was retrospectively analyzed. Among them, 18 patients (20 hips) obtained stability by intramedullary pressure provided by the S-ROM modular prostheses (group A); 22 patients (30 hips) underwent prophylactic binding by stainless steel wire after osteotomy and before stem implantation (group B); 23 patients (28 hips) were fixed with autogenous cortical strut grafts and stainless steel wire or cables (group C). There was no significant difference in gender, age, body mass index, affected limb side, and preoperative Harris score between groups ( P>0.05). The operation time, complications, imaging results, hip functional score of the three groups were recorded and compared. Results There was no significant difference in the operation time between groups ( P>0.05). All incisions healed by first intention. All patients were followed up, and the follow-up time was 2.5-4.0 years (mean, 3.1 years) in group A, 1.5-5.5 years (mean, 3.2 years) in group B, and 1.0-5.0 years (mean, 1.6 years) in group C. There was no significant difference in Harris score or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between groups at 4 and 12 months after operation ( P>0.05). X-ray films showed that there was no significant difference in osteotomy healing rate at 4, 8, and 12 months after operation and the osteotomy healing time between groups ( P>0.05). There was no complications such as joint dislocation, prosthesis loosening, prosthetic joint infection, or heterotopic ossification during follow-up, except for the distal femoral fracture of 1 hip during operation in group B. Conclusion In THA for patients with Crowe type Ⅳ DDH, the stainless steel wire binding alone and autogenous cortical strut grafts combined with stainless steel wire or cable binding can not significantly promote the osteotomy healing compared with femoral prosthesis intramedullary compression fixation. For patients with nonmatched medullary cavity after SSO, it is recommended to apply autogenous cortical strut grafts with wire or cables for additional fixation.
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Affiliation(s)
- Yubo Liu
- School of Medicine, Nankai University, Tianjin, 300071, P.R.China.,Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, 100048, P.R.China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Mingyang Ma
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, 100048, P.R.China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Minzhi Yang
- School of Medicine, Nankai University, Tianjin, 300071, P.R.China.,Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, 100048, P.R.China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Renwen Guo
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, 100048, P.R.China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China.,Medical School of Chinese PLA, Beijing, 100853, P.R.China
| | - Xiangpeng Kong
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, 100048, P.R.China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Wei Chai
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, 100048, P.R.China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
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Yang Y, Liao W, Yi W, Jiang H, Fu G, Ma Y, Zheng Q. Three-dimensional morphological study of the proximal femur in Crowe type IV developmental dysplasia of the hip. J Orthop Surg Res 2021; 16:621. [PMID: 34663420 PMCID: PMC8522035 DOI: 10.1186/s13018-021-02789-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/11/2021] [Indexed: 12/02/2022] Open
Abstract
Background When performing femoral reconstruction in patients with Crowe type IV developmental dysplasia of the hip (DDH), anatomical deformity presents many technical challenges to orthopedic surgeons. The false acetabulum is suggested to influence load transmission and femoral development. The aim of this study was to describe the morphological features of dysplastic femurs in Crowe type IV DDH and further evaluate the potential effect of the false acetabulum on morphological features and medullary canal of Crowe type IV femurs. Methods We analyzed preoperative computed tomography scans from 45 patients with 51 hips (25 hips without false acetabulum in the IVa group and 26 hips with false acetabulum in the IVb group) who were diagnosed with Crowe type IV DDH and 30 normal hips in our hospital between January 2009 and January 2019. Three-dimensional reconstruction was performed using Mimics software, and the coronal femoral plane was determined to evaluate the following parameters: dislocation height, dislocation ratio, height of the femoral head (FH), height of the greater trochanter (GT), GT–FH height discrepancy, height of the isthmus, neck-shaft angle, femoral offset and anteversion of the femoral neck. The mediolateral (ML) width, anterolateral (AP) width and diameter of medullary canal of the proximal femur were measured on the axial sections. Further, canal flare index (CFI), metaphyseal-CFI and diaphyseal-CFI were also calculated. Results Compared with the normal femurs, the Crowe type IV DDH femurs had a higher femoral head, larger GT–FH height discrepancy, larger femoral neck anteversion, higher isthmus position and smaller femoral offset. Dislocation height and dislocation rate were significantly larger in the IVa DDH group (65.34 ± 9.83 mm vs. 52.24 ± 11.42 mm). Further, the IVb femurs had a significantly lower isthmus position, larger neck-shaft angle and smaller femoral neck anteversion than IVa femurs. The ML, AP canal widths and the diameter of medullary canal in both DDH groups were significantly smaller than the normal group. Dimensional parameters of IVa femurs were also narrower than IVb femurs in most sections, but with no difference at the level of isthmus. According to the CFIs, the variation of proximal medullary canal in IVb femurs was mainly located in the diaphyseal region, while that in IVa femurs was located in the whole proximal femur. Conclusions High dislocated femurs are associated with more anteverted femoral neck, smaller femoral offset and narrower medullary canal. Without stimulation of the false acetabulum, IVa DDH femurs were associated with higher dislocation and notably narrower medullary canal, whose variation of medullary canal was located in the whole proximal femur.
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Affiliation(s)
- Yuhui Yang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Weihong Liao
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Weiqun Yi
- Department of Operating Room, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, People's Republic of China
| | - Hai Jiang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Guangtao Fu
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yuanchen Ma
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, People's Republic of China.
| | - Qiujian Zheng
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, People's Republic of China.
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Minimum 10-Year Results of Cementless Ceramic-On-Ceramic Total Hip Arthroplasty Performed With Transverse Subtrochanteric Osteotomy in Crowe Type IV Hips. J Arthroplasty 2021; 36:3519-3526. [PMID: 34127347 DOI: 10.1016/j.arth.2021.05.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/12/2021] [Accepted: 05/25/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) performed for developmental dysplasia of the hip is a technically difficult procedure with a high complication rate, especially in the presence of completely dislocated hips. This study aimed to evaluate at least 10 years of follow-up results of cementless, ceramic-on-ceramic (CoC) THA performed with transverse subtrochanteric osteotomy in Crowe type IV hips. METHODS We retrospectively reviewed 50 patients' 67 hips that underwent CoC, cementless THA with transverse subtrochanteric osteotomy between 2008 and 2011. Clinical and radiological data of the hips were examined. Clinical results were evaluated using the Harris Hip Score and the Western Ontario and McMaster Universities Osteoarthritis Index. RESULTS The mean Harris Hip Score improved from 22.9 ± 9.9 preoperatively to 94.1 ± 8.1 at the final follow-up (P < 0.001). The median Western Ontario and McMaster Universities Osteoarthritis Index score improved from 72 (interquartile range: 17) preoperatively to 2 (interquartile range: 17) postoperatively (P < 0.001). The preoperative mean leg length discrepancy was improved from 4.9 ± 1 cm to 1.5 ± 1 cm in unilateral cases at the last follow-up (P < 0.001). Revision surgery was required because of nonunion in two patients, prosthetic infection in one patient, and aseptic femoral loosening in the other patient. The overall ten-year survival rate was 94% for femoral stems and 98.5% for acetabular components as per Kaplan-Meier survival analysis. CONCLUSION Transverse subtrochanteric shortening osteotomy combined with using cementless acetabular and femoral components with a CoC bearing surface promises successful clinical results and high prosthesis survival in the treatment of Crowe IV hips at long-term follow-up.
