Impaction Grafting Is Sufficient to Address Acetabular Deficiency During Total Hip Arthroplasty of Most Dysplastic Hips With Over 30% Bone Defect

Mozafari, Javad Khaje; Pisoudeh, Karim; Gharanizadeh, Kaveh; Ghazavi, Mohammad; Abolghasemian, Mansour

doi:10.1016/j.arth.2022.02.108

Cited by 6 publications

(8 citation statements)

References 32 publications

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“…Release of the posterior capsule and short external rotators was routinely performed. The acetabulum was prepared at the anatomic location, as described [19]. Because the acetabulum is shallow in these patients, we ream in reverse, starting with a 36-mm reamer and increasing to a maximum size of 46 mm.…”

Section: Methodsmentioning

confidence: 99%

Subtrochanteric Shortening Osteotomy Provides Superior Function to Trochanter Slide Osteotomy in THA for Patients With Unilateral Crowe Type IV Dysplasia at a Minimum of 3 Years

Ravanbod,

Gharanizadeh,

Mirghaderi

et al. 2023

Clin Orthop Relat Res

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Background Performing THA in patients with high-riding developmental dysplasia of the hip (DDH) is associated with serious complications and technical challenges. Various methods of shortening osteotomy are available to facilitate femoral head reduction during THA in patients with high-riding hips; subtrochanteric shortening osteotomy and trochanteric slide osteotomy plus proximal shortening are the most common techniques. However, which approach is superior remains a topic of controversy. Questions/purposes (1) Is there any difference in clinical outcomes (defined as the Harris Hip Score [HHS] and residual limb length discrepancy) at a minimum of 3 years between subtrochanteric shortening osteotomy and trochanteric slide osteotomy in patients with Crowe Type IV DDH who underwent THA? (2) Is there any difference in the risk or type of complications between the two approaches? Methods We performed a retrospective, comparative study of two groups (subtrochanteric shortening osteotomy versus trochanteric slide osteotomy) matched for sex and preoperative HHS at a minimum of 3 years of follow-up. Between 2010 and 2018, we performed 67 THAs in patients with unilateral Crowe Type IV DDH. During that time, we generally used a trochanteric slide osteotomy for THA in all patients with Crowe Type IV hips and performed subtrochanteric shortening osteotomy when a conical stem was not available. A total of 42% (28) had THA with subtrochanteric shortening osteotomy, and 58% (39) had THA with trochanteric slide osteotomy. Of those, 89% (25) and 74% (29), respectively, were accounted for with complete datasets for possible matching at a minimum of 3 years of follow-up. Patients were matched for gender and preoperative HSS (within 10 points), leaving 22 patients in each group (79% of the subtrochanteric shortening osteotomy group and 56% of the trochanteric slide osteotomy group) for evaluation and analysis. Age (42 versus 46 years), gender (female: 73% versus 73%), preoperative HSS (40 versus 40), and preoperative leg length discrepancy (5.9 versus 5.3 cm) were comparable between the two groups (p > 0.05). The trochanteric slide osteotomy group exclusively received Cone Wagner (Zimmer) implants (100%), while Corail (DePuy Synthes) implants (77%) were the most commonly used in the subtrochanteric shortening osteotomy group. HHS at a minimum of 3 years as well as the presence or absence of a limp and Trendelenburg sign, functional leg length discrepancy, nonunion, nerve palsy, and other surgical complications were recorded and compared between the groups based on data drawn from a longitudinally maintained institutional database. Results At a mean follow-up of 73 months, improvement in HHS was greater in the subtrochanteric shortening osteotomy group than in the trochanteric slide osteotomy group (48 ± 4 points versus 36 ± 11 points, mean difference 12 points [95% CI 7 to 17 points]; p < 0.001). Although the preoperative leg length discrepancy was similar between the groups, there was a greater postoperative improvement in the subtrochanteric shortening osteotomy group (44 ± 8 mm and 38 ± 8 mm in the subtrochanteric shortening osteotomy and trochanteric slide osteotomy groups, respectively; p = 0.02). The risk of nonunion was higher with a trochanteric slide osteotomy than with a subtrochanteric shortening osteotomy (23% [5 of 22] versus 0% [0 of 22]; p = 0.048). Other complications, including intraoperative periprosthetic fractures, nerve palsy, heterotopic ossification, revision surgery, and dislocation, did not differ between the groups. Conclusion In patients with Crowe Type IV hips undergoing THA, surgeons might consider subtrochanteric shortening osteotomy rather than trochanteric slide osteotomy to minimize the risk of nonunion and achieve superior hip function. Better correction of leg length discrepancy may also be possible with subtrochanteric shortening osteotomy. The long-term survivorship of hips after these two techniques, as well as the influence of the specific anatomy of the proximal femur on the choice of technique, remain to be explored in future studies. Level of Evidence Level III, therapeutic study.

