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Işık Ç, Tahta M, Emre F. Placement of Standard Sized Acetabular Cup Between True and False Acetabulum in Patients with Crowe III/IV Dysplasia: A Safe Option in THA Without Femoral Osteotomy. Indian J Orthop 2024; 58:135-143. [PMID: 38312905 PMCID: PMC10830943 DOI: 10.1007/s43465-023-01083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/08/2023] [Indexed: 02/06/2024]
Abstract
Introduction There is no consensus in literature on the surgical treatment of patients with Crowe type III/IV patients. Each arthroplasty procedure has its own advantages and disadvantages. In this study by placing the acetabular cup between the true and false acetabulum, we aimed to share our experience about criteria of patient selection, surgical technique, and mid-term results of THA (total hip arthroplasty) in which the risk of dislocation was minimized using a standard-sized acetabular cup. Materials and Methods We reviewed the clinical and radiographic data of the patients with Crowe type III/IV treated by cementless THA without femoral shortening osteotomy from January 2015 to January 2020. The clinical (Harris hip score, Trendelenburg sign, limb lengths) and radiographic (AP/L hip X-ray, 3D CT) examinations before surgery; 1, 3 months and 1 year after the surgery were evaluated. All postsurgical complications were noted. Results Among all, 268 patients met the inclusion criteria. Thirty-two patients (11.9%) were male and 236 (88.1%) were female. Mean age was 46.8 years. Mean follow-up duration was 42.4 (26-57) months. Mean Harris Hip score (HHS) was 49.7 and Trendelenburg sign was positive in all patients preoperatively. In the final evaluation, mean HHS significantly improved to 80.2 (p < 0.005) and none of the patients had Trendelenburg sign. Mean lengthening of the operated leg was 4.3 cm. Conclusion Total hip arthroplasty with placement of acetabular cup between true and false acetabulum can be successfully preferred in selected patients with Crowe III/IV dysplasia.
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Affiliation(s)
- Çetin Işık
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Memorial Atasehir Hospital, Arel University, Istanbul, Turkey
| | - Mesut Tahta
- Department of Orthopaedics and Traumatology, Bozyaka Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Fahri Emre
- VM Medicalpark Ankara Hospital, Ankara, Turkey
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Peng J, Liu Z, Ding Z, Qian Q, Wu Y. Clinical efficacy of greater trochanter osteotomy with tension wire fixation in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip. J Orthop Surg Res 2024; 19:12. [PMID: 38167052 PMCID: PMC10763454 DOI: 10.1186/s13018-023-04344-w] [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: 08/14/2023] [Accepted: 11/03/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE The choice of osteotomy in joint replacement surgery for Crowe type IV developmental dysplasia of the hip (DDH) is a challenging and controversial procedure. In this study, we compared the clinical efficacy of a combination of greater trochanter osteotomy and tension wire fixation with that of subtrochanteric osteotomy. METHODS We performed 15 primary total hip arthroplasty (THA) procedures between January 2016 and July 2020 on 13 patients with a combination of greater trochanter osteotomy and tension wire fixation (the GTT group) and 12 THA procedures in 11 patients using subtrochanteric osteotomy (the STO group). The mean follow-up was 2.8 years (range 2.2-4.5 years) in the GTT group and 2.6 years (range 2.5-4.3 years) in the STO group. Clinical scores and radiographic results were evaluated during the final follow-up for the 15 hips in the GTT group and 12 hips in the STO group. RESULTS Postoperative Harris hip scores, implant position, and the surgery time did not differ between the treatment groups. There were no differences in preoperative leg length discrepancy LLD (P = 0.46) and postoperative LLD (P = 0.56) between the two groups. Bone union occurred within 6 months after surgery in 12 hips in the GTT group (92.3%) and in 9 hips (81.8%) in the STO group. One case in the GTT group and two cases in the STO group had nonunion, and additionally, there was one case of postoperative nerve injury in the STO group, while no symptoms of nerve damage were observed in the GTT group. CONCLUSION The GTT method demonstrated many advantages and reliable clinical results for Crowe type IV DDH patients undergoing THA. This is a surgical method that warrants further development and promotion clinically.
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Affiliation(s)
- Jinhui Peng
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, No.415, Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Ziye Liu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, No.415, Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Zheru Ding
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, No.415, Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Qirong Qian
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, No.415, Fengyang Road, Huangpu District, Shanghai, 200003, China.
| | - Yuli Wu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, No.415, Fengyang Road, Huangpu District, Shanghai, 200003, China.
