Outcomes in 385 developmental dysplastic hips requiring total hip arthroplasty

Seo, Lauren; Gabor, Jonathan A.; Novikov, Dmitry S.; Feng, James E.; Schwarzkopf, Ran; Vigdorchik, Jonathan M.

doi:10.1007/s00402-019-03143-5

Cited by 13 publications

(15 citation statements)

References 25 publications

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“…Total hip arthroplasty (THA) is one of the most successful surgeries in the 20 th century; a gradually increasing amount of patients with developmental dysplasia of the hip (DDH) received THA to release pain and improve function [1][2][3]. Despite their surgical complexity, DDH patients had also notably low rates of revision and obtained durable clinical results [2,[4][5][6][7]. During THA surgery, an obvious superolateral bone defect has been reported to be frequently observed above the surface of the acetabular cup at the level of the true acetabulum, especially in patients with Crowe II or III DDH [7,8].…”

Section: Introductionmentioning

confidence: 99%

Acetabular Bone Defect in Total Hip Arthroplasty for Crowe II or III Developmental Dysplasia of the Hip: A Finite Element Study

Sun

et al. 2020

BioMed Research International

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Background. The purpose of this study was to establish the finite element analysis (FEA) model of acetabular bone defect in Crowe type II or III developmental dysplasia of the hip (DDH), which could evaluate the stability of the acetabular cup with different types of bone defects, different diameters of femoral ceramic heads, and the use of screws and analyze the stress distribution of screws. Methods. The FEA model was based on the CT scan of a female patient without any acetabular bone defect. The model of acetabular bone defect in total hip arthroplasty for Crowe II or III DDH was made by the increasing superolateral bone defect area of the acetabular cup. Point A was located in the most medial part of the acetabular bone defect. A 52 mm PINNACLE cup with POROCOAT Porous coating was implanted, and two screws (the lengths were 25 mm and 40 mm) were implanted to fix the acetabular cup. The stability of the acetabular cup and the von Mises stress of point A and screws were analyzed by a single-legged stance loading applied in 1948 N (normal working). The different diameters of the femoral ceramic head (28 mm, 32 mm, and 36 mm) were also analyzed. Results. The von Mises stress of point A was gradually increased with the increasing uncoverage values. When the uncoverage values exceeded 24.5%, the von Mises stress of point A without screws increased significantly, leading to instability of the cup. Screws could effectively reduce the von Mises stress of point A with uncoverage values of more than 24.5%. However, the peak von Mises stress in the screws with the uncoverage values that exceeded 24.5% was considerably increased. The diameter of the femoral ceramic head had no significant effect on the von Mises stress and the stability of the acetabular cup. Conclusions. We recommend that uncoverage values of less than 24.5% with or without screw is safe for patients with Crowe II or III DDH.

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Section: Introductionmentioning

confidence: 99%

Acetabular Bone Defect in Total Hip Arthroplasty for Crowe II or III Developmental Dysplasia of the Hip: A Finite Element Study

Sun

et al. 2020

BioMed Research International

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“…However, instability is not a significant complication of THA for developmental dysplasia of the hip as demonstrated by 2 series that had three dislocation in total. 8,9…”

Section: Resultsmentioning

confidence: 99%

“…7 However, instability is not a significant complication of THA for developmental dysplasia of the hip as demonstrated by 2 series that had three dislocation in total. 8,9 Moreover, increased ASA score, neurological disability and patients with fixed spinopelvic alignment from standing to sitting position enhance the risk of dislocation. 10,11 Cerebral, spinal, neuromuscular junction, and muscle-tendon-bone integrity is required for normal hip function and stability.…”

Section: Patient-related Factorsmentioning

confidence: 99%

Unstable total hip replacement: why? Clinical and radiological aspects

2020

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Introduction: Dislocation after total hip arthroplasty (THA) is the most common cause of revision hip surgery in the United States, ahead of aseptic loosening and infection, and is responsible for considerable economic cost related to frequent readmission and/or revision surgery. The aim of this article is to identify the clinical and radiological factors related to the unstable total hip replacement. Methods: We performed a literature search to assess current strategies to define clinical and radiological characteristics of dislocation after primary THA using the PubMed platform. The characteristics related to THA instability were divided into patient related factors, implant related factors and surgeon experience. Results: Patient-related factors for instability identified are: age; inflammatory joint disease; prior hip surgery; preoperative diagnosis; comorbidity; ASA score; presence of spino-pelvic abnormality; and neurological disability. Gender, simultaneous bilateral THA and restrictive postoperative precautions do not influence rate of THA dislocation. Implant related factors identified are: surgical approach; component malposition; femoral head size; and the use of dual-mobility or constrained solution. Surgeon experience also reduces the rate of dislocation. Discussion: Dislocation is a major complication of THAs, and causes include patient-derived factors, surgical factors, or both. It is imperative to determine the cause of the instability via a complete patient and radiographic evaluation and to adjust the reconstruction strategy accordingly.

