Challenges in Total Hip Arthroplasty in the Setting of Developmental Dysplasia of the Hip

Greber, Eric M.; Pelt, Christopher E.; Gililland, Jeremy M.; Anderson, Mike B.; Erickson, Jill; Peters, Christopher L.

doi:10.1016/j.arth.2017.02.024

Cited by 156 publications

(162 citation statements)

References 44 publications

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“…Compared with ordinary hip osteoarthritis patients, DDH patients have abnormal anatomies, which increases the difficulty of THA operation and the occurrence of postoperative complications. The most notable of these morphological variants is the increased likelihood to have excessive native femoral anteversion. Previously, we have showed that native femoral anteversion in DDH patients is significantly greater than that in normal patients.…”

Section: Introductionmentioning

confidence: 97%

“…Total hip arthroplasty (THA) has been an effective method to relieve pain and improve function for adult patients with developmental dysplasia of the hip (DDH). Compared with ordinary hip osteoarthritis patients, DDH patients have abnormal anatomies, which increases the difficulty of THA operation and the occurrence of postoperative complications. The most notable of these morphological variants is the increased likelihood to have excessive native femoral anteversion.…”

Section: Introductionmentioning

confidence: 99%

“…However, even in mild DDH cases (Crowe I), there was a significant increase in anteversion. Hence, abnormal femoral anteversion should be considered in THA for DDH patients, even for the mild Crowe type I hips. Combined anteversion means the sum of the cup and stem anteversion in THA.…”

Section: Introductionmentioning

confidence: 99%

“…Cementless, straight, tapered femoral stems are commonly used, which depends mainly on the anatomy of the proximal femur, and in whom adjusting the anteversion of the femoral stem is difficult. If the preoperative femoral anteversion angle is eccentric, a monoblock or modular stem with adjustable anteversion is preferable to correct excessive anteversion. Therefore, prediction of the postoperative anteversion of the femoral stem helps choose an appropriate femoral prosthesis and optimize the combined anteversion.…”

Section: Introductionmentioning

confidence: 99%

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Optimal Level of Femoral Neck for Predicting Postoperative Stem Anteversion in Total Hip Arthroplasty for Crowe Type I Dysplastic Hip

Zhai

Zhang

et al. 2020

Orthopaedic Surgery

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Objective: To investigate the optimal level of femoral neck for measuring femoral anteversion to predict postoperative stem anteversion in Crowe type I developmental dysplasia of the hip.Methods: This retrospective study analyzed 108 Crowe type I hips that underwent THA between January 2016 and December 2017, including 70 women and 19 men with a mean age of 63.08 AE 9.13 (range, 41-83) years. The single-wedge stem was used in 37 hips, the double-wedge stem was used in 71 hips. Computed tomography scans were performed pre-and post-operation. Femoral anteversion at six levels of the proximal femur were measured via preoperative two-dimensional computed tomography. Femoral anteversion at the level of the femoral neck osteotomy plane and postoperative stem anteversion were measured via three-dimensional reconstructed models.Results: The mean follow-up period was 18.5 months (range, 12-27 months). The mean preoperative Harris Hip Score was 51.5 AE 8.7 and improved to 90.4 AE 7.8 (P < 0.001) by the last follow-up. There were no intraoperative fractures, and no infections occurred during the follow-up period. Two patients developed deep venous thrombosis. There was no sign of prosthetic loosening in all hips. No significant correlations were found between the height of the femoral neck osteotomy plane and postoperative stem anteversion (r = −0.119, P = 0.220). Femoral anteversion decreased gradually from 64.00 AE 10.51 at the center of lesser trochanter to 15.21 AE 13.31 at the head-neck junction, which was changed from more to less than stem anteversion (24.37 AE 13.86 ). The femoral anteversion at femoral head-neck junction (15.21 AE 13.31 ) was significantly less than postoperative stem anteversion (P = 0.000), with a difference of −9.16 AE 9.27 . The femoral anteversion at the level of the osteotomy plane (28.48 AE 15.34 ) was significantly more than the postoperative stem anteversion (P = 0.000), with a difference of 4.11 AE 9.56 . Among all six levels and the level of osteotomy, femoral anteversion at the 10-mm level above the proximal base of lesser trochanter (22.65 AE 12.92) displayed the smallest difference (−1.72 AE 8.90 ) and a good correlation (r = 0.764) with postoperative stem anteversion for all 108 hips, with a moderate correlation of 0.465 for single-wedge stem hips and an excellent correlation of 0.821 for double-wedge stem hips.Conclusion: For Crowe type I hips, femoral anteversion would be different if it was measured via different levels of the femoral neck. The 10-mm level above the proximal base of the lesser trochanter could be an optimum choice for measuring femoral anteversion to predict postoperative stem anteversion.