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Kim HS, Lee HJ, Yoo JJ. Minimal pre-operative leg length discrepancy as a risk factor of post-operative leg length discrepancy after total hip arthroplasty: a retrospective study of patients with non-traumatic osteonecrosis of the femoral head. BMC Musculoskelet Disord 2023; 24:954. [PMID: 38066461 PMCID: PMC10704764 DOI: 10.1186/s12891-023-07086-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Leg length discrepancy (LLD) is one of the troublesome complications of total hip arthroplasty (THA). Previously, several risk factors have been suggested, but they were subjected to their inherent limitations. By controlling confounding variables, we hypothesized that known risk factors be re-evaluated and novel ones be discovered. This study aimed to analyze the independent risk factors for LLD after primary THA in patients with non-traumatic osteonecrosis of the femoral head (ONFH). METHODS We retrospectively reviewed patients with non-traumatic ONFH who underwent unilateral THA between 2014 and 2021. All patients were operated by one senior surgeon using a single implant. Demographic data, surgical parameters, and radiological findings (pre-operative LLD, Dorr classification, and femoral neck resection) were analyzed to identify the risk factors of ≥ 5 mm post-operative LLD based on radiological measurement and to calculate odds ratios by logistic regression analysis. Post hoc power analysis demonstrated that the number of analyzed patients was sufficient with 80% power. RESULTS One hundred and eighty-six patients were analyzed, including 96 females, with a mean age of 58.8 years at the time of initial THA. The average post-operative LLD was 1.2 ± 2.9 mm in the control group and 9.7 ± 3.2 mm in the LLD group, respectively. The LLD group tended to have minimal pre-operative LLD than the control group (-3.2 ± 5.1 mm vs. -7.9 ± 5.8 mm p = 2.38 × 10- 8). No significant difference was found between the groups in age, gender, body mass index, femoral cortical index, and implant size. CONCLUSION Mild pre-operative LLD is associated with an increased risk of post-operative LLD after primary THA in patients with ONFH. Thus, surgeons should recognize pre-operative LLD to achieve an optimal outcome and must inform patients about the risk of developing LLD.
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Affiliation(s)
- Hong Seok Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
- Department of Orthopedic Surgery, College of Medicine, Seoul National University, Seoul, South Korea
| | - Han Jin Lee
- Department of Orthopedic Surgery, Hanil General Hospital, Seoul, South Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea.
- Department of Orthopedic Surgery, College of Medicine, Seoul National University, Seoul, South Korea.
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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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Turan K, Kezer M, Çamurcu Y, Uysal Y, Kızılay YO, Ucpunar H, Temiz A. Intraoperative Neurophysiological Monitoring in Total Hip Arthroplasty for Crowe Types 3 and 4 Hips. Clin Orthop Surg 2023; 15:711-717. [PMID: 37811513 PMCID: PMC10551681 DOI: 10.4055/cios22371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 10/10/2023] Open
Abstract
Background Crowe types 3 and 4 dysplastic hips usually need total hip arthroplasty (THA) with femoral shortening osteotomy (FSO) to facilitate reduction, equalize limb length, and decrease the traction stress in nerves. The frequency of peripheral nerve palsy after primary THA has been reported to range from 0.08% to 3.7%. Apart from direct trauma to the nerve, the excessive extension of the extremity is also reported as a common cause of nerve damage. The current study aimed to evaluate the outcomes of intraoperative neurophysiological monitoring (IONM) in THA for Crowe types 3 and 4 hips. Methods The data of patients who underwent primary THA with IONM were retrospectively reviewed using our medical records. Patients with Crowe types 3 and 4 dysplastic hips were included in the study. Motor-evoked potentials and somatosensory-evoked potentials were assessed intraoperatively. Preoperative dislocation height and postoperative trochanter minor differences were measured using preoperative and postoperative radiographs. Results Twenty-three hips of 19 patients (4 bilateral THAs) with a mean age of 45 years participated in the study. Ten hips (43%) were classified as Crowe type 4, whereas 13 hips (57%) were Crowe type 3. The mean preoperative dislocation height was 41.6 mm (range, 15-100 mm). Postoperatively, only 6 patients had a difference between trochanter minor levels with a mean of 8.5 mm (range, 3-17 mm). Three patients underwent a subtrochanteric FSO to achieve reduction. Postoperatively, no patient had any motor and sensory nerve dysfunction. Conclusions According to the results acquired from this study, no nerve palsy was observed after THA for Crowe types 3 and 4 hips, and subtrochanteric FSO was not performed in all Crowe type 3 hips and 70% of Crowe type 4 hips with the aid of IONM.
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Affiliation(s)
- Kayhan Turan
- Department of Orthopaedics and Traumatology, Turan Turan Health Group, Bursa, Türkiye
| | - Murat Kezer
- Department of Orthopaedics and Traumatology, Turan Turan Health Group, Bursa, Türkiye
| | - Yalkın Çamurcu
- Department of Orthopaedics and Traumatology, Turan Turan Health Group, Bursa, Türkiye
| | - Yunus Uysal
- Department of Orthopaedics and Traumatology, Turan Turan Health Group, Bursa, Türkiye
| | - Yusuf Onur Kızılay
- Department of Orthopaedics and Traumatology, Turan Turan Health Group, Bursa, Türkiye
| | - Hanifi Ucpunar
- Department of Orthopaedics and Traumatology, Turan Turan Health Group, Bursa, Türkiye
| | - Abdulaziz Temiz
- Department of Orthopaedics and Traumatology, Turan Turan Health Group, Bursa, Türkiye
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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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Two-Stage Total Hip Arthroplasty for Primary Advanced Septic Arthritis of the Hip in Adults. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8387465. [PMID: 35419459 PMCID: PMC9001105 DOI: 10.1155/2022/8387465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/22/2022] [Indexed: 12/02/2022]
Abstract
Background Comparing the outcomes of debridement and total hip arthroplasty (THA) with antibiotic-loaded spacer implantation and subsequent THA for the treatment of patients affected by primary advanced septic arthritis (SA) of the hip in adults. Methods All of the 20 patients (20 hips) underwent two-stage surgery. Nine patients were submitted to surgical debridement first and then THA (group 1), while 11 patients were treated with antibiotic-loaded spacer and subsequent THA (group 2). Patients were evaluated based on the recurrence of infection, Harris hip score, visual analogue scale (VAS) pain score, and leg length discrepancy. Results No cases of infection, deep vein thrombosis, death, and loosening of the hip prosthesis were observed during follow-up. The mean follow-up time was 29.09 ± 10.80 months in group 1 and 28.22 ± 14.80 months in group 2. Before the THA surgery, the mean leg length discrepancy was 2.80 ± 2.03 cm in group 1 and 0.50 ± 0.23 cm in group 2 (P < 0.05). In the latest follow-up, the Harris hip scores of patients were 90.33 ± 4.85 in group 1 and 94.36 ± 2.34 in group 2 (P < 0.05), respectively. There was no statistically significant difference in the VAS pain score of the hip between the two groups (P > 0.05). Conclusions Debridement and antibiotic-loaded spacer and subsequent THA were effective in eradicating the infection for advanced SA. However, antibiotic-loaded spacer and subsequent THA was superior for effectively maintaining the length of the lower limb and function of the hip.
