Favorable Results of Primary Total Hip Arthroplasty With Acetabular Impaction Bone Grafting for Large Segmental Bone Defects in Dysplastic Hips

Iwase, Toshiki; Morita, Daigo; Ito, Tadashi; Takemoto, Genta; Makida, Kazuya

doi:10.1016/j.arth.2016.03.048

Cited by 21 publications

(42 citation statements)

References 40 publications

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“…Currently, the management methods of DDH acetabular bone defect in THA mainly include: granule bone graft, structural bone graft, tantalum metal augment, and bone cement technology. [ 14 15 16 ] Impaction granule bone graft is usually performed using layer impaction technology, which has high technical requirements for the surgeon and requires special instruments. [14] Structural bone graft can provide good initial stability for the prosthesis, but there are high risks of bone resorption and collapse as well as prosthesis loosening in the long term.…”

Section: Discussionmentioning

confidence: 99%

“…[ 14 15 16 ] Impaction granule bone graft is usually performed using layer impaction technology, which has high technical requirements for the surgeon and requires special instruments. [14] Structural bone graft can provide good initial stability for the prosthesis, but there are high risks of bone resorption and collapse as well as prosthesis loosening in the long term. [17] Tantalum metal augment can effectively repair bone defects, but it is difficult to match with the bone defect shape perfectly and reconstruct bone defects accurately.…”

Section: Discussionmentioning

confidence: 99%

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Novel 3D printed integral customized acetabular prosthesis for anatomical rotation center restoration in hip arthroplasty for developmental dysplasia of the hip crowe type III

et al. 2020

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Rationale: Exact restoration of the rotation center in total hip arthroplasty (THA) is technically challenging in patients with end-stage osteoarthritis due to developmental dysplasia of the hip (DDH), especially in the Crowe type II and III procedures. The technical difficulty is attributable to the complex acetabular changes. In this study, a novel 3-dimensional (3D) printed integral customized acetabular prosthesis for anatomical rotation restoration in THA for DDH Crowe type III was developed using patient-specific Computer-aided design and additive manufacturing (AM) methods. Patient concerns: A 69-year-old female patient had developed left hip joint pain and restricted movement for 40 years; the symptoms had increased in the past 5 months. Pain, limited motion of the left hip joint, and lower limb length discrepancy were noted during physical examination. Diagnosis: The patient was diagnosed with left hip end-stage osteoarthritis secondary to DDH (Crowe type III). Intervention: A 3D printed acetabulum model was manufactured and a simulated operation was performed to improve the accuracy of reconstruction of the rotation center and bone defect. A 3D printed titanium alloy integral customized acetabular prosthesis was designed according to the result of simulated operation. The integral customized prothesis was implanted subsequently via the posterolateral approach. Radiography of the pelvis and Harris score assessment were performed during the perioperative period as well as at the 6- and 12-month follow-up. Outcomes: The 3D printed integral customized acetabular prosthesis matched precisely with the reamed acetabulum. The rotation center was restored and the bone defect was exactly reconstructed. There were no signs of prosthetic loosening at the 12-month follow-up. The Harris score gradually improved during the follow-up period. Lessons: Satisfactory results of hip rotation restoration and bone defect reconstruction could be achieved by using 3D printed integral customized acetabular prosthesis, which provides a promising way to reconstruct the acetabulum in patients with DDH anatomically and rapidly for THA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Novel 3D printed integral customized acetabular prosthesis for anatomical rotation center restoration in hip arthroplasty for developmental dysplasia of the hip crowe type III

et al. 2020

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“…In contrast to structural bone grafting, favorable mid-term to long-term effects of impaction bone grafting have been reported in the treatment of bone defects during THA for DDH. 6 , 25 However, impaction bone grafting is not helpful in the achievement of the initial stability of the cup. To overcome this weakness, we tried to apply impaction bone grafting in combination with cup blocking screws.…”

Section: Discussionmentioning

confidence: 99%

A simple technique to strengthen the initial and mid-term to long-term stability of the cup during total hip arthroplasty in developmental dysplasia of the hip

MingQiang

Zhou

2018

SMJ

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Objectives:To assess the effects of a technique of cup blocking screws combined with impaction bone grafting during total hip arthroplasty (THA) for patients with developmental dysplasia of the hip (DDH).Methods:From August 2011 to July 2015, 53 patients (59 hips) with DDH in our hospital were treated with THA using the technique of cup blocking screws combined with impaction particulate bone grafting. These patients were prospectively followed, and the clinical and imaging results were collected.Results:Harris hip score (HHS) was raised from 41.24 before surgery to 91.49 at the latest follow-up (p<0.001). Length discrepancy (LLD) was reduced from 28.97 mm before surgery to 6.08 mm after surgery (p<0.001). No loosening of the cup was detected at the last follow-up. The differences were insignificant in cup inclination and rate of cup coverage among the 3 groups of Crowe type II, type III, and type IV DDH (p>0.05).Conclusion:The technique of cup blocking screws combined with impaction particulate bone grafting is simple and reliable, and it not only simplifies the attainment of initial stability, but also strengthens the mid-term to long-term stability during THA in DDH.

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“…In addition to the immediate fixation and stability of the implant, the mid-and long-term stability may be compromised. Several methods of improving acetabular component stability and coverage have been utilized including autograft bone and metal adjuncts, oval shaped shells, reinforcement with acetabular augments, and larger acetabular cups placed superiorly (jumbo cup) (3)(4)(5)(6). However, the use of these treatment methods may require special instrumentation, different surgical techniques, and may increase operative times.…”

Section: Introductionmentioning

confidence: 99%

Use of an offset head center acetabular shell in difficult primary total hip arthroplasties

et al. 2019

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Several conditions may predispose patients to development of antero-lateral acetabular bone deficiency, including developmental dysplasia of the hip, osteonecrosis, or septic arthritis, among others. This may compromise the ability to gain acetabular component stability and impair reliable fixation. Large acetabular shells have often been used to achieve adequate fixation in scenarios of severe bone loss, however, these techniques have been shown to elevate the center of rotation (COR) of the hip and alter hip biomechanics. Recently, a new acetabular shell was developed with a goal of maintaining the native hip COR while achieving good fixation with standard instrumentation and technique. Previous radiographic studies have demonstrated the efficacy of this shell in lowering hip COR. In this case series, we demonstrate the use of this shell in patients with difficult hip pathologies. We have demonstrated how this offset COR acetabular shell may help bring down the COR of the hip in these quite challenging cases utilizing conventional techniques.

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Favorable Results of Primary Total Hip Arthroplasty With Acetabular Impaction Bone Grafting for Large Segmental Bone Defects in Dysplastic Hips

Cited by 21 publications

References 40 publications

Novel 3D printed integral customized acetabular prosthesis for anatomical rotation center restoration in hip arthroplasty for developmental dysplasia of the hip crowe type III

Novel 3D printed integral customized acetabular prosthesis for anatomical rotation center restoration in hip arthroplasty for developmental dysplasia of the hip crowe type III

A simple technique to strengthen the initial and mid-term to long-term stability of the cup during total hip arthroplasty in developmental dysplasia of the hip

Use of an offset head center acetabular shell in difficult primary total hip arthroplasties

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