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Inoue D, Kabata T, Kajino Y, Ohmori T, Ueoka K, Tsuchiya H. Comparison of mid-term clinical results between cementless and cemented femoral stems in total hip arthroplasty with femoral shortening osteotomy for Crowe type IV hips. Arch Orthop Trauma Surg 2021; 141:1057-1064. [PMID: 33484302 DOI: 10.1007/s00402-020-03749-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/22/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This report is the first study to compare the clinical outcomes between cementless and cemented femoral prostheses in total hip arthroplasty (THA) with subtrochanteric femoral shortening osteotomy for Crowe type IV hips. MATERIALS AND METHODS We identified 26 hips in 20 patients who had undergone cemented (n = 13) or cementless (n = 13) THA with subtrochanteric femoral shortening osteotomy for Crowe type IV hips with a minimum follow-up period of 2 years. The mean follow-up period was 60.8 ± 33.9 months (24-120 months). We compared radiological findings, postoperative clinical recoveries, postoperative complications, and implant survival rates. RESULTS In both groups, there were no cases of aseptic loosening for the acetabular and femoral implant. In terms of bone union at the osteotomy site, the mean duration was significantly longer in the cemented group (9.8 ± 4.2 months) than in the cementless group (5.0 ± 1.9 months). The clinical hip score in gait and pain at 3 months postoperatively was significantly higher in the cemented group than in the cementless group, while there were no significant changes at other timepoints between two groups. The number of postoperative complications was not significantly different between the two groups. The implant survival rate was 92% in the cementless group and 100% in the cemented group at 5 years postoperatively (P = 0.31). CONCLUSIONS The cemented femoral prosthesis is superior to the cementless femoral prosthesis for early clinical recovery, while the duration required to achieve bone union at the osteotomy site is longer in the cemented femoral prostheses. It is possible for surgeons to perform successful hip reconstructions, regardless of the fixation method used for THA with shortening femoral osteotomy.
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Affiliation(s)
- Daisuke Inoue
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tamon Kabata
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Yoshitomo Kajino
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takaaki Ohmori
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Ken Ueoka
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
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D'Apolito R, Bandettini G, Rossi G, Jacquot FP, Zagra L. Low Reinfection Rates But a High Rate of Complications in THA for Infection Sequelae in Childhood: A Systematic Review. Clin Orthop Relat Res 2021; 479:1094-1108. [PMID: 33617159 PMCID: PMC8116005 DOI: 10.1097/corr.0000000000001607] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/20/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Childhood hip infections can result in serious sequelae during adulthood, including persistent pain, functional limitations, and premature THA. When THA is performed in patients who had hip joint infections during childhood, surgeons surmise these arthroplasties are at an increased risk of complications and incomplete recovery. However, the degree to which this is true is not well characterized and has varied across a large number of small, retrospective studies. QUESTIONS/PURPOSES (1) What proportion of THAs performed in patients who had pediatric septic arthritis result in periprosthetic joint infection? (2) What are the Harris hip scores associated with these reconstructions? (3) What proportion of these patients develop complications after THA? (4) What proportion of patients undergo revision after these THAs? METHODS For this systematic review, we searched the MEDLINE (PubMed), Scopus, and CINAHL (EbscoHost) electronic databases. We evaluated studies published in English between 1980 and 2020 that had a minimum of 10 patients (with a minimum of 2 years of follow-up) in whom sequelae of septic arthritis of the hip were treated with single-stage THA. We also evaluated studies reporting clinical outcomes by means of the Harris hip score, along with a radiographic assessment of the prosthesis. Updates of previous studies using the same database, case reports, surgical technique reports, systematic reviews, and expert opinions were excluded. No restrictions were applied regarding study design and loss to follow-up. A total of 430 studies were identified through the initial search, and 11 studies were included after applying the inclusion and exclusion criteria. All but two studies, which included a historical control group, were retrospective case series. A total of 691 patients with a mean age of 45 years were involved. A total of 599 patients underwent cementless THAs, 84 patients underwent hybrid THA (cemented stems), and the remaining eight patients received a cemented THA. A total of 287 additional procedures were performed on the acetabulum, including autografting, allografting, and medial wall osteotomies; in three hips, tantalum augments were used. Three hundred thirty-five additional procedures were performed on the femora, including 223 shortening osteotomies and 112 greater trochanter osteotomies. The mean follow-up duration ranged from 5.5 to 15.2 years (minimum follow-up range 2-13 years). To assess the quality of the studies, we used the Methodological Index for Non-randomized Studies and the Assessment of Quality in Lower-limb Arthroplasty, for which a higher score represents a better study quality. The mean Methodological Index for Non-randomized Studies score for case series was 9 of 16 (range 6-12), and 19 and 18 of 24 for the two comparative studies. The mean reporting quality of the Assessment of Quality in Lower Limb Arthroplasty score was 6 of 8 (range 3-8). RESULTS Because of loss to follow-up, which was not consistently reported in the source studies, we caution the reader that the estimates provided here likely underestimate the risks of adverse events and overestimate the mean hip scores. The pooled proportion of patients in whom infections developed was 1% (seven of 691 THAs). Considering only studies published in the past 10 years, the proportion was 0.7% (two of 276 THAs). The Harris hip score increased from a mean of 52 ± 6 points before THA to a mean of 88 ± 2 points after THA. The pooled proportion of complications, including sciatic nerve palsy, femoral nerve palsy, intraoperative periprosthetic fracture, deep venous thrombosis, and dislocation, was 11% (76 complications among 691 THAs). The pooled proportion of patients who underwent revision was 8% (53 revisions of any components for any reason among 691 THAs) at a mean follow-up interval of 9.1 ± 3 years. CONCLUSION In THAs for sequelae of childhood septic arthritis, reinfections were uncommon, whereas generally, infection rates were slightly higher than those reported for conventional primary THAs. However, the duration of follow-up might have been insufficient to identify all patients in whom infections later developed, and the available data were not adequate to precisely detect the minimum quiescent period to avoid reinfections. Moreover, the studies in this systematic review were retrospective, and selection bias, transfer bias, and assessment bias likely influenced our findings. The general effect of these biases is to cause an underestimation of the harms of the intervention. Complications, especially intraoperative fracture and nerve palsy, were common in patients with the most-severe infections. Further data on this topic are needed, ideally from multicenter or registry studies with even longer follow-up durations. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Rocco D'Apolito
- R. D'Apolito, G. Bandettini, G. Rossi, F. P. Jacquot, L. Zagra, Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Clinical evaluation of direct anterior approach total hip arthroplasty for severe developmental dysplasia of the hip. Sci Rep 2021; 11:8105. [PMID: 33854151 PMCID: PMC8046760 DOI: 10.1038/s41598-021-87543-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/30/2021] [Indexed: 11/24/2022] Open
Abstract
It is challenging to treat developmental dysplasia of the hip (DDH) classified Crowe III-IV using direct anterior approach (DAA) total hip arthroplasty (THA), and very little is known on its outcome. This study aimed to investigate the clinical result in this defined disorder with DAA versus posterolateral approach. Twenty-three consecutive hips with Crowe III-IV DDH who underwent DAA were retrospectively evaluated from 2016 through 2018. Outcomes were primarily assessed by HHS, WOMAC, and SF-12 physical scales. The second evaluations included leg length discrepancy, hip muscle strength, radiographic review, complications, and limp recovery. Results were compared to a control cohort of 50 hips underwent posterolateral THA concurrently within the observational period. At last follow-up (DAA 28.5 months; PLA 39.0 months), the mean increase of the HHS for DAA was 48.2 and 30.3 for PLA (p = 0.003). The improvement in WOMAC score in DAA cohort was 15.89 higher that of the PLA cohort after adjusting preoperative difference [R2 = 0.532, P = 0.000, 95% CI (10.037, 21.735)]. DAA had more rapid recovery of hip abductor strength at 1-month (p = 0.03) and hip flexor strength at 3 months (p = 0.007) compared to PLA. No significant differences were found in the radiographic analysis with the exception of increased acetabular anteversion in the DAA cohort (p = 0.036). Satisfactory improvement in limp, indicated by the percentage of limp graded as none and mild to the total, was much higher in DAA cohort (97.6%), compared to that of PLA cohort (90.0%, p = 0.032). DAA for high-dislocated dysplasia demonstrate a significant improvement in clinical result comparable to posterolateral approach. Improved clinical outcome in terms of increased HHS and WOMAC scores, rapid recovery of hip abductor and flexor strength, and enhanced limp recovery without an increased risk in complications, could be acquired when the surgeons were specialized in this approach.