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Kaizu Y, Miyata K, Arii H. Predictors of post-hip fracture knee pain in hospitalized older adults with intertrochanteric femoral fracture. PM R 2022; 15:563-569. [PMID: 35238168 DOI: 10.1002/pmrj.12798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Post-hip fracture knee pain (PHFKP) is an important issue that contributes to reduced gait speed and prolonged hospitalization. Femoral morphology has been reported to contribute to the development of PHFKP, but an independent association has not been confirmed and clinically applicable cutoffs for predicting the development of PHFKP remain unclear. OBJECTIVE To determine whether femoral morphology and knee extension range of motion limitation are independent factors in PHFKP and to determine cutoffs for predicting the development of PHFKP. DESIGN Retrospective chart review study. SETTING Convalescent inpatient rehabilitation hospital. PARTICIPANTS Patients in a convalescent ward after intertrochanteric femoral fracture surgery. MAIN OUTCOME MEASURES PHFKP development, radiographic femoral morphology (leg length discrepancy and neck-shaft angle), and knee extension range of motion limitation. RESULTS PHFKP developed in 36 (35%) of the 103 patients enrolled. The PHFKP group had a longer hospital stay (p = .029), greater weight (p = .031), greater knee extension range of motion limitation (p = .001), and more varus neck-shaft angle (p < .001) compared to the non-PHFKP group. Varus neck-shaft angle (odds ratio, 0.85; 95% confidence interval [CI], 0.78-0.92; p < .001) and knee extension range of motion limitation (odds ratio, 1.18; 95% CI, 1.07-1.30; p = .001) were significant factors for PHFKP development. Neck-shaft angle discrepancy and knee extension range of motion limitation demonstrated moderate accuracy in discriminating development of PHFKP according to receiver operating characteristic analysis, with cutoffs of 9.6° and 7.5°, respectively. Areas under the receiver operating characteristic curve were 0.77 (95% CI, 0.66-0.88; p < .001) for neck-shaft angle discrepancy and 0.67 (95% CI, 0.56-0.79; p = .004) for knee extension range of motion limitation. CONCLUSIONS Varus neck-shaft angle and knee extension range of motion limitation were identified as independent predictors of PHFKP. The cutoff for neck-shaft angle may be useful for predicting PHFKP development and to define an acceptable angle of fracture reduction to prevent PHFKP.
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Affiliation(s)
- Yoichi Kaizu
- Department of Rehabilitation Center, Hidaka Hospital, Takasaki, Japan.,Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, Ibaraki, Japan
| | - Hironori Arii
- Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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Papachristou GC, Pappa E, Chytas D, Masouros PT, Nikolaou VS. Total Hip Replacement in Developmental Hip Dysplasia: A Narrative Review. Cureus 2021; 13:e14763. [PMID: 34094728 PMCID: PMC8168999 DOI: 10.7759/cureus.14763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The reconstruction of the hip joint in patients suffering from developmental hip dysplasia (DDH) is a demanding procedure and presents many challenges to the reconstructive surgeon. Higher rates of mechanical complications are present in this group of patients. The results of cemented and uncemented implants used in DDH patients are very promising, according to recent outcomes. However, the surgeon has to be aware of several complications, in order to establish an uneventful surgical management of DDH. The specific article investigates the technical challenges and clinical results of total hip arthroplasty in patients with DDH.
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Affiliation(s)
- George C Papachristou
- 2nd Department of Orthopaedics, School of Medicine. National and Kapodistrian University of Athens, Athens, GRC
| | - Eleni Pappa
- 5th Department of Orthopaedics, "KAT" General Hospital of Athens, Athens, GRC
| | - Dimitrios Chytas
- Department of Orthopaedics, European University of Cyprus, Nicosia, CYP
| | | | - Vasileios S Nikolaou
- 2nd Department of Orthopaedics, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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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: 0.7] [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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11
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Kaizu Y, Miyata K, Arii H, Tazawa M, Yamaji T. Femoral morphology is associated with development of knee pain after hip fracture injury among older adults: A nine-year retrospective study. J Orthop 2021; 24:190-193. [PMID: 33737793 DOI: 10.1016/j.jor.2021.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/14/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction We aimed to clarify differences in femoral morphology associated with post-hip fracture knee pain (PHFKP). Methods Medical records and radiographic examinations were retrospectively reviewed to determine the relationship between PHFKP development and femoral morphology. Leg length discrepancy (LLD) and neck-shaft angle discrepancy (NSAD) were measured from hip radiographs. Results 202 were enrolled, of whom 64 (31.7%) developed PHFKP. The PHFKP group showed more varus NSA. Intertrochanteric femoral fractures (γ-nail or CHS) displayed a more varus NSA. Conclusions Femoral morphology (varus NSA) may be involved in the development of PHFKP.
