Current concepts in developmental dysplasia of the hip and Total hip arthroplasty

Wang, Yan

doi:10.1186/s42836-019-0004-6

Cited by 15 publications

(10 citation statements)

References 71 publications

(68 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The results indicated that the difference in femoral medullary torsion angle between the DDH and control medullary canals was possibly caused by the femoral anteversion, which refers to the rotation of the femoral neck around the diaphysis. A normal femoral anteversion is beneficial to restoring the normal biomechanics of the dysplastic joint ( Noble et al, 2003 ; Wang, 2019 ), as well as improving the postoperative durable implant fixation and joint mobility ( Dorr et al, 2009 ), thus a suitable femoral replacement design for patients with severe DDH may need to consider correcting the excessive femoral anteversion. This could be achieved using a modular stem with a rotatable sleeve ( Liu et al, 2016 ), or a cone stem ( Zhen et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

“…Developmental dysplasia of the hip (DDH), which is characterized by a shallow acetabulum, shortened femoral neck, excessive femoral anteversion and narrow femoral medullary cavity ( Nakahara et al, 2014 ), may result in a range of complications to the hip joint such as dislocation, focal necrosis, and discrepancies in leg length ( Naci and Kadri, 2011 ). Modular hip system and straight cone femoral stem are usually recommended for the treatment of DDH, due to the free setting of anteversion ( Zhen et al, 2017 ; Wang, 2019 ; Gholson et al, 2020 ), and have shown good postoperative results ( Gholson et al, 2020 ). However, difficult operative implantation of femoral stem in the patients with highly dislocated DDH hips ( Liu et al, 2016 ) and intraoperative femoral fracture ( Zang et al, 2019 ) were reported in previous clinical studies.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Three-Dimensional Morphology of Femoral Medullary Cavity in the Developmental Dysplasia of the Hip

Zhang

Liu

et al. 2021

Front. Bioeng. Biotechnol.

View full text Add to dashboard Cite

ObjectiveThis study aimed to assess the morphology of the femoral medullary canal in subjects with developmental dysplasia of the hip (DDH) with the intent of improving the design of femoral stems in total hip arthroplasty.MethodsComputed tomography images of 56 DDH hips, which were classified into Crowe I to Crowe IV, and 30 normal hips were collected and used to reconstruct three-dimensional morphology of the femoral medullary cavity. Images of twenty-one cross sections were taken from 20 mm above the apex of the lesser trochanter to the isthmus. The morphology of femoral cavity was evaluated on each cross section for the longest canal diameter, the femoral medullary torsion angle (FMTA), and the femoral medullary roundness index (FMRI).ResultsThe Crowe IV group displayed the narrowest medullary canal in the region superior to the end of the lesser trochanter, but then gradually aligned with the medullary diameter of the other groups down to the isthmus. The FMTA along the femoral cavity increased with the severity of DDH, but the rate of variation of FMTA along the femoral canal was consistent in the DDH groups. The DDH hips generally showed a larger FMRI than the normal hips, indicating more elliptical shapes.ConclusionA femoral stem with a cone shape in the proximal femur and a cylindrical shape for the remainder down to the isthmus may benefit the subjects with severe DDH. This design could protect bone, recover excessive femoral anteversion and facilitate the implantation in the narrow medullary canal.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Three-Dimensional Morphology of Femoral Medullary Cavity in the Developmental Dysplasia of the Hip

Zhang

Liu

et al. 2021

Front. Bioeng. Biotechnol.

View full text Add to dashboard Cite

show abstract

“…Several femoral stem types including conical stems with flutes, rectangular stems, and modular stems have been used to increase the rotational stability of the SFSO in the treatment of DDH. [18] Hua et al [19] had 0% non-union rate with combination of conical stem with strut autograft and cables. Mu et al [16] used rectangular femoral stem alone as primary stabilizer of the SFSO and reported a non-union rate of 3.3%.…”

Section: Discussionmentioning

confidence: 98%

Use of proximal humerus plates for the fixation of the subtrochanteric femoral shortening osteotomy during total hip arthroplasty for Crowe type IV developmental dysplasia of the hip patients