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Qian Z, Mamtimin A, Zhang X, Xu B, Mu W, Cao L. Mid-Term Outcomes of Cementless Total Hip Arthroplasty in Adult Patients with Childhood Hip Infection. Med Sci Monit 2021; 27:e930760. [PMID: 33712550 PMCID: PMC7968116 DOI: 10.12659/msm.930760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Patients with hip joint infections in childhood often have many aftereffects of different degrees, regardless of the kind of treatment or natural course. Total hip arthroplasty is currently the most effective treatment for sequelae of childhood hip septic or tuberculous infection. This is a mid-term follow-up study of treatment results of patients who had undergone total hip arthroplasty (THA) with cementless prostheses. MATERIAL AND METHODS We retrospectively analyzed and followed 45 patients (45 hips) who underwent THA with cementless prostheses between 2010 and 2017. There were 45 patients, including 17 men and 28 women. The average age of the patients was 46 years (range, 18-67 years). All hip infections occurred in early childhood or adolescence, and the mean interval between initial infection and THA was 38.2 years (range, 15-60 years). The mean follow-up was 6.1 years (range, 2.7-9.5 years). RESULTS Two patients underwent revision surgery because of loosening of the prosthesis, and 1 patient underwent revision surgery because of a new infection with no relationship with childhood infection during the follow-up. The average Harris hip scores significantly increased from 43.1 to 86.4 (P<0.01), and the average visual analog scale significantly increased from 4.6 to 1.7 (P<0.01). The hip dysfunction and osteoarthritis outcome scores were also significantly changed (P<0.01) at the final follow-up. There were 2 cases of transient sciatic nerve palsy and intraoperative periprosthetic fractures in 3 cases. During follow-up, single revision was performed after 6 years of primary arthroplasty because of aseptic loosening in 2 cases and prosthesis infection in 1 case, which was not related to childhood pathogens. CONCLUSIONS THA for patients with sequelae of hip joint infection has a satisfactory effect that can effectively relieve joint pain and improve hip function. The recurrence rate of infection after either pyogenic infection or tuberculous is very low. The mid-term outcomes of THA in this setting were satisfactory, with high prosthesis survivorship and hip function scores.
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31
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Lee SJ, Yoon KS. Two-stage total hip arthroplasty following skeletal traction after extensive soft tissue release for severe limb-length discrepancy. Hip Int 2021; 31:223-230. [PMID: 31328568 DOI: 10.1177/1120700019865742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION To maximise limb-length discrepancy (LLD) resolution during total hip arthroplasty (THA) for untreated developmental hip dysplasia or septic hip sequelae, THA following limb lengthening was introduced using different methods. We aimed to evaluate 2-stage THA results following limb lengthening via skeletal traction after extensive soft tissue release. METHOD In total, 24 hips with severe LLD in 10 men and 14 women (mean age, 49.6 ± 15.2 years) underwent 2-stage THA and were followed thereafter (mean 6.3 ± 3.7 years). The entire abductor muscle origin was subperiosteally released from the ilium, and the soft tissue around the hip joint, including the psoas tendon, short external rotator, joint capsule, and adductor tendon, was extensively released. 2-stage THA was performed after 2-week skeletal traction using proximal tibial pins. During the final THA, 7 hips necessitated subtrochanteric shortening osteotomy (STO) for hip joint reduction. We evaluated the clinical and radiological results and especially focused on LLD and neurological complications. RESULTS The Harris Hip Score improved from 57.1 ± 9.6 to 88.3 ± 6.3 points. No patients showed worse abductor power. LLD improved from 5.0 ± 2.0 to 1.4 ± 1.0 cm. No permanent neurological complications occurred except for 1 transient peroneal nerve palsy during traction, which resolved fully after cessation of traction. There were 2 hips with STO nonunion treated with osteosynthesis and stem revision. CONCLUSION 2-stage THA following skeletal traction after extensive soft tissue release showed favourable results in terms of neurologic complication prevention and LLD resolution. However, a large proportion of patients still necessitated shortening osteotomy with a risk for nonunion at the osteotomy site. Though surgical procedures might be complicated and necessitate longer hospital stays, 2-stage THA with extensive soft tissue release might be an alternative treatment option for patients with severe LLD willing to resolve their limb length discrepancy.
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Affiliation(s)
- Soong Joon Lee
- Department of Orthopaedic Surgery SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kang Sup Yoon
- Department of Orthopaedic Surgery SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Sun C, Zhang Y, Li LT, Ding H, Guo T, Zhao JN. Long-Term Outcomes of Total Hip Arthroplasty With Transverse Subtrochanteric Shortening Osteotomy and Modular Stem in Crowe IV Developmental Dysplasia. J Arthroplasty 2021; 36:630-635. [PMID: 32919844 DOI: 10.1016/j.arth.2020.08.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The reconstruction of high dislocation related to developmental dysplasia of the hip (DDH) remains challenging for joint surgeons. The aim of this study is to evaluate the rate of union, the revision rate, functional scores, and complications in patients with Crowe IV DDH treated with total hip arthroplasty, transverse subtrochanteric shortening osteotomy, and modular stem in an average 10-year follow-up. METHODS Twenty-eight patients (33 hips) with Crowe IV DDH who were operated on between 2008 and 2013 were followed. All patients underwent uncemented total hip arthroplasty with transverse subtrochanteric shortening osteotomy and anatomical acetabular cup implantation. The mean age was 36.6 years, and the mean follow-up period was 121 months. Clinical and radiological outcomes were evaluated. RESULTS The mean Harris Hip Score significantly improved from 47.0 preoperatively to 89.6 postoperatively. The mean limb length discrepancy was significantly reduced from 3.8 to 0.8 cm. The mean osteotomy union time was 6.8 months. At the mean follow-up of 121 months, there were 3 cases of postoperative dislocation, 2 cases of intraoperative fracture, and 1 case of posterior tibial venous thrombosis. No revision occurred, and no signs of component loosening or migration were observed at the last follow-up. CONCLUSION Crowe IV DDH patients treated with transverse subtrochanteric shortening osteotomy, modular stem, and anatomic acetabular component insertion can have satisfactory and reliable 10-year clinical outcomes.