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Section: Methodsmentioning

confidence: 99%

Subtrochanteric Shortening Osteotomy Provides Superior Function to Trochanter Slide Osteotomy in THA for Patients With Unilateral Crowe Type IV Dysplasia at a Minimum of 3 Years

Ravanbod,

Gharanizadeh,

Mirghaderi

et al. 2023

Clin Orthop Relat Res

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“…Acetabular bone defects are frequently encountered in THA, and the reconstruction can be challenging for surgeons, especially in large defects [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…All autografts incorporated completely into host bone, with a significant relationship between the type of graft and the graft incorporation. In patients with dysplastic hip who underwent cementless THA, Mozafari et al [ 22 ] reported 96.5% rate of complete graft incorporation in patients with dysplastic hips with over 30% acetabular bone defect who had impaction autograft and cementless THA, with a mean follow-up of 93.3 months.…”

Section: Discussionmentioning

confidence: 99%

Impaction bone grafting for contained acetabular defects in total hip arthroplasty

Abu-Zeid,

Habib,

Marei

et al. 2023

J Orthop Surg Res

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Background Acetabular bone loss is a technical challenge in total hip arthroplasty (THA). This study sought to report the functional and radiological results of acetabular reconstruction using impaction bone grafting (IBG) in patients with acetabular bone deficiency undergoing primary or revision THA. Methods In this prospective study, full history taking, preoperative clinical and radiological evaluation, and preoperative planning and templating were performed. The Paprosky classification and the American Academy of Orthopaedic Surgeons classification were used to assess the acetabular deficiencies. Clinical outcomes were assessed utilizing the Harris hip score (HHS) and a 4-question satisfaction questionnaire. Graft incorporation was evaluated in the last follow-up X-rays. Results This study included 50 patients with a mean age of 46.7 ± 15.3 years. The THA was primary in 14 (28%) patients and revision in 36 (72%) patients. The mean HHS improved significantly from 28.8 ± 24.1 preoperatively to 76.6 ± 6.1, with a mean follow-up period of 23 months. Overall, 88% of patients were very satisfied. Complete radiological graft incorporation to host bone was achieved in 35 (70%) patients, and the remaining patients had partial incorporation. Complete graft incorporation was associated more frequently with primary THA, autografts, cementless cups, decreased defect size, and decreased graft layer thickness. Conclusions IBG for acetabular reconstruction in THA can achieve excellent clinical and radiological outcomes with a low complication rate. Level of evidence Level IV.

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“…Currently, the main solutions of Crowe type II and III DDH acetabular bone defect in THA include: granule bone graft, structural bone graft, tantalum metal augment, as well as bone cement (14,(21)(22)(23).…”

Section: Inappropriate Anteversion and Inclination Are Important Fact...mentioning

confidence: 99%

“…Impaction granule bone graft is a reliable technique ,which has high requirements for the surgeon to perform layer impaction (24). Structural bone graft is widely accepted by most orthopedists due to good initial stability for the acetabular cup and easy manipulation, however , it can not be avoided that high risks of the failure of osseointegration and subsequent bone resorption and collapse as well as prosthesis loosening (14).…”

Section: Inappropriate Anteversion and Inclination Are Important Fact...mentioning

confidence: 99%

How to Develope a Novel 3D Printed Integral Customized Anatomical Acetabular Prosthesis in Hip Arthroplasty for Crowe Type II and III Developmental Dysplasia of the Hip?

Zhang

Cheng

et al. 2022

Preprint

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BackgroundThe acetabular pathomorphology in patients with Crowe type II and III developmental dysplasia of the hip(DDH)often present complicated changes, which bring challenges to the anatomical reconstruction of acetabulum in total hip arthroplasty (THA). The objective of this study was to develope a novel 3D printed integral customized acetabular prosthesis, which provides a promising way to reconstruct the acetabulum with higher accuracy and efficiency by digital softwares, compared with previous 3D printing model method.Methods15 patients (18 hips) with end-stage hip osteoarthritis due to Crowe type II/III DDH who underwent primary cementless THA from January 2015 to November 2021 were included. The 15 patients consisted of 3 men (3 hips) and 12 women (15 hips) with an average age of 53.89 ± 8.48 years (range from 32 to 69 years). The novel 3D printed integral customized acetabular prosthesis was designed by the model method and software method respectively. The indicators of the cup size, the volume and superficial area of bone defect, the inclination and anteversion of acetabular cup, the horizontal and vertical distance of hip center and working time were compared between two methods.ResultsThere were statistically significant difference between the software group and model group on the volume and superficial area of bone defect as well as working time (t = 2.397, 2.707,138.509, P < 0.05). The mean anteversion and inclination of acetabular cup in the software group and model group were(15.17±0.52)°,(40.24±0.58)°and (33.79 ±13.43)°, (30.50 ±11.03)°respectively, the difference was statistically significant (t = 5.859, 3.767, P < 0.05).There were no statistically significant difference between the software group and model group on cup size, the horizontal and vertical distance of hip center(t =1.458,0.114, 1.712, P > 0.05)ConclusionsThe application of digital softwares could design and develope the novel 3D printed integral customized anatomical acetabular prosthesis in THA for □Crowe type II and III DDH with high accuracy and efficiency.

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Impaction Grafting Is Sufficient to Address Acetabular Deficiency During Total Hip Arthroplasty of Most Dysplastic Hips With Over 30% Bone Defect

Cited by 6 publications

References 32 publications

Subtrochanteric Shortening Osteotomy Provides Superior Function to Trochanter Slide Osteotomy in THA for Patients With Unilateral Crowe Type IV Dysplasia at a Minimum of 3 Years

Subtrochanteric Shortening Osteotomy Provides Superior Function to Trochanter Slide Osteotomy in THA for Patients With Unilateral Crowe Type IV Dysplasia at a Minimum of 3 Years

Impaction bone grafting for contained acetabular defects in total hip arthroplasty

How to Develope a Novel 3D Printed Integral Customized Anatomical Acetabular Prosthesis in Hip Arthroplasty for Crowe Type II and III Developmental Dysplasia of the Hip?

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