et al. 2020

View full text Add to dashboard Cite

The number of patients undergoing total hip arthroplasty is rising. [1] Developmental dysplasia of the hip (DDH) is a frequent diagnosis for total hip arthroplasty and a subtrochanteric femoral shortening osteotomy (SFSO) is often required for the Crowe type IV patients. [2,3] After the SFSO, fixation may be necessary to obtain the rotational stability. [4] However, the femoral stem reduces the space required for fixation which makes this procedure challenging. Cables, cables with strut grafts, plate and screws, cable plates, and various osteotomy methods are used for fixation of the SFSO during total hip arthroplasty. [4-9] Non-union and implant irritation are the major problems encountered with these methods. [10,11] Denis et al. [12] compared plate and cable in their biomechanical study for the fixation around the femoral stem in periprosthetic fracture model and it was shown that unicortical screw fixation proximal to osteotomy was biomechanically stronger than cable fixation. For this reason, we considered that a proximal humerus plate may be a good alternative for SFSO fixation as it has many locking screws option Objectives: This study aims to evaluate the efficacy of proximal humerus plate in the fixation of subtrochanteric femoral shortening osteotomy (SFSO) during total hip arthroplasty. Patients and methods: Thirty female patients (mean age 49.8 years; range, 22 to 68 years) who underwent hip arthroplasty with a SFSO and fixed with a proximal humerus plate between January 2014 and June 2018 were evaluated retrospectively. Rate of fracture healing, the number of fixed cortices at both sides of the osteotomy, and complications were documented. Results: The mean follow-up period was 28 months (range, 12-68 months). The average time to union was 106 days (range, 45-229 days). The mean number of cortices fixed in the proximal segment of the osteotomy was 6.2 (range, 4-9), and the mean number of cortices fixed in the distal segment of the osteotomy was 4.0 (range, 3-7). None of the patients had implant irritation or implant failure at the control visits. We observed only one non-union and our non-union rate was 3.3%. Conclusion: In conclusion, the use of a proximal humerus plate for the fixation of SFSO can be an alternative procedure for achieving adequate rotational stability until a solid union.

show abstract

“…Precision in achieving the preoperative plan is especially important in patients with developmental dysplasia of the hip (DDH) with challenging anatomy, as they may eventually require revision surgery. Determining and achieving appropriate acetabular cup position has implications on hip biomechanics, leg length, implant longevity and wear, component stability, and gait [16].…”

Section: Introductionmentioning

confidence: 99%

“…In patients with dysplasia, the acetabula are hypoplastic and deficient in various planes and dimensions, thus increasing the difficulty of placing the acetabular cup [ 14 ]. In addition, patients with dysplasia often have narrow femoral canals and increased anteversion in addition to bone stock deficiency [ 13 , 15 , 16 ]. These and other anatomical aberrations make the surgery more challenging and increase the risk of complications [ [17] , [18] , [19] ].…”

Section: Introductionmentioning

confidence: 99%

The Use of Robotic-Assisted Total Hip Arthroplasty in Developmental Dysplasia of the Hip

Vigdorchik

Sharma

Aggarwal³

et al. 2020

Arthroplasty Today

View full text Add to dashboard Cite

Background: Total hip arthroplasty (THA) is an effective operation for patients with hip osteoarthritis; however, patients with hip dysplasia present a particular challenge. Our novel study examined the effect of robot-assisted THA in patients with hip dysplasia. Methods: We retrospectively reviewed patients with developmental dysplasia of the hip undergoing primary THA using robotic arm assistance at 2 institutions from January 2010 to January 2017. Patients undergoing revision arthroplasty were excluded. Preoperatively, all patients underwent a computed tomography scan so that 3-dimensional templating could be performed. Hip range of motion (ROM) and clinical leg length discrepancy were recorded preoperatively. Two independent observers calculated Crowe and Hartofilakidis grades for each operative hip. At the final follow-up, hip ROM, postoperative complications, and modified Harris Hip scores were obtained. Results: Seventy-nine patients underwent THA because of degenerative joint disease in the setting of developmental dysplasia of the hip. There were 56 females and 23 males with a mean age of 45 years (range: 26-64 years). We found that components were placed according to the preoperative plan, that there was an improvement in the modified Harris hip score from 29 to 86 (P < .001), an improvement in the hip ROM (flexion improvement from 66 to 91 , P < .0001), and a correction of leg length discrepancy (17.1 vs 4 mm, P < .0002). There were no complications during the short-term interim follow-up (mean: 3.1 years). Conclusions: Robot-assisted THA can be a useful method to ensure adequate component positioning and excellent outcomes in patients with hip dysplasia.

show abstract

Current concepts in developmental dysplasia of the hip and Total hip arthroplasty

Cited by 15 publications

References 71 publications

The Three-Dimensional Morphology of Femoral Medullary Cavity in the Developmental Dysplasia of the Hip

The Three-Dimensional Morphology of Femoral Medullary Cavity in the Developmental Dysplasia of the Hip

Use of proximal humerus plates for the fixation of the subtrochanteric femoral shortening osteotomy during total hip arthroplasty for Crowe type IV developmental dysplasia of the hip patients

The Use of Robotic-Assisted Total Hip Arthroplasty in Developmental Dysplasia of the Hip

Contact Info

Product

Resources

About