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Affiliation(s)
- Chang Sun
- Department of Orthopedics, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, People's Republic of China
| | - Yu Zhang
- Department of Orthopedics, Jinling Hospital, the first School of Clinical Medicine, Southern Medical University, Nanjing 210002, People's Republic of China
| | - Lin Tao Li
- Department of Orthopedics, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, People's Republic of China
| | - Hao Ding
- Department of Orthopedics, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, People's Republic of China
| | - Ting Guo
- Department of Orthopedics, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, People's Republic of China
| | - Jian Ning Zhao
- Department of Orthopedics, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, People's Republic of China; Department of Orthopedics, Jinling Hospital, the first School of Clinical Medicine, Southern Medical University, Nanjing 210002, People's Republic of China
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Zhao E, Liu Z, Ding Z, Luo Z, Li H, Zhou Z. A propensity score-matched analysis between patients with high hip dislocation after childhood pyogenic infection and Crowe IV developmental dysplasia of the hip in total hip arthroplasty with subtrochanteric shortening osteotomy. J Orthop Surg Res 2020; 15:418. [PMID: 32943097 PMCID: PMC7496208 DOI: 10.1186/s13018-020-01947-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/07/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Whether satisfactory clinical and radiological outcomes of total hip arthroplasty (THA) with subtrochanteric shortening osteotomy (SSO) in high hip dislocation after childhood pyogenic infection can be achieved as in Crowe IV developmental dysplasia of the hip (DDH) remains unclear. METHODS Between September 2009 and December 2016, 151 primary THAs performed at our institution using similar SSO technique and prosthetic design were retrospectively reviewed. After excluding patients who met exclusion criteria, 29 patients were identified as high dislocation (Crowe IV) after childhood infection (HDACI) and 107 as Crowe IV developmental dysplasia of the hip (DDH). Propensity score matching was used to select 29 Crowe IV DDH patients as a control group for the HDACI group with comparable preoperative conditions. Clinical and radiological outcomes and complication were compared and analyzed. The mean follow-up duration of the 2 groups was 5.0 years. RESULTS The mean Harris hip score (HHS) and the mean score in range of motion (ROM) domain of the modified Merle d'Aubigné-Postel (MAP) were 84.6 and 4.5 in the HDACI group, compared with 88.3 and 4.9 in the DDH group; there was significant difference between the 2 groups in these parameters (P = 0.015 and 0.035, respectively). Meanwhile, in the HDACI group, the median time of osteotomy union was 4 months and osteotomy nonunion rate was 3%; no significant difference was detected in the median time of osteotomy union and osteotomy nonunion rate between the 2 groups (P = 0.388 and 1.000, respectively). And no significant difference was found in the rate of complications between two groups. CONCLUSIONS HDACI patients who received THA combined with SSO could achieve similar satisfactory results as DDH patients in Crowe type IV. The fixation technique of autogenous cortical bone struts had a positive influence on osteotomy healing of SSO in this specific setting.
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Affiliation(s)
- Enze Zhao
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, People's Republic of China
| | - Zunhan Liu
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, People's Republic of China
| | - Zichuan Ding
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, People's Republic of China
| | - Zhenyu Luo
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, People's Republic of China
| | - Hao Li
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, People's Republic of China
| | - Zongke Zhou
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, People's Republic of China.
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Total Hip Arthroplasty Combined With Subtrochanteric Transverse Shortening Osteotomy: Factors Associated With Delayed Union at the Osteotomy Site. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00056. [PMID: 32852915 PMCID: PMC7417148 DOI: 10.5435/jaaosglobal-d-20-00056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Total hip arthroplasty (THA) with subtrochanteric shortening osteotomy for Crowe type IV hips poses the risk of nonunion at the osteotomy site. The aim of this study was to analyze the factors that affect the bone union rate at the osteotomy site. METHODS We retrospectively reviewed a consecutive series of 27 THAs with subtrochanteric transverse shortening osteotomy performed for Crowe type IV hips. The effects of patient-related and surgery-related factors on the risk of delayed union were analyzed using univariate and multivariate regression analyses. RESULTS The mean follow-up period was 10.0 (1.4 to 19.1) years. The implant survival rate was 87.8% (95% confidence interval: 60.2% to 97.2%) at 10 years. The length of femoral bone resection was the only factor associated with the risk of delayed union. Longer bone resection lengths were significantly correlated with the reduced risk of delayed union (odds ratio: 0.63 [0.030 to 0.90], P = 0.0013). Other variables, including the use of a cement stem (P = 0.34) and the presence of a gap >1 mm at the osteotomy site (P = 0.98), were not associated with the risk of delayed union. DISCUSSION THA with subtrochanteric transverse osteotomy provides satisfactory long-term results for Crowe type IV hips. For shorter required femoral resection lengths, the risk of delayed union was higher. A longer resection could permit fabrication of longer autologous longitudinal bone struts and likely contributes to enhanced stability at the osteotomy site.
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Liu Z, Zhang J, Wu S, Li Z, Xu Z, Zhang X, Zhou Y, Zhang Y. Direct Anterior Approach in Crowe Type III-IV Developmental Dysplasia of the Hip: Surgical Technique and 2 years Follow-up from Southwest China. Orthop Surg 2020; 12:1140-1152. [PMID: 32510863 PMCID: PMC7454225 DOI: 10.1111/os.12713] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To summarize our pioneering surgical practice and clinical outcome of Crowe type III-IV developmental dysplasia of the hip (DDH) with a direct anterior approach total hip arthroplasty in a single teaching hospital in Southwest China. METHODS Fourteen patients (15 hips) diagnosed with Crowe type III-IV developmental dysplasia of the hip were involved in this single-center retrospective study between 2016 and 2018. A comprehensive surgical procedure, including preoperative planning and algorithms for leg length equalization, intraoperative stepwise soft tissue release, bone defect reconstruction, and an innovative subtrochanteric osteotomy, was described. Furthermore, advancements in intraoperative CT guidance, computer navigation, and nerve monitoring were available for specific demands. The short-term clinical outcome was evaluated at the endpoint of follow-up by three patient-reported functional scales (Harris, WOMAC, and SF-12 scores), and objective data collected at the clinic, including functional recovery (muscle strength of hip flexor and abductor, correction of the pelvic tilt, leg length discrepancy, and limp), radiographic analysis, and complication occurrence. RESULTS The intraoperative variables were carefully recorded. The mean operating times in Crowe type III and IV groups were 115.8 min and 156.2 min, and the median blood loss volumes were 520.5 mL and 810.2 mL, respectively. The general changes in the Harris, SF-12, and WOMAC scores of the two groups were 46.2, 8.7 and 134.3, respectively, at a mean follow-up of 25.4 months. Enhanced recovery of hip abductor muscle strength was identified in 85.7% of the population at the third postoperative month. The equalization of leg length and correction of the pelvic tile were observed at the sixth postoperative month, with a 36-mm decrease in leg length discrepancy. No radiographic evidence of the loosening or migration of the components was observed. A self-innovated subtrochanteric shortening osteotomy was performed in five patients, and they healed after 6 months. Specific complications included two cases of distal femoral cracks and one case of a periprosthetic fracture needing internal fixation. Two patients received a late iliotibial band release at the 3rd month postoperatively due to progressive genu valgum. No records of infection, dislocation, nerve palsy, bone non-union, or revision surgery were identified. DISCUSSION The direct anterior approach total hip arthroplasty showed potential advantages, including optimum component positioning, improved hip stability, steerable complication rate, and enhanced functional recovery with Crowe type III-IV DDH. The short-term outcome is comparable to that of the traditional posterolateral approach.