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Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Optimal Level of Femoral Neck for Predicting Postoperative Stem Anteversion in Total Hip Arthroplasty for Crowe Type I Dysplastic Hip

Zhai

Zhang

et al. 2020

Orthopaedic Surgery

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“…For example, it is difficult for young surgeons to judge the orientation of the osteotomy, the position of the true acetabulum, the installation position of the prosthesis, and the exposure of the anatomical safe range. These difficulties often lead to operation complications, such as prolonged operation time, larger surgical incision, and more bleeding, which can result in poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

Mixed Reality Combined with Three‐Dimensional Printing Technology in Total Hip Arthroplasty: An Updated Review with a Preliminary Case Presentation

Lei

Kong

et al. 2019

Orthopaedic Surgery

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Three‐dimensional (3D) printing technology, virtual reality, and augmented reality technology have been used to help surgeons to complete complex total hip arthroplasty, while their respective shortcomings limit their further application. With the development of technology, mixed reality (MR) technology has been applied to improve the success rate of complicated hip arthroplasty because of its unique advantages. We presented a case of a 59‐year‐old man with an intertrochanteric fracture in the left femur, who had received a prior left hip fusion. After admission to our hospital, a left total hip arthroplasty was performed on the patient using a combination of MR technology and 3D printing technology. Before surgery, 3D reconstruction of a certain bony landmark exposed in the surgical area was first performed. Then a veneer part was designed according to the bony landmark and connected to a reference registration landmark outside the body through a connecting rod. After that, the series of parts were made into a holistic reference registration instrument using 3D printing technology, and the patient's data for bone and surrounding tissue, along with digital 3D information of the reference registration instrument, were imported into the head‐mounted display (HMD). During the operation, the disinfected reference registration instrument was installed on the selected bony landmark, and then the automatic real‐time registration was realized by HMD through recognizing the registration landmark on the reference registration instrument, whereby the patient's virtual bone and other anatomical structures were quickly and accurately superimposed on the real body of the patient. To the best of our knowledge, this is the first report to use MR combined with 3D printing technology in total hip arthroplasty.

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Total Hip Arthroplasty for Developmental Dysplasia of the Hip. Part 1: Crowe I–II

Tang

2022

Principles of Primary Total Hip Arthroplasty

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Challenges in Total Hip Arthroplasty in the Setting of Developmental Dysplasia of the Hip

Cited by 156 publications

References 44 publications

Optimal Level of Femoral Neck for Predicting Postoperative Stem Anteversion in Total Hip Arthroplasty for Crowe Type I Dysplastic Hip

Optimal Level of Femoral Neck for Predicting Postoperative Stem Anteversion in Total Hip Arthroplasty for Crowe Type I Dysplastic Hip

Mixed Reality Combined with Three‐Dimensional Printing Technology in Total Hip Arthroplasty: An Updated Review with a Preliminary Case Presentation

Total Hip Arthroplasty for Developmental Dysplasia of the Hip. Part 1: Crowe I–II

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