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Affiliation(s)
- Yoichi Kaizu
- Department of Rehabilitation Centre, Hidaka Hospital, 886 Nakao-machi, Takasaki, Gunma, 370-0001, Japan
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, 4669-2 Inashiki-gun, Ami-Machi, Ibaraki, 300-0394, Japan
| | - Hironori Arii
- Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
- Department of Rehabilitation Medicine, Fujioka General Hospital, 813-1 Nakakurisu, Fujioka, Gunma, 375-0015, Japan
| | - Masayuki Tazawa
- Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Takehiko Yamaji
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
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Vigdorchik JM, Sharma AK, Aggarwal VK, Carroll KM, Jerabek SA. The Use of Robotic-Assisted Total Hip Arthroplasty in Developmental Dysplasia of the Hip. Arthroplast Today 2020; 6:770-776. [PMID: 32964085 PMCID: PMC7490591 DOI: 10.1016/j.artd.2020.07.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is an effective operation for patients with hip osteoarthritis; however, patients with hip dysplasia present a particular challenge. Our novel study examined the effect of robot-assisted THA in patients with hip dysplasia. METHODS We retrospectively reviewed patients with developmental dysplasia of the hip undergoing primary THA using robotic arm assistance at 2 institutions from January 2010 to January 2017. Patients undergoing revision arthroplasty were excluded. Preoperatively, all patients underwent a computed tomography scan so that 3-dimensional templating could be performed. Hip range of motion (ROM) and clinical leg length discrepancy were recorded preoperatively. Two independent observers calculated Crowe and Hartofilakidis grades for each operative hip. At the final follow-up, hip ROM, postoperative complications, and modified Harris Hip scores were obtained. RESULTS Seventy-nine patients underwent THA because of degenerative joint disease in the setting of developmental dysplasia of the hip. There were 56 females and 23 males with a mean age of 45 years (range: 26-64 years). We found that components were placed according to the preoperative plan, that there was an improvement in the modified Harris hip score from 29 to 86 (P < .001), an improvement in the hip ROM (flexion improvement from 66° to 91°, P < .0001), and a correction of leg length discrepancy (17.1 vs 4 mm, P < .0002). There were no complications during the short-term interim follow-up (mean: 3.1 years). CONCLUSIONS Robot-assisted THA can be a useful method to ensure adequate component positioning and excellent outcomes in patients with hip dysplasia. LEVEL OF EVIDENCE Level III, Retrospective.
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Affiliation(s)
- Jonathan M. Vigdorchik
- Department of Orthopedic Surgery, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Service, New York, NY, USA
| | - Abhinav K. Sharma
- Department of Orthopedic Surgery, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Service, New York, NY, USA
| | - Vinay K. Aggarwal
- Department of Orthopedic Surgery, NYU Langone Health, Division of Adult Reconstruction, New York, NY, USA
| | - Kaitlin M. Carroll
- Department of Orthopedic Surgery, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Service, New York, NY, USA
| | - Seth A. Jerabek
- Department of Orthopedic Surgery, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Service, New York, NY, USA
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Kim JT, Kim HS, Lee YK, Ha YC, Koo KH. Total Hip Arthroplasty With Trochanteric Ostectomy for Patients With Angular Deformity of the Proximal Femur. J Arthroplasty 2020; 35:2911-2918. [PMID: 32473769 DOI: 10.1016/j.arth.2020.04.099] [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: 03/20/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) of patients with a proximal femoral deformity is technically demanding. This deformity poses the risk of femoral fracture or perforation; stem malposition; and failed stem fixation. To insert a femoral stem in neutral position with a good fit, we removed the greater trochanter in case of a varus deformity, and the lesser trochanter in case of valgus deformity, while performing THA. We aimed to evaluate stem position, implant stability, clinical results, and radiological changes after THAs using this technique. METHODS Fifteen patients (17 hips; 11 varus hips and 6 valgus hips) underwent cementless THA using the trochanteric osteotomy technique in one institution. We evaluated procedure-specific complications: intraoperative femoral fracture, stem malposition, weakness of the abductor power and limp. Modified Harris Hip Score, radiological changes, and the stability of stems were assessed at a mean of 7.1 years of follow-up (range 2.0-15.5). RESULTS Femoral fracture occurred during the insertion of the stem in 4 hips. All stems were aligned in neutral position. At the latest follow-up, the mean power of the abductor was 4.3 (range 3-5). Eleven patients had slight limp and 4 patients had moderate limp. All stems had bone-ingrown stability and no stem was revised. The mean modified Harris Hip Score improved from 50 points at the preoperative evaluation to 81 points at the final follow-up. CONCLUSION The trochanteric excision enabled neutral insertion of cementless stem in patients with varus/valgus deformity of the proximal femur, and THA using this technique rendered favorable results.