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Affiliation(s)
- Zai‐yang Liu
- Joint Disease & Sport Medicine Center, Department of Orthopaedics, Xinqiao HospitalArmy Medical UniversityChongqingChina
| | - Jun Zhang
- Joint Disease & Sport Medicine Center, Department of Orthopaedics, Xinqiao HospitalArmy Medical UniversityChongqingChina
| | - Song‐tao Wu
- Department of OrthopaedicsPeople's Hospital of YunyangChongqingChina
| | - Zi‐qiang Li
- Department of OrthopedicsPeople's Hospital of LinshuiGuang'anChina
| | - Zhong‐hua Xu
- Joint Disease & Sport Medicine Center, Department of Orthopaedics, Xinqiao HospitalArmy Medical UniversityChongqingChina
| | - Xia Zhang
- Joint Disease & Sport Medicine Center, Department of Orthopaedics, Xinqiao HospitalArmy Medical UniversityChongqingChina
| | - Yue Zhou
- Joint Disease & Sport Medicine Center, Department of Orthopaedics, Xinqiao HospitalArmy Medical UniversityChongqingChina
| | - Yuan Zhang
- Joint Disease & Sport Medicine Center, Department of Orthopaedics, Xinqiao HospitalArmy Medical UniversityChongqingChina
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Cementless Total Hip Arthroplasty for Adult Patients With Sequelae From Childhood Hip Infection: A Medium-Term Follow-Up Study. J Arthroplasty 2020; 35:1885-1890. [PMID: 32197960 DOI: 10.1016/j.arth.2020.02.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/04/2020] [Accepted: 02/16/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this study is to evaluate midterm clinical and radiographic results of total hip arthroplasties (THAs) with cementless implants for adult patients with sequelae from childhood hip infection. METHODS Between 2002 and 2016, 165 patients (165 hips) who had a hip infection during childhood were treated with THAs with cementless implants. The average duration of follow-up was 93.5 months (range 26-206). Clinical results were evaluated via the Harris Hip Score and radiographic results were analyzed with postoperative serial X-rays. RESULTS The average Harris Hip Score increased from 27 (range 8-53) before surgery to 91 (range 45-100) at the latest follow-up examination (P < .001). At the latest follow-up evaluation, 9 cementless acetabular components demonstrated partial, nonprogressive radiolucencies. No subsidence of more than 2 mm or evidence of a radiolucent line was observed around the femoral components. Intraoperative periprosthetic fractures occurred in 11 hips, including 3 acetabular fractures, 2 fractures of greater trochanter, 1 femoral shaft fracture, and 5 fractures of femoral calcar. Postoperative complications included 3 cases of periprosthetic infection, 1 episode of dislocation, 1 case of a femoral periprosthetic fracture, 5 cases of sciatic nerve injury, 1 case of femoral nerve injury, and 1 case of squeaking from a ceramic bearing surface. CONCLUSION Cementless THA for adult patients with sequelae from childhood hip infection presents significant technical challenges and a relatively high complication rate. With meticulous surgical planning and anticipation for the key technical challenges frequently encountered, the medium-term clinical and radiographic results of THA in this setting were good with high implant survivorship and patient satisfaction.
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Zhang Y, Zhang X, Zhou Y. Direct Anterior Approach: The Outlook of Total Hip Arthroplasty in Crowe Type III-IV Hip Dysplasia. Orthop Surg 2020; 12:1016-1018. [PMID: 32372505 PMCID: PMC7307234 DOI: 10.1111/os.12672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/22/2020] [Accepted: 03/12/2020] [Indexed: 02/05/2023] Open
Affiliation(s)
- Yuan Zhang
- Joint Disease & Sport Medicine Center, Department of Orthopedics, Xinqiao HospitalArmy Medical UniversityChongqingChina
| | - Xia Zhang
- Joint Disease & Sport Medicine Center, Department of Orthopedics, Xinqiao HospitalArmy Medical UniversityChongqingChina
| | - Yue Zhou
- Joint Disease & Sport Medicine Center, Department of Orthopedics, Xinqiao HospitalArmy Medical UniversityChongqingChina
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Huang ZY, Liu H, Li M, Ling J, Zhang JH, Zeng ZM. Optimal location of subtrochanteric osteotomy in total hip arthroplasty for crowe type IV developmental dysplasia of hip. BMC Musculoskelet Disord 2020; 21:210. [PMID: 32252730 PMCID: PMC7137204 DOI: 10.1186/s12891-020-03248-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 03/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When reconstructing a hip with developmental dysplasia and high dislocation, sub-trochanteric shortening osteotomy is typically needed for placing the acetabular component in the appropriate anatomical position. However, the procedure can result in complications such as non-union of the osteotomy. We evaluated the contact area and the coincidence rate between the proximal and distal fragments at different femoral osteotomy levels and lengths. We then determined the optimal location of subtrochanteric femoral shortening transverse osteotomy in patients with unilateral Crowe type IV developmental dysplasia of the hip (DDH). The consistency between the proximal and distal segments was assessed as a possible predictive indicator of the union at the osteotomy site. METHODS We retrospectively reviewed 57 patients with unilateral Crowe type IV DDH who underwent X-ray imaging of both hip joints. We labelled the inner and outer diameters of the circular ring as N (mm) and M (mm), respectively. We defined the overlapped area between the proximal and distal ring as contact area S (mm2), and the ratio of contact area to distal ring area as coincidence rate R. RESULTS N varied from 9.8-15.2 mm and M varied from 20.7-24 mm, both demonstrated a decreasing trend in the proximal to distal direction. At osteotomy lengths ranging from 0.5-2 cm, there were no differences in S between the different levels of osteotomy in each group. At osteotomy lengths ≤2.5 cm, a significant higher coincidence rate was noted from 2 cm below the lesser trochanter to other positions below the level. At osteotomy lengths from 3 to 5.5 cm, a significantly higher coincidence rate was observed from the level of 1.5 cm below the lesser trochanter to other positions below the level. CONCLUSIONS Our findings suggest that femoral shortening transverse osteotomy at the optimal subtrochanteric level can predictably increase the contact area and coincidence rate, which may contribute to the union at the osteotomy site. Considering the stability of the prostheses, it appears appropriate that osteotomy location should be shifted slightly distally. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Zhe-Yu Huang
- The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, 1059# ZhongShan East Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Hua Liu
- The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, 1059# ZhongShan East Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Ming Li
- The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, 1059# ZhongShan East Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Jing Ling
- The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, 1059# ZhongShan East Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Jun-Hui Zhang
- The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, 1059# ZhongShan East Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Zhi-Min Zeng
- The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, 1059# ZhongShan East Road, Ningbo, Zhejiang, 315040, People's Republic of China.
