Changes in Alignment of Ipsilateral Knee on Computed Tomography after Total Hip Arthroplasty for Developmental Dysplasia of the Hip

Yu, Degang; Zhang, Jingwei; Xu, Chen; Xu, Jie; Li, Huiwu; Zhu, Zhenan; Liu, Feng‐xiang

doi:10.1111/os.12462

Cited by 9 publications

(8 citation statements)

References 36 publications

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“…Nevertheless, such goals turned out to be a quite difficult challenge due to pathomorphology changes in some DDH patients. Compromised reconstruction goals were proposed for such patients to reduce the disturbance to lower extremity alignments and the need for adjuvant procedures such as femoral shortening osteotomy or acetabulum bone grafting, which lowered the duration of anesthesia and surgery complexity and favored postoperative recovery ( Russotti and Harris, 1991 ; Gustke, 2004 ; Yu et al, 2019 ). Such techniques take preoperative morphology into account and conflict against common anatomic reconstruction targets.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Hip Center Position Associated With the Range of Internal Rotation and Extension During Gait in Hip Dysplasia Patients After Total Hip Arthroplasty

Zou

Sun

et al. 2022

Front. Bioeng. Biotechnol.

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Background: Total hip arthroplasty (THA) for hip dysplasia patients is sometimes complex and compromises pathomorphological changes in these patients. However, it remains unclear whether it is preoperative deformities or postoperative structures or anatomic changes during THA that have the most remarkable correlation with the hip dynamic function during gait. The purpose of this study was to investigate this relationship and propose insights into the surgical reconstruction strategy in patients with developmental dysplasia of the hip.Methods: A total of 21 unilateral hip dysplasia patients received computed tomography scans for the creation of 3D hip models before surgery and at the last follow-up. Acetabular and femoral orientations, hip center positions, and femoral length were measured before and after THA. Hip kinematics of the operated side during gait was quantified using a dual fluoroscopic imaging technique. Pearson correlation and multiple linear regression were performed to evaluate the relationship between hip maximum range of motion in six directions and demographics characters and above hip anatomic parameters before and after THA and their changes in surgery.Results: Pearson correlation analysis found significant correlations with the gait range of motion mainly in postoperative structures, including postoperative hip center positions and acetabulum and combined anteversion. Further multiple linear regression indicated that a laterally placed hip center was significantly correlated with an increased internal rotation (R2 = 0.25, p = 0.021), which together with increased postoperative acetabulum anteversion explained 45% of external rotation decreasing (p = 0.004). A proximally placed hip center was correlated with more extension (R2 = 0.30, p = 0.010). No significant demographic characters or preoperative deformities or surgical changes were included into other multiple regression models.Conclusion: Strong correlations between postoperative structures, especially hip center positions and gait range of motion in unilateral hip dysplasia patients after THA were found. It indicated that postoperative prosthesis structures, particularly hip center positions had significant impact on the hip gait motion range and should be treated with particular caution in surgery.

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Section: Discussionmentioning

confidence: 99%

Postoperative Hip Center Position Associated With the Range of Internal Rotation and Extension During Gait in Hip Dysplasia Patients After Total Hip Arthroplasty

Zou

Sun

et al. 2022

Front. Bioeng. Biotechnol.

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“…However, this is not always possible in some patients due of preoperative deformities. Adjustive and compromised reconstruction strategies are adopted to avoid extreme surgical changes, including femoral shortening osteotomy and high hip center displacement, which contribute to smooth surgery and fast postoperative recovery ( 34 – 36 ). However, such compromised strategies inevitably change hip biomechanics and may alter gait patterns, further affecting clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Postoperative hip center position is associated with gait symmetry in range of axial rotation in dysplasia patients after THA

Zou

Jiang

et al. 2023

Front. Surg.