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Affiliation(s)
- Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Hong Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Benjamin B, Haddad FS. Management of limb length problems during total hip arthroplasty for patients with developmental dysplasia of the hip. Br J Hosp Med (Lond) 2020; 81:1-7. [PMID: 32730164 DOI: 10.12968/hmed.2019.0362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The anatomy of the acetabulum and femur is usually significantly altered in people with developmental dysplasia of the hip and this leads to secondary osteoarthritis of the hip joint. Ideal positioning of implants and reduction of the joint is technically demanding during arthroplasty. Lengthening may result in nerve palsies and therefore procedures may have to be undertaken to shorten the femur. Other complications include dislocation and non-union at the shortening osteotomy site. Thorough preoperative planning and templating is required before surgery to assess the need for shortening. Shortening osteotomies can be performed at the proximal femur, diaphysis or distal femoral levels, with subtrochanteric being the most common level. The procedure should be customised for each patient after extensive planning and detailed counselling.
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Affiliation(s)
- Biju Benjamin
- Department of Trauma and Orthopaedics, Forth Valley Royal Hospital, NHS Forth Valley, Larbert, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedics, University College London Hospital, London, UK Conflicts of interest
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15
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Jacquet C, Flecher X, Pioger C, Fabre-Aubrespy M, Ollivier M, Argenson JN. Long-term results of custom-made femoral stems. DER ORTHOPADE 2020; 49:408-416. [PMID: 32240324 DOI: 10.1007/s00132-020-03901-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The progress of 3D imaging and manufacturing of implants has made it possible to achieve a custom-made concept in THA. The custom-made cementless femoral stem provides optimal implant stability combined with restoration of the native hip mechanics. OBJECTIVE The purpose of this study was to evaluate the long-term survivorship of custom-made hip femoral stems in two populations of patients undergoing THA: patients under 50 years old (young patients group) and patients with high-grade developmental dysplasia of the hip (DDH group). METHODS A series of 232 primary custom-made cementless THA stems were retrospectively evaluated in patients less than 50 years old at the time of surgery and at follow-up after an average of 20 years. A second series of 26 custom-made cementless stem THAs for late DDH (21 patients) including only Crowe grade III and grade IV were also retrospectively evaluated with an average follow-up of 16 years. The clinical and radiological evaluations were performed preoperatively and at yearly intervals. RESULTS For the young patient group, the follow-up ranged from 14 to 27 years. The HHS and the Merle D'Aubigne-Postel score significantly improved from preoperatively to a mean of 94.1 (range 48-100) and 15.9 (range 9-18), respectively. Taking stem revision for aseptic loosening as an endpoint, survivorship was 96.8% at 20 years (95% confidence interval, CI 95.1-98.5). For the DDH group, the follow-up ranged from 10 to 22 years. The mean HHS increased significantly from preoperative 49 ± 22 points to the most recent follow-up examination with 86 13 points and survivorship was 96.1% (95% CI, 92.7-99.9). CONCLUSION Custom-made femoral stems provide good functional outcome and long-term survivorship in two specific populations of patients undergoing THAs: patients under 50 years old with high expectations and patients with high-grade DDH.
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Affiliation(s)
- Christophe Jacquet
- Institute for Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274, Marseille, France
| | - Xavier Flecher
- Institute for Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274, Marseille, France
| | - Charles Pioger
- Institute for Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274, Marseille, France
| | - Maxime Fabre-Aubrespy
- Institute for Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274, Marseille, France
| | - Matthieu Ollivier
- Institute for Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274, Marseille, France
| | - Jean-Noel Argenson
- Institute for Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274, Marseille, France.
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16
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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: 2.5] [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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Liu T, Wang S, Huang G, Wang W. Treatment of Crowe IV developmental dysplasia of the hip with cementless total hip arthroplasty and shortening subtrochanteric osteotomy. J Int Med Res 2019; 47:3223-3233. [PMID: 31187684 PMCID: PMC6683936 DOI: 10.1177/0300060519853383] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective This study was performed to document the clinical and radiographic results of consecutive patients with Crowe IV developmental dysplasia of the hip (DDH) treated by cementless total hip arthroplasty (THA) using an S-ROM femoral component with shortening derotational subtrochanteric osteotomy. Methods Twenty-three hips of 21 patients with Crowe IV DDH were treated by cementless THA combined with shortening derotational subtrochanteric osteotomy from January 2005 to January 2011. The mean preoperative modified Harris hip score (mHHS) and University of California, Los Angeles (UCLA) activity score were 40.7 and 4.2, respectively. Results The mean follow-up was 105 months. The mean mHHS and UCLA score improved to 87.0 and 9.1, respectively, at the latest follow-up. Nine of the 23 hips had a negative Trendelenburg sign. One of the 23 hips was outside the Lewinnek acetabular cup inclination safe range, and 3 of the 23 hips were outside the Lewinnek acetabular cup anteversion safe range. The probability of prosthesis survival was 100% at 5 years and 91.3% at 10 years. Conclusion Patients with Crowe IV DDH can be treated by cementless THA combined with shortening derotational subtrochanteric osteotomy. This method can greatly improve hip joint function and relieve pain without significant complications.