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Akbaba YA, Can A, Erdogan F. The outcome of total hip arthroplasty in patients with developmental dysplasia of the hip. J Back Musculoskelet Rehabil 2020; 32:913-919. [PMID: 30958333 DOI: 10.3233/bmr-181367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The optimal rehabilitation program for patients with post-total hip arthroplasty (THA) after developmental dysplasia of the hip (DDH) remains unclear. OBJECTIVE The aim of the present study was to evaluate the clinical outcomes, to define a postoperative rehabilitation program, and to report the complication rate of THA in patients with DDH. METHODS DDH hips (n= 89) were recruited. The transverse proximal femoral shortening osteotomy was applied to all patients. The rehabilitation program was performed on the first day immediately after operation to the 6th week. Pain was assessed via Visual Analogue Scale, and the function was evaluated by the Harris Hip Score at the end of the 3rd month and the first year. The weakness of hip abduction was assessed via the Trendelenburg test before the operation and at one year. RESULTS Statistically significant improvements were seen for pain (p< 0.001) and function (p< 0.001) in the third month. This improvement continued for pain from three months to one year (p< 0.001). However, the function did not increase from month three to one year (p= 0.47). The Trendelenburg test was positive in all cases in the first assessment; it decreased to 24.7% at one year. The complication rate was 11.23%. CONCLUSIONS The pain and function of patients who performed exercise following THA due to DDH might improve, especially in the first three months.
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Affiliation(s)
- Yildiz Analay Akbaba
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Ata Can
- Department of Orthopaedics and Traumatology, Nisantası Ortopedi Clinic, Turkey
| | - Fahri Erdogan
- Department of Orthopaedics and Traumatology, Nisantası Ortopedi Clinic, Turkey
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Yang Y, Yu QP, Wang SL, Zhang SL, Li J, Zhou Y, Fan HQ, Zhang X, Zhou Y, Zhou M, Zhou MQ, Li N, Liu JL. Outcomes after Total Hip Arthroplasty Using a Cementless S-ROM Modular Stem for Patients with High Hip Dislocation Secondary to Hip Pyogenic Arthritis. Orthop Surg 2020; 11:460-466. [PMID: 31243926 PMCID: PMC6595098 DOI: 10.1111/os.12485] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/07/2019] [Accepted: 05/05/2019] [Indexed: 02/05/2023] Open
Abstract
Objective To evaluate the midterm results of the cementless S‐ROM modular femoral stem used with subtrochanteric transverse shortening osteotomy for the treatment of high hip dislocation secondary to hip pyogenic arthritis. Methods We retrospectively reviewed the data of 49 patients (49 hips) with an average infection quiescent period of 37.4 years who underwent cementless total hip arthroplasty (THA) with simultaneous subtrochanteric transverse shortening osteotomy from July 2008 to June 2012. There were 23 men and 26 women with a mean age of 44.3 years at the time of surgery. The following clinical outcomes were evaluated: the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, Harris hip score (HSS), modified Merle d'Aubigne‐Postel hip (MAP) score, low back pain visual analog scale score, 12‐item short‐form health survey questionnaire score, limp, and Trendelenburg sign. Radiographic outcomes and complications were also evaluated. Results The mean follow‐up period was 8.7 years (range, 5.5–10 years). No infection recurrence was observed after THA. The average HSS significantly improved from 45.0 to 84.8. The WOMAC score improved from 70.1 ± 3.5 (range, 65–76) to 43.1 ± 13.4 (range, 21–67). The modified MAP score improved from 5.9 ± 1.9 (range, 3–9) to 14.3 ± 2.4 (range, 11–18). The low back pain visual analog scale score, 12‐item short‐form health survey questionnaire score, limp, and Trendelenburg sign also improved significantly. The average limb length discrepancy decreased from 39.6 mm (range, 30–55 mm) to 7.2 mm (range, 0–22 mm). Two patients had temporary sciatic nerve paralysis but recovered within 6 months without any functional defects; one had an intraoperative fracture fixed by cerclage wires. One hip required revision surgery because of femoral stem aseptic loosening. Conclusions The cementless S‐ROM modular femoral stem used with subtrochanteric transverse shortening osteotomy is safe and effective for high hip dislocation secondary to pyogenic arthritis and provides satisfactory midterm results. Significant improvements in clinical function were observed, as were high rates of stable fixation of the cementless implant, restoration of more normal limb lengths, and a low incidence of complications.
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Affiliation(s)
- Yang Yang
- Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Qiu-Ping Yu
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Shao-Lin Wang
- Department of Orthopaedics, Chongqing General Hospital, Chongqing, China
| | - Sheng-Li Zhang
- Department of Orthopaedics, Chongqing General Hospital, Chongqing, China
| | - Juan Li
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yi Zhou
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hua-Quan Fan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xin Zhang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yu Zhou
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Min Zhou
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ming-Quan Zhou
- Department of Orthopaedics, Chongqing General Hospital, Chongqing, China
| | - Ning Li
- Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jun-Li Liu
- Department of Orthopaedics, Chongqing General Hospital, Chongqing, China
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Park CW, Lim SJ, Cha YT, Park YS. Total Hip Arthroplasty With Subtrochanteric Shortening Osteotomy in Patients With High Hip Dislocation Secondary to Childhood Septic Arthritis: A Matched Comparative Study With Crowe IV Developmental Dysplasia. J Arthroplasty 2020; 35:204-211. [PMID: 31521447 DOI: 10.1016/j.arth.2019.08.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/06/2019] [Accepted: 08/13/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) with subtrochanteric shortening osteotomy (SSO) is performed to manage hips with high dislocations. We compared outcomes of THA with SSO in patients with high hip dislocation resulting from childhood septic arthritis and Crowe IV developmental dysplasia of the hip (DDH). METHODS We reviewed 60 THAs with SSO performed between May 1996 and December 2013. Thirty-one cases were classified as sequelae of childhood infection and 29 as DDH. Twenty-five hips were selected for each group after the propensity score was matched with preoperative demographics and leg length discrepancy (LLD). Clinical scores, complication and reoperation rates, radiographic results, and survivorships were compared. The mean duration of follow-up was 12.3 (range 5-22) years. RESULTS The average correction in LLD was 2.5 cm for childhood infection and 3.6 cm for DDH (P = .002). The infection group received more transfusions (mean 3.3 vs 2.0 units, P = .002), required more time for union of osteotomy site (mean 6.8 vs 5.2 months, P = .042), and reported lower Harris Hip Score (mean 85.1 vs 91.3, P = .017). Reoperations were performed in 11 (44%) previously infected hips and 3 (12%) DDHs (P = .012). Kaplan-Meier survivorship with an endpoint of revision for any reason was lower in the infection group (83.6%) than in the DDH group (100%) at 10 years (log rank, P = .040). CONCLUSION THA with SSO in high hip dislocation secondary to childhood septic arthritis demonstrated less favorable clinical outcomes with increased risks of complication, compared with those performed in Crowe IV DDH with similar degree of chronic dislocation.
