Controlled fracture of the 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 the hip: a retrospective cohort study

Abstract

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 the hip (DDH). However, there was no study comparing the results of controlled fracture of the medial wall with a structural autograft with a bulk femoral head. Methods Sixty-seven hips classified as Crowe II/III were retrospectively included in this cohort study, which consisted of 33 controlled fractures (group A) and 34 structural autografts (group B). The Harris Hip Scores (HHS) were recorded. The radiological assessments were analyzed. Also, complications are assessed. The paired-sample t test was used for data analysis before and after the operation, while the independent sample T test was used for the comparison between the two groups. The Pearson chi-square test or the Fisher exact test was used to analyze the qualitative comparative parameters. Kaplan-Meier was utilized in the analysis of survivorship with the end points as a revision for any component. Results All patients were reconstructed acetabulum at the anatomical location. HHS increased greatly for both groups (p = 0.18). No statistic difference was observed for the 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 the hip center (2.25 ± 0.42 cm for group A and 2.09 ± 0.31 cm for group B, p = 0.13), and inclination of the 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 for group A (91 ± 5%), (p = .009). The rate of cup protrusio was 48 ± 4% for group A. For both groups, no statistical difference was observed in the cup diameter (p > .05), while group A showed less operation time than group B (p < .001). No complications were observed at the latest follow-up. Conclusion Controlled fracture of the medial wall to increase cup coverage by host bone at the anatomical location can act as an alternative technique for DDH Crowe II/III with the advantage of shorter operation time and less technically demanding.

Acetabular Revision Arthroplasty Based on 3-Dimensional Reconstruction Technology Using Jumbo Cups

“…Increasing the contact area between the acetabular cup and the host bone can ensure good initial stability, which is a crucial success factor of hip arthroplasty revision. CC is usually used to evaluate this contact area and in DDH hip replacement ( Yang et al, 2017 ; Liu et al, 2018 ; Mou et al, 2020 ; Takasago et al, 2021 ). Generally, insufficient CC will increase the stress at the bone cup interface, thus increasing the probability of mechanical failure ( Apostu et al, 2018 ; Zuo et al, 2021 ).…”

A Multi‐factor Analysis of Revision in Total Hip Replacement Using the Collarless‐Polished‐Tapered Stems with Different Cups

“…24 Mou et al compared two surgical methods and found that one was better than another in the coverage rate, indicating that the higher the coverage rate, the better. 25 Most previous studies agreed that a higher acetabular coverage rate would give lower revision, 26,27 although this topic is still to be further explored. There is little research reporting the relationship among the Trilogy, the coverage rates and revision rates.…”

Integrated acetabular prosthesis versus bone grafting in total hip arthroplasty for Crowe type II and III hip dysplasia: a retrospective case–control study

“…Crowe type II and III DDH with THA may choose to achieve su cient bone coverage for acetabular cup stability by moving the hip joint center upward or inward (7). However, the movement of the rotational center may lead to changes in the biomechanics of the hip joint (8).…”