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Affiliation(s)
- Tang Liu
- 1 Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Sisi Wang
- 1 Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China.,2 Department of Orthopedic Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States
| | - Guoliang Huang
- 1 Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Wanchun Wang
- 1 Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
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18
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Hitz OF, Flecher X, Parratte S, Ollivier M, Argenson JN. Minimum 10-Year Outcome of One-Stage Total Hip Arthroplasty Without Subtrochanteric Osteotomy Using a Cementless Custom Stem for Crowe III and IV Hip Dislocation. J Arthroplasty 2018; 33:2197-2202. [PMID: 29573918 DOI: 10.1016/j.arth.2018.02.055] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/29/2018] [Accepted: 02/12/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Options for total hip arthroplasty (THA) in high dislocated hips include subtrochanteric osteotomy (STO), high hip center positioning, and 2-stage surgery with progressive lowering using an external fixator before THA. We described the long-term results of 1-stage THA performed without STO, using a cementless customized stem associated if necessary with sequential tenotomies and/or greater trochanteric osteotomy. METHODS Ninety-eight consecutive THA without STO were performed using this technique. Of those 98 hips, 26 hips with high dislocation (12 class III and 14 class IV according to the Crowe classification) were evaluated at an average follow-up of 16 (10-22) years. RESULTS At the time of last follow-up, the mean Harris Hip Score was 86 points (37-100). The mean leg-length discrepancy was 7 ± 5 mm (0-17). Two transient (7.7%) nerve palsies (1 sciatic and 1 femoral) were notified. A revision was required for 6 hips (23.1%). Kaplan-Meier survivorship analysis at 15 years regarding aseptic loosening of the femoral component was 87.5% (95% confidence interval, 76.5-99.1). During the same period, acetabular implant survivorship free from revision for aseptic loosening was 96.1% (95% confidence interval, 92.7-99.9). CONCLUSION The combination of intramedullary fit and extramedullary adaptation for offset and anteversion provided by the custom stem can avoid additional procedures associated to THA in high developmental dysplasia of the hip. The clinical function and long-term survival reported in this series is encouraging for THA performed in case of high hip dislocation.
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Affiliation(s)
- Olivier Freddy Hitz
- Lausanne University, Lausanne, Switzerland; Department of Orthopedic Surgery and Traumatology, Institute for Locomotion, St. Marguerite Hospital, Marseille, France
| | - Xavier Flecher
- Department of Orthopedic Surgery and Traumatology, Institute for Locomotion, St. Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille Cedex 09, France
| | - Sébastien Parratte
- Department of Orthopedic Surgery and Traumatology, Institute for Locomotion, St. Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille Cedex 09, France
| | - Matthieu Ollivier
- Department of Orthopedic Surgery and Traumatology, Institute for Locomotion, St. Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille Cedex 09, France
| | - Jean-Noël Argenson
- Department of Orthopedic Surgery and Traumatology, Institute for Locomotion, St. Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille Cedex 09, France
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Li Y, Zhang X, Wang Q, Peng X, Wang Q, Jiang Y, Chen Y. Equalisation of leg lengths in total hip arthroplasty for patients with Crowe type-IV developmental dysplasia of the hip: classification and management. Bone Joint J 2017; 99-B:872-879. [PMID: 28663391 DOI: 10.1302/0301-620x.99b7.bjj-2016-1328.r1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/23/2017] [Indexed: 11/05/2022]
Abstract
AIMS There is no consensus about the best method of achieving equal leg lengths at total hip arthroplasty (THA) in patients with Crowe type-IV developmental dysplasia of the hip (DDH). We reviewed our experience of a consecutive series of patients who underwent THA for this indication. PATIENTS AND METHODS We retrospectively reviewed 78 patients (86 THAs) with Crowe type-IV DDH, including 64 women and 14 men, with a minimum follow-up of two years. The mean age at the time of surgery was 52.2 years (34 to 82). We subdivided Crowe type-IV DDH into two major types according to the number of dislocated hips, and further categorised them into three groups according to the occurrence of pelvic obliquity or spinal curvature. Leg length discrepancy (LLD) and functional scores were analysed. RESULTS Type-I included 53 patients with unilateral dislocation, in which 25 (category A) had no pelvic obliquity or spinal deformity, 19 (category B) had pelvic obliquity with a compensated spinal curvature and nine (category C) had pelvic obliquity and decompensated spinal degenerative changes. Type-II included 25 patients with one dislocated and one dysplastic hip, in which there were eight of category A, 15 of category B and two of category C. Pre-operatively, there were significant differences between the anatomical and functional LLD in type-IB (p = 0.005) and -IC (p < 0.001), but not in type-IA, -IIA or -IIB. Post-operatively, bony LLD increased significantly in types-IB, -IC and -IIB, whereas functional LLD decreased significantly in each type except for IIA. The mean functional LLD decreased from 30.7 mm (standard deviation (sd) 18.5) pre-operatively to 6.2 mm (sd 4.4) post-operatively and the mean anatomical LLD improved from 35.8 mm (sd 19.7) pre-operatively to 12.4 mm (sd 8.3) post-operatively. CONCLUSION Pelvic and spinal changes are common in patients with Crowe type-IV DDH and need to be taken into consideration when planning THA, in order to obtain equal leg lengths post-operatively. The principal subdivisions of Crowe type-IV DDH which we describe proved effective in achieving equal leg lengths and satisfactory outcomes. Cite this article: Bone Joint J 2017;99-B:872-9.
