Total hip arthroplasty with a sliding iliac graft for acetabular dysplasia

Anatomic acetabular reconstruction with femoral head autograft for developmental dysplasia of the hip (DDH) with a minimum follow-up of 10 years

BACKGROUND

DDH with coxarthrosis causes significant deformity and bone deficiency. Various reconstructive techniques have been proposed to treat developmental dysplasia of the hip. However, the existing literature has not yet reached a consensus on the best technique regarding long-term survival.

OBJECTIVES

This study aims to evaluate the long-term survival of uncemented hydroxyapatite (HA) coated acetabular components augmented with a femoral head autograft.

METHODS

We retrospectively reviewed the cases of 31 hips in 29 patients (24 female, 5 male, mean age 45.06 years) treated with HA-coated cementless components and femoral head autograft between 2000-2008 with a minimum follow-up of 10 years. Graft resorption, cup loosening and the anatomical hip centre were determined. Functional outcomes were calculated using the Harris Hip Scoring system. The survival of the acetabular component was evaluated using the Kaplan-Meier method.

RESULTS

In 24 hips (77,4%), we reconstructed the hip centre anatomically. The remaining cups had variable deviations from the anatomical rotation centre. Only one patient required revision due to loosening. Survival analysis revealed 96.8% survival at 10 years. The mean Harris Hip Score was 39.23 preoperatively and 84.77 at final follow-up. There was no statistical correlation between revision and any of the measured parameters.

DISCUSSION

Acetabular reconstruction with a femoral head autograft allows for anatomical cup positioning, early structural support and increases bone stock for future revisions. Although our prior cemented cup study showed that anatomical cup orientation is critical, this study demonstrated the absence of a correlation between implant failure and cup positioning, suggesting that HA-coated cementless cups are more stable and forgiving.

CONCLUSIONS

HA-coated acetabular cups augmented with femoral head autograft provided long-term, reliable and durable cup fixation in dysplastic hips of young adults.

Stepped osteotomy of femoral head autograft for acetabular reconstruction in total hip arthroplasty for dysplasia of the hip: 3 to 12 years' results

OBJECTIVES

This study aims to describe a stepped osteotomy technique applied to the femoral head autograft to keep the graft volume at a sufficient level, provide primary stability, and direct cancellous-cancellous bone contact.

PATIENTS AND METHODS

In this retrospective study, 24 hips of 20 patients (5 males, 15 females; mean age 53 years; range, 43 to 68 years) with dysplasia of the hip (DDH) who underwent total hip arthroplasty with femoral head stepped osteotomy technique were evaluated between April 2003 and June 2010. Patients' age, gender, operation side, and postoperative complications were recorded. Aseptic loosening of the acetabular cup and graft integration/resorption were evaluated radiographically. Radiological evaluations were performed according to the methods of DeLee and Charnley, and Mulroy and Harris. Functional status of the patients was determined according to the criteria of Merle d'Aubigné and Postel, and Harris hip score (HHS).

RESULTS

The mean follow-up period was 5.5 years (range, 3 to 12 years). None of the patients had any complications in the early postoperative period. In all patients, the percentage of acetabular component coverage by the graft was measured as 27% (range, 19 to 38%) on average. At the last follow-up, all patients were satisfied with the result and there was no sign of clinically loosening, osteointegration was complete, and there was no radiographic evidence of graft resorption or collapse of any hip. The overall Merle d'Aubigné scores and HHSs of the patients significantly improved at the final follow-up.

CONCLUSION

This stepped osteotomy technique increases the probability of osteointegration, reduces the need for early revision, and provides reliable stability with satisfactory clinical and radiological midterm results.

Intraosseous structural graft technique: a new surgical concept in the treatment of superolateral defects in case of dysplastic acetabulum, during hip replacement surgery biomechanical and cadaver experimentations

PURPOSE

The replacement of the dysplastic hip, despite the numerous available surgical techniques, is not entirely solved. One of the reasons for this is the relative lack of bone in the acetabulum. In this study, we present a new concept (intraosseous structural graft technique), with the aim to improve the primary stability and biological environment of the graft.

METHODS

During the procedure in the cranial quadrant of the acetabulum, a proximally hinged cortico-spongious plate is fashioned that is opened laterally and a wedge-shaped graft made from the femoral head is impacted. The precisely fitted graft has good primary rotational and cranial stability which is further improved by a bicortical screw.

RESULTS

The hypothesis is supported by examination on 3D models. Cadaver experimentations were performed on 19 hips of 10 cadavers, and stability testing was done on a further 20 hips of 10 cadavers with a material testing apparatus. Also the analysis of the biological and mechanical properties of the graft and the implant were examined.

CONCLUSION

Based on our results, it can be concluded that our technique provides good primary stability with a more favorable biological condition for bony incorporation compared to other bulk bone graft techniques.

Total hip arthroplasty with bulk femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip

Developmental hip dysplasia (DDH) presents considerable technical challenges to the primary arthroplasty surgeon. Autogenous bulk grafting using the femoral head has been utilised to achieve anatomic cup placement and superolateral bone coverage in these patients, but reported outcomes on this technique have been mixed with the lack of graft integration and subsequent collapse, an early cause of failures. We describe a novel technique combining the use of bulk autograft with an iliac osteotomy, which provides primary stability and direct cancellous-cancellous bone contact, optimising the environment for early osseointegration. Twenty-one hips in 21 patients with DDH underwent this technique and were followed for a mean of 8.1 years. The preoperative radiographic classification was Crowe type I in 12 hips (57%), type II in 4 hips, and type III in 5 hips, and the mean Sharp angle was 49.6° (range 42°–60°). All grafts united by year. At time of followup, there was no radiographic evidence of graft collapse or loosening. There were no reoperations. Our study has shown that this technique variation combining an iliac osteotomy with bulk autograft in cases of developmental hip dysplasia provides early stability and reliable graft incorporation, together with satisfactory clinical and radiological outcomes in the medium term. Longer term study is necessary to confirm the clinical success of this procedure.

Long-term results of cementless anatomic total hip replacement in dysplastic hips

This perspective study analyzes the long-term outcomes of cementless anatomic total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). Between 1990 and 2004, 100 ABG total hip prosthesis were implanted in 87 patients with DDH. The average follow-up was 9 years (range 4-18 years). The mean Harris Hip Score was 87.13 (SD = 14.6) at the last follow-up. Radiographic analysis showed good results for the stems, while in 38% of the hips we recorded periacetabular bone resorption. Mean linear polyethylene wear was 0.23 mm/year. Ten revisions have been performed, survival rate was 99% for the stems and 90% for the cups. Cementless THA with hemispherical cup and anatomical stem is recommended when possible for patients with DDH although high rates of polyethylene wear and subsequent osteolysis have been the limiting factor in the long-term success of this implant.