Cementless Total Hip Arthroplasty in Crowe III and IV Dysplasia: High Hip Center and Modular Necks

Montalti, Maurizio; Castagnini, Francesco; Giardina, Federico; Tassinari, Enrico; Biondi, Federico; Toni, Aldo

doi:10.1016/j.arth.2018.01.041

Cited by 58 publications

(57 citation statements)

References 23 publications

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“…Because it is difficult to reconstruct the hip center at its original position in type IV DDH cases involving a small, shallow true acetabulum, the high hip technique, wherein the acetabulum is reconstructed superior to the anatomic one, may be employed. Using a high hip center technique in a cohort of 84 patients, Montalti and colleagues obtained mean vertical and horizontal distances from the rotational center of 33 ± 8 mm and 30 ± 5 mm in type III DDH cases and IV DDH cases, respectively. After 15 years, revision was performed in only 2 of those cases due to aseptic loosening (one cup and one stem).…”

Section: Direct Anterior Approach Total Hip Arthroplastymentioning

confidence: 99%

“…Using a high hip center technique in a cohort of 84 patients, Montalti and colleagues obtained mean vertical and horizontal distances from the rotational center of 33 ± 8 mm and 30 ± 5 mm in type III DDH cases and IV DDH cases, respectively. After 15 years, revision was performed in only 2 of those cases due to aseptic loosening (one cup and one stem). Galea et al .…”

Section: Direct Anterior Approach Total Hip Arthroplastymentioning

confidence: 99%

“…A challenging reduction process during THA can put patients at increased risk of osteotomy site nonunion (rate range, 2.8%–7.1%). Nonunion risk can be mitigated with plate and screw fixation, an eagle claw hook and cable system, or the application of cerclage wires to two longitudinally split halves of resected femur.…”

Section: Direct Anterior Approach Total Hip Arthroplastymentioning

confidence: 99%

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Total Hip Arthroplasty for Crowe Type IV Hip Dysplasia: Surgical Techniques and Postoperative Complications

Shi

Han

et al. 2019

Orthopaedic Surgery

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Total hip arthroplasty (THA) of Crowe type IV developmental dysplasia of the hip (DDH) is challenging. Although traditional (lateral, posterolateral, and posterior) THA approaches have been used with great anatomic success, they damage periarticular muscles, which are already quite weak in type IV DDH. The recently developed direct anterior approach (DAA) can provide an inter‐nerve and inter‐muscle approach for THA of type IV dysplasia hips. However, femur exposure with the DAA could be difficult during surgery and it is hard to apply femoral shortening osteotomy. THA techniques used for type IV DDH include anatomic hip center techniques (true acetabular reconstruction) and high hip center techniques, wherein an acetabulum is reconstructed above the original one. Although anatomic construction of the hip center is considered “the gold standard” treatment, it is impossible if the anatomical acetabular is too small and shallow. Procedures used to support type IV DDH reduction with anatomic hip center techniques include greater trochanter osteotomy, lesser trochanter osteotomy, and subtrochanteric osteotomy. However, these techniques have yet to be standardized, and it is unclear which is best for type IV DDH. One‐state and two‐state non‐osteotomy reduction techniques have also been introduced to treat type IV DDH. Potential complications of THA performed in patients with type IV DDH include leg length discrepancy (LLD), peri‐operative femur fracture, nonunion of the osteotomy site, and nerve injury. It is worth noting that nowadays an increasing number of Crowe type IV DDH patients are more sensitive to postoperative LLD.

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Section: Direct Anterior Approach Total Hip Arthroplastymentioning

confidence: 99%

Section: Direct Anterior Approach Total Hip Arthroplastymentioning

confidence: 99%

Section: Direct Anterior Approach Total Hip Arthroplastymentioning

confidence: 99%

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Total Hip Arthroplasty for Crowe Type IV Hip Dysplasia: Surgical Techniques and Postoperative Complications

Shi

Han

et al. 2019

Orthopaedic Surgery

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“…According to these authors, the EP's anatomical positioning ensures the proper functioning of the gluteal muscles, allowing walking without pronounced limping. Others like Montalti et al (2018) argue that the AC-EP can be inserted into the joint's secondary socket. Harris et al (1998) and Bozic et al (2004) have the same opinion regarding very serious cases of dysplasia.…”