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Affiliation(s)
- Chan-Woo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Jae Lim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Taek Cha
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Youn-Soo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Classifications in Brief: The Hartofilakidis Classification of Developmental Dysplasia of the Hip. Clin Orthop Relat Res 2020; 478:189-194. [PMID: 31135539 PMCID: PMC7000062 DOI: 10.1097/corr.0000000000000802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Lu W, Zeng M, Lei P, Xie J, Hu Y. [Total hip arthroplasty with Wagner Cone stem and subtrochanteric shortening osteotomy in treatment of Crowe Ⅳ developmental dysplasia of hip in adults]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:929-934. [PMID: 31407548 DOI: 10.7507/1002-1892.201810062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the short-term effectiveness of total hip arthroplasty with Wagner Cone stem combined with subtrochanteric shortening osteotomy for adult patients with Crowe Ⅳ developmental dysplasia of the hip (DDH). Methods A clinical data of 18 patients (20 hips) with Crowe Ⅳ DDH between January 2015 and June 2017 was retrospectively analyzed. There were 5 males (6 hips) and 13 females (14 hips), with an average age of 42 years (range, 20-67 years). There were 18 cases with unilateral DDH and 2 cases with bilateral DDHs. The "4" sign and Trendelenburg sign of affected hip were positive. Preoperative Harris score and visual analogue scale (VAS) score were 41.95±6.90 and 5.05±1.15, respectively. The length discrepancy was (4.76±2.59) cm in patients with unilateral DDH. And the lengths of bilateral lower limbs in patients with bilateral DDH were equal. The acetabular anteversion angle, femoral anteversion angle, and combined anteversion angle were (32.82±2.79), (46.18±6.80), and (79.01±7.54) °, respectively. All patients were treated by total hip arthroplasty with Wagner Cone stem and subtrochanteric shortening osteotomy. The length of osteotomy ranged from 2.0 to 3.5 cm (mean, 2.38 cm). Results The operation time was 116-161 minutes (mean, 138.4 minutes); the volume of intraoperative blood loss was 600-1 200 mL (mean, 795 mL); the volume of drainage after operation was 100-630 mL (mean, 252 mL). All incisions healed by first intention. The symptom of sciatic nerve injury occurred in 1 case and relieved after symptomatic treatment. All patients were followed up 12-29 months (mean, 18.4 months). The "4" sign and Trendelenburg sign of affected hip were negative. The Harris score and VAS score at last follow-up were 87.50±5.06 and 0.75±0.85, respectively. The acetabular anteversion angle, femoral anteversion angle, and combined anteversion angle were (16.21±4.84), (18.99±2.55), and (35.20±5.80)°, respectively. There were significant differences in above indexes between pre- and post-operation ( P<0.05). The length discrepancy was (0.72±0.70) cm in patients with unilateral DDH, which was significant shorter than the preoperative value ( t=7.751, P=0.000). And the lengths of bilateral lower limbs in patients with bilateral DDH were equal. X-ray films showed that the osteotomy of femur healed at 3-6 months (mean, 4.1 months) without the signs of loosening, sinking, osteolysis, and dislocation. Conclusion Total hip arthroplasty with Wagner Cone stem and subtrochanteric shortening osteotomy can obviously improve the hip joint function and restore the length of lower limb. The short-term effectiveness is satisfactory, but the long-term effectiveness and survival rate of prosthesis need to be further observed.
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Affiliation(s)
- Wei Lu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China
| | - Min Zeng
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China
| | - Pengfei Lei
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China
| | - Jie Xie
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China
| | - Yihe Hu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha Hunan, 410008,
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Peng H, Zhang G, Xu C, Wang T, Wang Y. Is pseudoacetabulum an important factor determining SSTO application in total hip arthroplasty for Crowe IV hips? a retrospective cohort study. J Orthop Surg Res 2019; 14:201. [PMID: 31269956 PMCID: PMC6610809 DOI: 10.1186/s13018-019-1216-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/29/2019] [Indexed: 01/13/2025] Open
Affiliation(s)
- Haiwen Peng
- Department of Orthopaedic Surgery, Medical School of Chinese People's Liberation Army, Army Medical University of Chinese People's Liberation Army, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Guoqiang Zhang
- Department of Orthopaedic Surgery, Medical School of Chinese People's Liberation Army, Army Medical University of Chinese People's Liberation Army, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Chi Xu
- Department of Orthopaedic Surgery, Medical School of Chinese People's Liberation Army, Army Medical University of Chinese People's Liberation Army, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Tianhao Wang
- Department of Orthopaedic Surgery, Medical School of Chinese People's Liberation Army, Army Medical University of Chinese People's Liberation Army, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yan Wang
- Department of Orthopaedic Surgery, Medical School of Chinese People's Liberation Army, Army Medical University of Chinese People's Liberation Army, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China. .,Department of Orthopaedic Surgery, Medical School of Chinese People's Liberation Army, General Hospital of Chinese People's Liberation Army, Beijing, China.
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The causes and management of nonunion of femoral subtrochanteric shortening osteotomy in a THA patient: a case report. BMC Musculoskelet Disord 2019; 20:203. [PMID: 31077180 PMCID: PMC6511172 DOI: 10.1186/s12891-019-2612-2] [Citation(s) in RCA: 4] [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: 09/18/2018] [Accepted: 05/03/2019] [Indexed: 01/28/2023] Open
Abstract
Background Total hip arthroplasty (THA) is considerably difficult to perform in patients with Crowe type IV developmental dysplasia of the hip (DDH). Some Crowe type IV DDH patients require a femoral subtrochanteric shortening osteotomy to equalize the length of the lower extremities and decrease the difficulty of intraoperative reduction. Subtrochanteric transverse osteotomy has been proven to have superior clinical efficacy, but some cases of nonunion occur. Case presentation We present the case of a 62-year-old male patient who underwent right THA with femoral subtrochanteric transverse osteotomy due to Crowe type IV DDH. Nonunion of the osteotomy occurred during the follow-up period. In July 2017, the patient underwent right THA and femoral subtrochanteric transverse osteotomy due to Crowe type IV DDH. In November 2017, a slight feeling of bone rubbing and slight pain in the hip were reported. The ends of the osteotomy had rotated and united poorly. However, the patient requested to undergo continued observation. In December 2017, the patient reported an obvious sensation of bone rubbing and aggravated hip pain. The ends of the osteotomy had rotated and continued to exhibit nonunion. On December 26, 2017, the patient was treated with plate and screw internal fixation with bone morphogenetic protein (BMP) following our suggestion. In August 2018, the ends of the osteotomy had united after internal fixation was applied. Conclusions THA with femoral subtrochanteric transverse osteotomy exhibits good efficacy for the treatment of patients with Crowe type IV DDH. However, postoperative nonunion occurs in a small number of cases. The causes of nonunion should be analysed, and effective measures should be taken to prevent this situation. Plate and screw internal fixation with BMP is an effective treatment for nonunion of the ends of an osteotomy.
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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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Luo Y, Yang Z, Yeersheng R, Li D, Kang P. Clinical outcomes and quality of life after total hip arthroplasty in adult patients with a history of infection of the hip in childhood: a mid-term follow-up study. J Orthop Surg Res 2019; 14:38. [PMID: 30709358 PMCID: PMC6359810 DOI: 10.1186/s13018-019-1074-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Total hip arthroplasty for adult patients with a history of infection of the hip in childhood could be a more technically demanding procedure due to complicated anatomy and the possibility of reinfection. Here, we conducted a mid-term analysis of clinical outcomes in such patients after primary cementless total hip arthroplasty (THA). METHODS We reviewed 101 patients (101 hips; 51 men; mean age, 52.3 years) who underwent cementless THA between 2008 and 2015, at a mean of 24 years (range, 11-43) since the resolution of childhood hip infection. Patients were followed up for a mean of 6.1 years (range, 2.1-9.6). Clinical outcomes and quality of life after THA were assessed at final follow-up. RESULTS No cases of infection were reported during the follow-up, and patients showed significant improvement in Harris Hip Score, for which the mean score increased from 48.5 to 90 points; the modified Merle d'Aubigne and Postel (MAP) Hip Score; the Hip Dysfunction and Osteoarthritis Outcome Score; the SF-12; and mean limb length discrepancy, which decreased from 3.4 to 1.1 cm. During follow-up, four cases of prosthesis dislocation, three of transient sciatic paralysis, seven of femoral fracture, five of heterotopic ossification, and 19 of osteolysis were recorded. Revision surgery was performed for two patients, one for isolated loosening of the acetabular component and another for loosening of the femoral stem. CONCLUSION Cementless THA can effectively treat patients with a quiescent period of infection of the hip of more than 10 years, resulting in good functional outcomes and fewer complications. Risk of infection recurrence after THA in these patients seems extremely low.
