15-year Comparison of Cementless Total Hip Arthroplasty With Anatomical or High Cup Placement for Crowe I to III Hip Dysplasia

Abstract

This study compared radiological and clinical results of Mallory-Head (Biomet, Warsaw, Indiana) cementless total hip arthroplasty (THA) by anatomical (AP group) or high cup placement (HP group) for Crowe I to III developmental dysplasia of the hip. Of the 68 hips studied, 43 hips were available for 15.3-year follow-up. Ten cups were placed at anatomical center with bulk bone grafting, and 33 cups were at high hip center without bulk bone grafting. No acetabular or femoral components showed loosening in either group. One standard polyethylene liner in a highly placed cup was revised due to excessive wear after 11 years. The average rate of polyethylene wear was 0.128 mm/year in the AP group and 0.148 mm/year in the HP group (except for the revision case). The extent of grafted bone coverage was 34.6% in the AP group. Hip center height was 24.5 mm from the inter-teardrop line in the HP group. The center of the hip horizontal location in the AP group (24.5 mm) and HP group (26.4 mm) was significantly shorter than in normal hips (35.6 mm). Postoperative center-edge angle was 11° (except grafted bone) in the AP group and 25° in the HP group. Mean Harris Hip Score in the AP group improved from 38 points preoperatively to 82 points postoperatively and in the HP group improved from 40 points preoperatively to 88 points postoperatively. Survivorship was 100% in the AP group and 97% in the HP group. Our results indicate that moderate high cup placement without bulk bone grafting at a horizontal locus more medial than that of a normal hip is an alternative durable solution.

The Structure of Early Revisions After Hip Replacement

“…При вы-вихах и расшатывании такие дефекты характе-ризовались нарушением ориентации компонен-тов и высоким расположением центра ротации. Возможно, смещение центра ротации является неизбежным в некоторых случаях, например, при выраженной дисплазии или посттравмати-ческой деформации области вертлужной впа-дины, однако преднамеренное нарушение есте-ственной биомеханики тазобедренного сустава должно компенсироваться обеспечением адек-ватного мышечного баланса и абсолютно кор-ректной ориентацией компонентов эндопротеза [3,8,15,16,17,19,20,24,27,28,29,32].…”

Total Hip Replacement in Developmental Dysplasia of the Hip: Pitfalls and Challenges

“…There are several studies that showed good results with cemented and noncemented acetabular components [21,50,51]. Results of a study that was compared the survivorship of the components for anatomical or high-cup placement; 100% in the anatomical placement and 97% for high hip center group [52]. Higher loosening and revision rates for both femoral and acetabular components have been reported with cemented acetabular cups for high hip center [40,53].…”

Endoprothese bei Dysplasiecoxarthrose

“…Obwohl die Mehrzahl der Autoren eine Implantation im primären Pfannenzentrum favorisiert [24,25,28,56,64], tendieren einige Anwender zum sogenannten "hohen Hüftzentrum" [38,50,53,61]. Dabei muss jedoch darauf hingewiesen werden, dass es sich in den letztgenannten Untersuchungen in der Regel um eine Kranialverschiebung der Implantation um maximal 1-2 cm gegenüber dem primä-ren Pfannenzentrum handelt und diese nur dann günstige Ergebnisse aufweist, wenn sie mit einer ausreichenden Medialisierung verbunden ist.…”