Section: Introductionmentioning

confidence: 99%

Choice of the Acetabular Component Placement in Dysplastic Hip Patients

Zebolds

Pētersons

Jumtiņš

2019

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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Total hip arthroplasty (THA) in patients with hip dysplasia is a challenging surgical operation. Many orthopedic surgeons concur that the anatomical placement of the acetabular components of endoprostheses (AC-EPs) during THA yields the best result. However, there are advocates of the high rotation center of the hip joint after replacement surgery. In our study, we compared the outcomes of THA based on the placement of acetabular cups to identify the most favorable site for AC-EPs in patients with varying grades of dysplastic osteoarthritis. Our study included 88 patients with dysplastic hip osteoarthritis who underwent 106 THAs during a three-year period using cementless fixation endoprostheses. Functional results were assessed by Merle d’Aubigne and Postel’s method and by instrumental gait analysis (IGA). Gait deviation index was calculated based on IGA to compare results in different acetabular component placement groups. Functional assessment of patients by Merle d’Aubigne and Postel’s grading method and IGA showed no significant difference in results due to the placement of the acetabular component. Most complications were found in the severe dysplasia patients group with the anatomical placement of the AC-EP. The appropriate location of cementless acetabular cups during THA in dysplastic hips depends on the grade of dysplasia, expected elongation of the leg, and the potential for adequate bone coverage for the AC-EP. In cases of severe dysplasia, the placement of the AC-EP in the secondary socket can provide a good functional outcome and reduce the risk of complications.

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“…Деформированная вертлужная впадина затрудняет интраоперационную ориентацию вертлужного компонента тотального эндопротеза тазобедренного сустава, а наличие выраженных дефектов уменьшает возможности фиксации имплантата [1,2,3]. чем значительнее анатомические изменения вертлужной впадины, тем чаще для оптимизации фиксации требуется нестандартное размещение вертлужного компонента [4,5,6,7,8], приводящее к малопрогнозируемым изменениям биомеханики [9,10,11].…”

Section: Introductionunclassified

Assessment of Acetabulum Deformity During Preoperative Planning for Hip Arthroplasty

Martynenko

Волошин

Sherman

et al. 2019

Traumatology and Orthopedics of Russia

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Purpose of the study — to improve the two-dimensional planning of total hip joint arthroplasty to ensure precise positioning of the acetabular component in the deformed acetabulum. Materials and methods. Features of roentgenological anatomy of acetabulum and its coverage were studied on 1058 hip joint x-rays in the AP view in accordance with the procedure developed by the authors to define acetabular square — the site of standard positioning of a spherical femoral head in the acetabulum or of a hemispherical acetabular component. The method consisted of identifying the apex of “teardrop” figure; the most lateral points of the pelvic terminal line and roof of the acetabulum; superior part of the acetabular cavity; medial and inferior points of acetabular coverage, and building the sides of acetabular square — medial, inferior, lateral and superior boundary lines. Connection of “teardrop” apex and lateral point of the pelvic terminal line formed the medial side of acetabular square, and a perpendicular to that line drawn through the “teardrop” apex to its inferior side. The lateral side was drawn either through the intersection of the ascending diagonal line — bisector from the top of the “teardrop” figure with the contour of the acetabulum roof, or was a part of the projection of the most lateral point of the acetabular roof on the inferior side of the square. The superior side was a perpendicular connecting the intersection of the ascending diagonal and lateral bounding lines with the medial side of the acetabular square. The area of the deformed acetabular cavity located outside of the acetabular square was assessed as the acetabular defect. Results. Method of defining the acetabular square allowed to identify types of ratios between acetabular cavity and acetabular coverage in transverse (9 types) and longitudinal (7 types) direction. Combination of transverse ratio of acetabular cavity and coverage with longitudinal type allowed to define the options of acetabular deformities in two-dimensional view. The authors identified 25 types of acetabular deformities. Bone defects of acetabular walls were of the major importance among all anatomical features. Cranial defect of acetabulum was observed in 450 cases, medial wall defect — in 38 cases, defect including cranial and medial areas — in 7 cases. Conclusion. The method suggested by the authors to determine acetabular square and acetabular deformity variations allows to screen the anatomical features of the acetabulum during two-dimensional preoperative planning and to make an informed decision on the need to use other planning techniques. The type of acetabular deformity identified during preoperative planning allows to elaborate the indications for replacement of acetabular bone defects and/or resection of acetabular osteophytes.

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Cementless Total Hip Arthroplasty in Crowe III and IV Dysplasia: High Hip Center and Modular Necks

Cited by 58 publications

References 23 publications

Total Hip Arthroplasty for Crowe Type IV Hip Dysplasia: Surgical Techniques and Postoperative Complications

Total Hip Arthroplasty for Crowe Type IV Hip Dysplasia: Surgical Techniques and Postoperative Complications

Choice of the Acetabular Component Placement in Dysplastic Hip Patients

Assessment of Acetabulum Deformity During Preoperative Planning for Hip Arthroplasty

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