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“…В противовес этому при типе С1 такой размер вертлужных компонентов использовался только в 58% наблюдений, а отношение шан-рис. 5. на обзорной рентгенограмме таза головка смещена краниально примерно на 75% ее высоты (а), соответственно это тип crowe III, но при 3D-реконструкции КТ-изображения четко видно, что имеется полный вывих головки бедренной кости (crowe IV или тип С2 по Hartofilakidis)истинная и ложная впадина не имеют общего пространства (b) Функциональные результаты замены тазобедренного сустава, представленные в литературе, так же, как и в нашем исследовании, существенно хуже, чем при стандартном первичном эндопротезировании, что связано не только со сложностью выполнения операции, но и с системными изменениями всего скелета -деформациями костей нижних конечностей, вальгусной установкой в коленных суставах, длительным нарушением позвоночно-тазовых взаимотношений [4,11,18,29,34].…”

Section: Discussionunclassified

“…Обычно у пациентов с высоким вывихом бедра основными сложностями для эндопротезирования считают тяжелые анатомические изменения вертлужной впадины, ограничивающие надежную фиксацию чашки эндопротеза и затрудняющие выбор пары трения ввиду малого размера вертлужного компонента, а также значительное укорочение конечности и связанные с этим необходимость использования специальных хирургических технологий и трудность использования стандартного бедренного компонента [5,6,9,10,11]. В таких случаях установка вертлужного компонента в область истинной вертлужной впадины ведет к необходимости значительного удлинения оперируемой конечности, иногда до 8-9 см, что невозможно выполнить без серьезного повреждения окружающих сустав мышц и тракционного повреждения седалищного и бедренного нервов [12].…”

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Is the Any Clinical Importance for Separation Congenitally Dislocated Hip in Adults into Types C1 and C2 by Hartofilakidis?

Тихилов¹,

Shubnyakov

Шубняков³

et al. 2019

Traumatology and Orthopedics of Russia

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The main questions of the study: 1) is there any difference in anatomical features between subtypes C1 and C2 of high hip dislocation by Hartofolakidis classification; 2) are the conditions for performing the THA different and what are the surgical decisions; 3) what are the THA results in different groups? Materials and Methods. In a single center study the authors retrospectively evaluated the outcomes of 561 THAs performed in 349 patients with a high hip dislocation including 32 men (9.2%) and 317 women (90.8%) with the follow up from 12 to 188 months (average 69,4 months). In 326 cases (58.1%) the dislocation was assessed as type C1, and in 235 cases (41.9%) — as type C2. The average age of the patients at the time of surgery was 47.6 (19 to 74) years, for men — 39.1 years and 48.1 years for women. Results. Paavilainen shortening osteotomy was performed in 100% of patients with type C2 and only in 50.6% of patients with type C1, p<0.001. The cup was implanted into the true acetabulum cavity in 99.1% of cases with type C2, and for type C1 only in 69.0% of cases, p<0.001. Lateral under-coverage of the cup in patients with type C2 required supplementing by femoral head autograft only in three cases, and for type C1 — in 18 patients, p = 0.009. In the group of C2, the mean length of the osteotomized fragment of the proximal femur was 78.6 mm compared to 62.5 mm in patients with type C1. This provided a better contact area between the greater trochanter and the femur and in 92.8% of cases fixation was done by cerclage wires and two screws. In the group of patients with type C1, this option was feasible only in 60.0% of cases. Odds ratio (OR) for fixation of the greater trochanter by a special plate for primary indications in patients with type C1 were 10 367, p = 0.008. Harris Hip score improved averaged from 39.5 points to 83.6, without statistically significant differences between groups of C1 and C2. Early complications included 9 dislocations (1.6%), 8 cases of femoral nerve neuropathy (1.4%) and 3 early infections (0.5%). No cases of sciatic nerve paresis were observed. Non-union of the greater trochanter was observed with almost equal frequency in patients with C1 and C2 types, and revision fixation was needed in 27 patients (6.8%). Revision arthroplasty was performed in 22 cases (3.9%) due to 4 infections, 2 aseptic loosening of the stem, 11 aseptic loosening of the acetabular component and 5 recurrent dislocations. Conclusion. The group of patients with high hip dislocation is very heterogenic in terms of severity of anatomical changes and demands different surgical tactics. Hartofolakidis classification helps the surgeon to select the best type of the surgical procedure, minimize the mistakes and predict treatment outcomes.

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Outcomes in 385 developmental dysplastic hips requiring total hip arthroplasty

Cited by 13 publications

References 25 publications

Acetabular Bone Defect in Total Hip Arthroplasty for Crowe II or III Developmental Dysplasia of the Hip: A Finite Element Study

Acetabular Bone Defect in Total Hip Arthroplasty for Crowe II or III Developmental Dysplasia of the Hip: A Finite Element Study

Unstable total hip replacement: why? Clinical and radiological aspects

Is the Any Clinical Importance for Separation Congenitally Dislocated Hip in Adults into Types C1 and C2 by Hartofilakidis?

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