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Affiliation(s)
- Yue Luo
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zhouyuan Yang
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Releken Yeersheng
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Donghai Li
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Pengde Kang
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
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Zeng WN, Liu JL, Jia XL, Zhou Q, Yang L, Zhang Y. Midterm Results of Total Hip Arthroplasty in Patients With High Hip Dislocation After Suppurative Hip Arthritis. J Arthroplasty 2019; 34:102-107. [PMID: 30342951 DOI: 10.1016/j.arth.2018.09.081] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is technically challenging in patients with high dislocation of the hip secondary to suppurative arthritis. The technical difficulty is attributable to the complex hip anatomy and the potential risk of recurrent infection in these patients. This study investigated the midterm results of THA in patients with Crowe type III and IV high dislocation of the hip secondary to suppurative arthritis. METHODS This study retrospectively reviewed 45 patients (45 hips) who underwent cementless THA with a mean quiescent infection period of 34.2 years. This study included 23 men and 22 women (mean age, 45.9 years) at the time of operation. The mean follow-up was 6.4 years. Clinical and radiographic outcomes and complications were evaluated. RESULTS The mean Harris hip score significantly improved from 48.1 to 87.6. The modified Merle d'Aubigné-Postel, Western Ontario and McMaster Universities Arthritis Index, low back pain visual analog scale, and the 12-item short-form health survey scores also improved significantly. The mean limb length discrepancy was reduced from 38.9 mm to 6.4 mm. Postoperative dislocation occurred in 2, temporary sciatic nerve paralysis in 3, and intraoperative fracture in 2 patients. Infection and femoral stem loosening necessitated hip revision surgery in 1 patient each. CONCLUSION THA could provide good joint function and significantly improve quality of life at the time of midterm follow-up in patients undergoing high hip dislocation secondary to suppurative arthritis. However, a relatively high incidence of complications occurred which can be treated.
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Affiliation(s)
- Wei-Nan Zeng
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jun-Li Liu
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; Department of Orthopaedics, Chongqing General Hospital, Chongqing, China
| | - Xiao-Lin Jia
- Department of Orthopaedics, Chongqing General Hospital, Chongqing, China
| | - Qiang Zhou
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yun Zhang
- Department of Orthopedics of Traditional Chinese Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
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Zhang G, Liu R, Wang K, Li H, Tang Y, Bai C, Dang X. [Effectiveness of total hip arthroplasty for hip infection sequelae]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1495-1499. [PMID: 30569672 DOI: 10.7507/1002-1892.201807033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate hip function and reinfection of the patients with hip infection sequelae after total hip arthroplasty (THA) treatment. Methods A clinical data of 31 patients (31 hips) with hip infection sequelae, who were treated with THA between June 2010 and May 2017, was retrospectively analyzed. There were 18 males and 13 females, with an average age of 46.1 years (range, 20-71 years). There were pyogenic infection in 17 cases, tuberculous infection in 9 cases, and unknown source of infection in 5 cases. The average time from infection to cure was 13.9 months (range, 6-25 months). The average time from cure to operation was 23.4 years (range, 6-58 years) for patients with confirmed source of infection. According to Kim classification, 12 cases were rated as typeⅠ, 9 as typeⅡ, and 10 as type Ⅲ. There were 21 cases of osteoarthritis after dysplasia, 7 cases of pathologic dislocation, and 3 cases of hip ankylosis. After operation, the infection was assessed by physical signs and laboratory tests; X-ray film of the hip was taken to assess the skeletal structure of the hip and infectious lesion; the length of the lower limb was measured, and the function of the hip joint was evaluated by Harris score. Results All patients were followed up 10-63 months (mean, 34 months). The result of bacterial culture was negative. The incisions healed by first intention. The sciatic nerve stimulation occurred in 1 case and posterior dislocation of the joint occurred in 1 case after operation. There was no recurrence of infection and no aseptic loosening of the prosthesis. According to Harris score, the function of the hip was rated as excellent in 8 cases, good in 19 cases, and fair in 4 cases at last follow-up; and the excellent and good rate of hip joint function was 87%. X-ray films showed no patchy bone density reduction, spot hardening, or light areas. The length of affected limb was not fully equal with the unaffected limb in 5 cases, and the difference between two sides ranged from 0.4 to 1.3 cm (mean, 0.6 cm). At last follow-up, all patients had no obvious claudication or sensation of unequal length. Conclusion THA can obtain satisfactory hip function and has low risk of infection recurrence for the patients with hip infection sequelae, who were assessed as the hip infection in a dormant state.
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Affiliation(s)
- Gensheng Zhang
- Department of Orthopedics, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an Shaanxi, 710004, P.R.China;Department of Orthopedics, Hanzhong Railway Central Hospital, Hanzhong Shaanxi, 723000, P.R.China
| | - Ruiyu Liu
- Department of Orthopedics, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an Shaanxi, 710004,
| | - Kunzheng Wang
- Department of Orthopedics, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an Shaanxi, 710004, P.R.China
| | - Haitao Li
- Department of Orthopedics, Hanzhong People's Hospital, Hanzhong Shaanxi, 723000, P.R.China
| | - Yilun Tang
- Department of Orthopedics, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an Shaanxi, 710004, P.R.China
| | - Chuanyi Bai
- Department of Orthopedics, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an Shaanxi, 710004, P.R.China
| | - Xiaoqian Dang
- Department of Orthopedics, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an Shaanxi, 710004, P.R.China
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Yin S, Li R, Mou P, Zhong H, Yang J. [Mid-term effectiveness of total hip arthroplasty with subtrochanteric shortening osteotomy in treatment of Crowe type Ⅳ developmental dysplasia of hip]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:385-388. [PMID: 29806293 DOI: 10.7507/1002-1892.201711053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To explore the mid-term effectiveness of total hip arthroplasty (THA) with subtrochanteric shortening osteotomy in treatment of Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods Between September 2009 and March 2014, a total of 49 patients (57 hips) who were diagnosed with Crowe type Ⅳ DDH were treated with THA and subtrochanteric shortening osteotomy. Of the 49 patients, 7 were male and 42 were female with an average age of 44.6 years (range, 20-73 years). The preoperative Harris score was 44.68±3.39 and the preoperative leg length discrepancy was (5.27±0.55) cm. Results All incisions healed primarily. All patients were followed up 32-87 months (mean, 52.1 months). At last follow-up, the Harris score was 85.67±2.89 and the leg length discrepancy was (1.12±0.48) cm, showing significant differences when compared with the preoperative values ( t=-69.53, P=0.00; t=42.94, P=0.00). X-ray films showed that bone union of the femoral osteotomy end at 6 months after operation. There was no loosening and subsidence of prosthesis at last follow-up. Conclusion The subtrochanteric shortening osteotomy with THA in treatment of Crowe type Ⅳ DDH can obtain satisfactory mid-term effectiveness with low risk of peripheral vascular and nerve traction injuries.
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Affiliation(s)
- Shijiu Yin
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Ruibo Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Ping Mou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Hang Zhong
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jing Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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