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Affiliation(s)
- Y Li
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 6 Building, No. 600 Yishan Road, Shanghai, China
| | - X Zhang
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 6 Building, No. 600 Yishan Road, Shanghai, China
| | - Q Wang
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 6 Building, No. 600 Yishan Road, Shanghai, China
| | - X Peng
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 6 Building, No. 600 Yishan Road, Shanghai, China
| | - Q Wang
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 6 Building, No. 600 Yishan Road, Shanghai, China
| | - Y Jiang
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 6 Building, No. 600 Yishan Road, Shanghai, China
| | - Y Chen
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 6 Building, No. 600 Yishan Road, Shanghai, China
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Li YM, Li JH, Li B, Wang JX, Chen YS. The radiological research for pelvis asymmetry of unilateral developmental dysplasia of the hip in adult. Saudi Med J 2017; 37:1344-1349. [PMID: 27874150 PMCID: PMC5303773 DOI: 10.15537/smj.2016.12.15945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives To investigate whether adult patients with unilateral developmental dysplasia of the hip (UDDH) have pelvic asymmetry and what correlation existing between them. Methods A total of 100 adult patients with UDDH were enrolled in the retrospective observational study in Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, China, between January 2012 and February 2014. The anteroposterior pelvic radiographs were reviewed and the pelvic heights and ischium heights were measured and compared between the affected and non-affected sides to find out the relationship between the pelvic morphology and hip dysplasia. Results The pelvic heights demonstrated significant differences between the non-affected side and the affected side in patients with Crowe type II-IV UDDH (p<0.05), but not in patients with Crowe type I UDDH (p=0.09). There were significant differences in the bilateral ischium heights in patients with Crowe type III and IV UDDH (p<0.05), but not in patients with Crowe type I and II UDDH (p=0.78, p=0.055). In addition, the degree of hip dysplasia was positively associated with the degrees of asymmetry of pelvis (r=0.78, p<0.001) and ischium (r=0.72, p<0.001) in UDDH patients. Conclusion The pelvic asymmetry exists in adult patients with UDDH. In addition, the degree of asymmetry has correlation with the degree of hip dysplasia. We recommend that it should be taken more cautions to use teardrops and ischial tuberosity as anatomy landmarks to balance leg-length discrepancy for unilateral DDH patients in preoperative planning and total hip arthroplasty.
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Affiliation(s)
- Ya-Min Li
- Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China. E-mail.
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Subtrochanteric femoral shortening osteotomy combined with cementless total hip replacement for Crowe type IV developmental dysplasia: a retrospective study. J Orthop Traumatol 2017; 18:407-413. [PMID: 28741029 PMCID: PMC5685984 DOI: 10.1007/s10195-017-0466-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 07/03/2017] [Indexed: 01/15/2023] Open
Abstract
Background Total hip replacement for high dislocation of the hip presents some difficulties, considering patients’ young ages, the abnormal hip anatomy and the high rate of complications. In this study, we present our experience in terms of clinical and radiological results in the treatment of Crowe type IV hips with subtrochanteric femoral shortening osteotomy and cementless total hip replacement. Materials and Methods We retrospectively reviewed 15 patients with Crowe type IV hip dysplasia (two bilateral cases for a total of 17 hips) treated with cementless total hip replacement associated with shortening subtrochanteric osteotomies (nine transversal and eight Z-shape osteotomies) between March 2000 to February 2006. The mean follow-up was 88 months (range 63–133). Harris hip score, leg length discrepancy, neurological status, union status of the osteotomy and the component stability were the criteria of the evaluation. All complications were noted. Results The mean HHS improved from 38.3 (range 32–52) to 85.6 (range 69–90). The mean preoperative leg length discrepancy was of 45 mm (range 38–70) and reduced to a mean of 12 mm (range 9–1.6) postoperatively. All osteotomies resulted healed at an average of 12.3 weeks (range 10–15). No cases of delayed union or nonunion were detected. Two patients (11%) showed early symptoms of sciatic nerve palsy which resolved uneventfully in 6 months. There was no migrations and none of the implants required revision. Conclusions Cementless THA with shortening subtrochanteric osteotomy is an effective method in the treatment of patients with Crowe type IV development dysplasia of the hip. Level of evidence IV.
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Qiu A, Yang Z, Wang J, Wang T. Clinical evaluation of ultrasound screening in follow-up visits of infants with cerebral palsy at high risk for developmental dysplasia of the hip. Exp Ther Med 2016; 12:2431-2434. [PMID: 27698744 PMCID: PMC5038176 DOI: 10.3892/etm.2016.3653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/11/2016] [Indexed: 11/20/2022] Open
Abstract
The aim of the study was to assess the clinical value of ultrasound screenings for the developmental dysplasia of the hip (DDH) and explore its etiology in high-risk infants with cerebral palsy in follow-up visits. A group of 98 cases of infants at high-risk of cerebral palsy who received rehabilitation treatment between July, 2009 and July, 2010 were selected. Infants included 58 men and 40 women, aged <6 months and not lost to follow-up visits. Ultrasound (using Graf static inspection) screening of hips was performed and the infants with abnormalities were given clinical intervention, and 1- to 2-year-old infants were given outpatient follow-ups. The results were analyzed and there were 40 abnormal cases among the 98 cases of infants at high risk of cerebral palsy, including 18 cases of unstable hip joint, and 22 cases of DDH (12 cases of hip dysplasia, 3 cases of hip subluxation and 7 cases of hip dislocation). Early clinical intervention for infants with hip dysplasia and outpatient follow up for infants aged 1–2 years was carried out and had ischemic necrosis of femoral head, with the exception of 1 case of femoral detorsion that was poorly restored. In conclusion, the probability of DDH was higher in infants at high-risk of cerebral palsy compared to the normal infants. Hip ultrasound is a safe, simple, and effective screening method for these infants, which is of great clinical significance for an earlier diagnosis and treatment of DDH in infants with cerebral palsy.