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BackgroundThis study aimed to explore whether pre- or postoperative hip structures or surgical changes significantly influence hip range of motion (ROM) symmetry in patients with hip dysplasia during gait after total hip arthroplasty (THA) and provide possible surgical suggestions.MethodsFourteen patients with unilateral hip dysplasia underwent computed tomography before and after surgery to create three-dimensional hip models. Pre- and postoperative acetabular and femoral orientations, hip rotation centers (HRC), and femoral lengths were measured. Bilateral hip ROM during level walking after THA was quantified using dual fluoroscopy. The ROM symmetry in flexion-extension, adduction-abduction, and axial rotation was calculated using the symmetry index (SI). The relationship between SI and the above anatomical parameters and demographic characteristics was tested using Pearson's correlation and linear regression.ResultsThe average SI values for flexion-extension, adduction-abduction, and axial rotation during gait were −0.29, −0.30, and −0.10, respectively. Significant correlations were detected mainly in the postoperative HRC position. A distally placed HRC was associated with increased SI values for adduction-abduction (R = −0.47, p = 0.045), while a medially placed HRC was associated with decreased SI values for axial rotation (R = 0.63, p = 0.007). A regression analysis indicated that horizontal HRC positions significantly determined axial rotational symmetry (R2 = 0.40, p = 0.015). Normal axial rotation SI values were achieved with HRC between 17 mm medially and 16 mm laterally.ConclusionsPostoperative HRC position was significantly correlated with gait symmetry in the frontal and transverse planes in patients with unilateral hip dysplasia after THA. Surgical reconstruction of the HRC to between 17 mm medially and 16 mm laterally may contribute to gait symmetry.

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“…CT evaluation was performed as we previously reported 19 by using the Hitachi Radix Turbo (Tokyo, Japan) (120 kVp, 200 mA, 5‐mm collimation, 5 mm/s table speed, and 5‐mm resolution index) device. By using axial sections passing from the anterior superior iliac spine to the tibial tubercle, patients underwent 1‐mm‐interval CT in the supine position with the hips and knees fully extended and the lower limbs as horizontal and parallel as possible.…”

Section: Methodsmentioning

confidence: 99%

A New Method to Predict Postoperative Stem Anteversion in Total Hip Arthroplasty for Developmental Dysplasia of the Hip

Hu,

Sun,

Zhang

et al. 2024

Orthopaedic Surgery

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BackgroundPreoperative evaluation of femoral anteversion to predict postoperative stem anteversion aids the selection of an appropriate prosthesis and optimizes the combined anteversion in total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH). The conventional prediction methods are based on the femoral anteversion measurement at the location of the femoral head and/or neck. However, varied differences between femoral anteversion and postoperative stem anteversion were demonstrated. This study investigated the predictive role of a new method based on the principle of sagittal three‐point fixation.MethodsFrom January 2017 to December 2018, a total of 133 DDH hips that underwent THA were retrospectively analyzed. There were 76 Crowe type I, 27 type II, and 30 type III hips. The single‐wedge stem was used in 49 hips, and the double‐wedge stem was used in 84 hips. Preoperative native femoral anteversion at the femoral head–neck junction, anterior cortex anteversion at 2 levels of the lesser trochanter, posterior cortex anteversion at 5 levels of the femoral neck, and postoperative stem anteversion were measured using two‐dimensional computed tomography. Predictive anteversion by the new method was calculated as the average anteversion formed by the anterior cortex at the lesser trochanter and the posterior cortex at the femoral neck.ResultsFor hips with different neck heights, different Crowe types, different stem types, or different femoral anteversions, native femoral anteversion showed widely varied differences and correlations with stem anteversion, with differences ranging from −1.27 ± 8.33° to −13.67 ± 9.47° and correlations ranging from 0.122 (p = 0.705, no correlation) to 0.813. Predictive anteversion formed by the anterior cortex at the lesser trochanter proximal base and posterior cortex 10 mm above the lesser trochanter proximal base showed no significant difference with stem anteversion, with less varied differences (0.92 ± 7.52°) and good to excellent correlations (r = 0.826).ConclusionAdopting our new method, predictive anteversion, measured as the average anteversion of the anterior cortex at the lesser trochanter proximal base and posterior cortex 10 mm above the lesser trochanter proximal base, predicted postoperative stem anteversion more reliably than native femoral anteversion.

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Changes in Alignment of Ipsilateral Knee on Computed Tomography after Total Hip Arthroplasty for Developmental Dysplasia of the Hip

Cited by 9 publications

References 36 publications

Postoperative Hip Center Position Associated With the Range of Internal Rotation and Extension During Gait in Hip Dysplasia Patients After Total Hip Arthroplasty

Postoperative Hip Center Position Associated With the Range of Internal Rotation and Extension During Gait in Hip Dysplasia Patients After Total Hip Arthroplasty

Postoperative hip center position is associated with gait symmetry in range of axial rotation in dysplasia patients after THA

A New Method to Predict Postoperative Stem Anteversion in Total Hip Arthroplasty for Developmental Dysplasia of the Hip

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