Medial Protrusio Technique in Cementless Total Hip Arthroplasty for Developmental Dysplasia of the Hip: A Prospective 6- to 9-Year Follow-Up of 43 Consecutive Patients

Zha, Guo-Chun; Sun, Junying; Guo, Kaijin; Zhao, Fengchao; Pang, Yong; Zheng, Xin

doi:10.1016/j.arth.2016.01.052

Cited by 18 publications

(33 citation statements)

References 26 publications

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“…Increasing the femoral head size from 22 mm to 28 mm can be reliable and effective to decrease the dislocation rate. Surgeons may choose other approaches to increase the cup coverage, including the medial protrusio technique, use of autologous bulk bone graft and augment, and avoid excessive decrease of the diameter of the acetabulum and femoral head. Close attention – including enhanced preoperative patient education, postoperative precaution, and prohibited hip positions and maneuvers – should be paid to Crowe type IV patients, especially older patients and patients without a false acetabulum.…”

Section: Discussionmentioning

confidence: 99%

Risk of Dislocation After Total Hip Arthroplasty in Patients with Crowe Type IV Developmental Dysplasia of the Hip

Ding

Zeng

Mou

et al. 2020

Orthopaedic Surgery

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Objective: To investigate whether the risk of dislocation after total hip arthroplasty (THA) in patients with Crowe type IV developmental dysplasia of the hip (DDH) is high and to further identify the risk factors for postoperative dislocation in these patients.Methods: This retrospective cohort study reviewed Crowe type IV DDH patients undergoing THA between January 2009 and December 2017 in our institution. Each Crowe type IV DDH patient was matched with three Crowe type I, II, or III DDH patients according to gender, side and date of operation. The primary outcome of this study was postoperative dislocation after THA. Occurrence, rate, classification, treatment and outcome of dislocation were documented in detail for all patients. The dislocation rates were compared between Crowe type IV DDH patients and Crowe type I, II, or III DDH patients. Demographic data, implant factors, and surgical factors were compared between the dislocation and no dislocation groups. Multiple logistic regression analysis was used to determine the independent risk factors for dislocation in Crowe type IV hips.Results: A total of 131 Crowe type IV hips were followed up for a mean of 76.5 AE 28.1 months. Three hundred and ninety-three Crowe type I, II and III hips, including 261 type I hips, 94 type II hips, and 38 type III hips, were identified as controls and followed up for a mean of 76.4 AE 28.2 months. No significant difference was observed in follow-up time between two groups (P = 0.804). One or more dislocations occurred in 22 of the 524 dysplasia hips (4.20%). Of the 22 dislocated hips, 20 hips (90.9%) were successfully managed with non-operative treatment. Two patients (9.1%, one Crowe type I and one Crowe type IV) experienced recurrent dislocation and required revision surgery. Crowe type IV hips had a significantly higher postoperative dislocation rate than type I, II, and III hips (11.45% vs 1.78%, P < 0.001). The use of a 22-mm femoral head (odds ratio [OR] = 23.55, 95% confidence interval [CI] = 1.901-291.788, P = 0.014), older age (OR = 1.128, 95% CI = 1.037-1.275, P = 0.031), and absence of false acetabulum (OR = 12.425, 95% CI = 1.982-77.879, P = 0.007) were identified as independent risk factors for dislocation in Crowe type IV hips.Conclusions: Crowe type IV DDH patients were at a high risk of dislocation after THA, and using large femoral heads and improving abductor muscle strength may help decrease the rate of postoperative dislocation in such patients.

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Section: Discussionmentioning

confidence: 99%

Risk of Dislocation After Total Hip Arthroplasty in Patients with Crowe Type IV Developmental Dysplasia of the Hip

Ding

Zeng

Mou

et al. 2020

Orthopaedic Surgery

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“…High hip centre is de ned as the perpendicular distance from the femoral head center to the inter-teardrop line more than 35 mm [21]. Some scholars [8,10,14,16,31] agreed on the inserting the cup into true acetabulum due to superior biomechanics, better…”

Section: Discussionmentioning

confidence: 99%

“…However, we must address problems such as limb lengthening [32], nerve palsy [32], less coverage of the cup [16]. Gratifyingly, subtrochanteric osteotomy [7], structural autograft [14] and medial protrusio technique [8] have provided novel and valid methods. Additionally, creation of high hip center was also proposed for primary acetabular reconstruction and was reported good long-term outcomes and showed no difference in polyethylene wear [33,34].…”