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Li L, Yu M, Yang C, Gu G. Total hip arthroplasty (S-ROM stem) and subtrochanteric osteotomy for Crowe type IV developmental dysplasia of the hip. Indian J Orthop 2016; 50:195-200. [PMID: 27053810 PMCID: PMC4800963 DOI: 10.4103/0019-5413.177575] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) in adults with severe pain and disability is best treated by total hip arthroplasty (THA). The purpose of this study was to retrospectively evaluate the outcomes of subtrochanteric shortening osteotomy combined with THA using S-ROM stem for those severe patients with a special focus on the effect of two shapes in the subtrochanteric osteotomy ends: Oblique and transverse. MATERIALS AND METHODS Twenty one cases with mean age of 43.6 years who met inclusion criteria and were operated between February 2007 and February 2012 were included in the study. Those cases had been divided into two groups (oblique vs. transverse) and all records between the two groups were analyzed. RESULTS The Harris hip score significantly improved from 30.6 (range 18-59) preoperatively to 91.2 (range 87-98) postoperatively by the latest followup. Complications including one deep venous thrombosis, one intraoperative fracture of femur and two dislocations occurred while they were addressed properly afterward. The oblique group showed significant advantages in operative time, union time and additional fixation in comparison with the transverse group. CONCLUSIONS In the primary THA for the treatment of irreducible DDH, subtrochanteric oblique osteotomy combined with the freely-rotatable S-ROM stem provided favorable short term outcomes by affording both morphological and functional advantages.
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Affiliation(s)
- Liangtao Li
- Department of Joint Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin, China
| | - Mingyang Yu
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, Liaoning, P. R. China
| | - Chen Yang
- Department of Joint Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin, China
| | - Guishan Gu
- Department of Joint Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin, China
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Günther KP, Stiehler M, Goronzy J, Schneiders W, Hartmann A. [Arthroplasty for osteoarthritis secondary to hip dysplasia: Problem-oriented treatment strategies]. DER ORTHOPADE 2015; 44:497-8, 500-9. [PMID: 25860120 DOI: 10.1007/s00132-015-3106-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Because of anatomical variations total hip arthroplasty (THA) can be demanding in patients with osteoarthritis secondary to hip dysplasia. OBJECTIVES Depending on the degree of bony deformation, hip dislocation and soft tissue alteration numerous treatment strategies are available. This review describes current approaches that address frequent deformities. MATERIALS AND METHODS Review of relevant clinical studies, meta-analyses, and presentation of our own approach. RESULTS Pre-operative planning (based on a thorough clinical and radiographic examination) is essential. Acetabular reconstruction close to the primary acetabulum should always be intended. Roof augmentation and/or cup medialization can support stable bony implant fixation. Subtrochanteric shortening osteotomy of the femur is a demanding but reliable technique that avoids nerve damage in cases where inappropriate lengthening would be necessary (i.e., high riding dislocation). CONCLUSIONS Although the post-operative complication rate is elevated after THA for dysplastic hips compared with primary osteoarthritis, the overall functional results and implant survival are comparable.
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Affiliation(s)
- K P Günther
- UniversitätsCentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Deutschland,
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Kwak HS, Yoo JJ, Lee YK, Koo KH, Yoon KS, Kim HJ. The result of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a polyethylene liner. Clin Orthop Surg 2015; 7:46-53. [PMID: 25729518 PMCID: PMC4329532 DOI: 10.4055/cios.2015.7.1.46] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 10/13/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Wear cannot be completely prevented after total hip arthroplasty. If severe polyethylene (PE) liner wear develops, the so-called catastrophic failure occurs and metallosis develops. We postulated that longevity of the new implant may be affected after revision surgery for metallosis following a catastrophic failure of a PE liner due to the substantial amount of PE wear particles and infiltration of the metal particles in this catastrophic condition. METHODS Twenty-three hips of 23 patients were identified because they showed metallosis during revision total hip arthroplasties performed in Seoul National University Hospital between January 1996 and August 2004. They were followed for at least 6.5 years after the index revision total hip arthroplasty. The clinical and radiological results of revision total hip arthroplasties in these patients were evaluated. RESULTS The median Harris hip score increased from 60 points before revision total hip arthroplasties to 90 points at the final follow-up. Osteolysis was detected at an average of 9.3 years after revision total hip arthroplasties in 13 hips and acetabular cup loosening at average 9.8 years after revision total hip arthroplasties in 9 hips. With radiographic evidence of osteolysis and loosening as the end points, the 15-year survival rates were 28.2% and 56.0%, respectively. CONCLUSIONS The survival rate of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a PE liner was low.
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Affiliation(s)
- Hong Suk Kwak
- Department of Orthopedic Surgery, Joint and Spine Center, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kang Sup Yoon
- Department of Orthopedic Surgery, Joint and Spine Center, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Joong Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea. ; Medical Research Center, Seoul National University, Seoul, Korea
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