Section: Discussionmentioning

confidence: 99%

“…The abnormal femoral change of the oversize anteversion and narrow medullary cavity can be easily dealed with by modular hip stem, which can correct the overanteverted femoral neck and provide rotational stability if subtrochanteric shortening osteotomy was performed [5]. But for the distorted acetabulum especially DDH Crowe II/III, it always manifests with pathomorphologic changes including shallow true acetabulum, formation of a neoacetabulum and superolateral bony de ciency [1,[6][7][8], All of which make it more complicated and technically demanding to balance acetabular reconstruction at anatomical location and rate of cup coverage by host bone [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Controlled Fracture of Medial Wall Versus Structural Autograft With Bulk Femoral Head to Increase Cup Coverage by Host Bone for Total Hip Arthroplasty in Osteoarthritis Secondary to Developmental Dysplasia of Hip: a Retrospective Cohort Study

Mou

Liao

Chen

et al. 2020

Preprint

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Background: Many methods have been proposed to increase cup coverage by host bone during primary total hip arthroplasty (THA) in hip osteoarthritis secondary to developmental dysplasia of hip (DDH). However, there was no study comparing results of controlled fracture of medial wall with structural autograft with bulk femoral head. Methods: 67 hips classified as Crowe II/III were retrospectively included in this cohort study, which consisted of 33 controlled fracture (group A) and 34 structural autograft (group B). The Harris Hip Scores (HHS) was recorded. The radiological assessments were analyzed. Also, complications are assessed. The paired sample t test was used for data analysis before and after operation, while independent sample T test was used for the comparison between the two groups.Results: All patients were reconstructed acetabulum at anatomical location. HHS increased greatly for both groups (P=0.18). No statistic difference was observed for two groups in postoperative leg-length discrepancy ((0.51±0.29) cm for group A and (0.46±0.39) cm for group B, P=0.64 ), postoperative height of hip center ((2.25±0.42) cm for group A and (2.09±0.31) cm for group B, P=0.13), inclination of cup ((39±4)°for group A and (38±3)°for group B, P=0.65 ). The rate of cup coverage for group B ((94±2)% ) was better than group A ((91±5)%), ( P=.009). Rate of cup protrusio was (48±4)% for group A. For both two groups, no complications were observed at the latest follow-up. Conclusion: Controlled fracture of medial wall to increase cup coverage by host bone at anatomical location can act as an alternative technique for DDH Crowe II/III with advantage of shorter operation time and less technically demanding.

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“…The only disadvantage of this method is the loss of bone stock of the medial acetabulum. The rate of medial protrusion of <60% is recommended for acceptable clinical and radiographic results [23].…”

Section: Developmental Diseases Of the Hip -Diagnosis And Managementmentioning

confidence: 99%

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

Korkmaz¹,

Malkoç²

2017

Developmental Diseases of the Hip - Diagnosis and Management

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Introduction: Surgical treatment methods for developmental dysplasia of the hip (DDH) in the elderly patients contain pelvic or periacetabular osteotomy and hip arthroplasty. Total hip arthroplasty (THA) is the last and definitive surgical treatment modality for the end stage developmental dysplasia of the hip. Deformity classification and reconstruction:Crowe classification system describes the degree of dysplasia and gives information about the reconstruction procedure with hip arthroplasty. Classification is based on the magnitude of proximal femoral migration relative to the acetabulum. Acetabular component must be implanted to the true acetabulum for the optimal range of motion and stability of the reconstructed hip. The femoral component must be placed in neutral or slight anteversion but narrow femoral canal can be a problem for the reconstruction of femur. Conclusion-key results:The results of total hip arthroplasty in developmental dysplasia of the hip have been satisfactory for stability, mobility, and pain relief. The survivorship of cemented arthroplasty in dysplastic hips is inferior because of the young age of the patients and the complexity of the procedures. Early and midterm results of cementless hip arthroplasty are better. Most important complications after the surgery are dislocation of the reconstructed hip and sciatic nerve injury.

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Medial Protrusio Technique in Cementless Total Hip Arthroplasty for Developmental Dysplasia of the Hip: A Prospective 6- to 9-Year Follow-Up of 43 Consecutive Patients

Cited by 18 publications

References 26 publications

Risk of Dislocation After Total Hip Arthroplasty in Patients with Crowe Type IV Developmental Dysplasia of the Hip

Risk of Dislocation After Total Hip Arthroplasty in Patients with Crowe Type IV Developmental Dysplasia of the Hip

Controlled Fracture of Medial Wall Versus Structural Autograft With Bulk Femoral Head to Increase Cup Coverage by Host Bone for Total Hip Arthroplasty in Osteoarthritis Secondary to Developmental Dysplasia of Hip: a Retrospective Cohort Study

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

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