Stepped osteotomy of femoral head autograft for acetabular reconstruction in total hip arthroplasty for dysplasia of the hip: 3 to 12 years’ results

Abstract

This study aims to describe a stepped osteotomy technique applied to the femoral head autograft to keep the graft volume at a sufficient level, provide primary stability, and direct cancellous-cancellous bone contact. Patients and methods: In this retrospective study, 24 hips of 20 patients (5 males, 15 females; mean age 53 years; range, 43 to 68 years) with dysplasia of the hip (DDH) who underwent total hip arthroplasty with femoral head stepped osteotomy technique were evaluated between April 2003 and June 2010. Patients' age, gender, operation side, and postoperative complications were recorded. Aseptic loosening of the acetabular cup and graft integration/resorption were evaluated radiographically. Radiological evaluations were performed according to the methods of DeLee and Charnley, and Mulroy and Harris. Functional status of the patients was determined according to the criteria of Merle d'Aubigné and Postel, and Harris hip score (HHS). Results: The mean follow-up period was 5.5 years (range, 3 to 12 years). None of the patients had any complications in the early postoperative period. In all patients, the percentage of acetabular component coverage by the graft was measured as 27% (range, 19 to 38%) on average. At the last follow-up, all patients were satisfied with the result and there was no sign of clinically loosening, osteointegration was complete, and there was no radiographic evidence of graft resorption or collapse of any hip. The overall Merle d'Aubigné scores and HHSs of the patients significantly improved at the final follow-up. Conclusion: This stepped osteotomy technique increases the probability of osteointegration, reduces the need for early revision, and provides reliable stability with satisfactory clinical and radiological midterm results.

Femoral Head Autograft Can Reliably Reconstruct Dysplastic Acetabula Through the Direct Anterior Approach for Total Hip Arthroplasty

“…This study demonstrates that reconstructing the true acetabulum in dysplastic hips (Crowe I-III) with FHA can be successfully accomplished via a DAA with significant improvements in clinical and radiographic outcomes. Although satisfactory clinical and radiographic outcomes have been demonstrated using similar techniques and indications through alternative surgical approaches [ [3] , [4] , [5] , [18] , [19] , [20] , [21] , [22] ], potential advantages of the DAA include (1) direct exposure of the anterolateral acetabular defect, that is, typical of dysplastic hips [ 28 ]; (2) the use of intraoperative fluoroscopy, which facilitates graft placement and fixation, component positioning, and restoration of LLDs [ [31] , [32] , [33] ]; (3) an expediated functional recovery with prior studies demonstrating improvements in early gait, reduced hospital LOS, minimal activity restrictions, a low dislocation rate, and reduced postoperative pain [ 20 , [24] , [25] , [26] ].…”

“…Despite conflicting historical concerns of long-term graft resorption [ 15 ], recent literature has been largely positive for FHA [ [3] , [4] , [5] , [18] , [19] , [20] , [21] , [22] ]. In the present series, there was radiographic evidence of graft incorporation in all patients at a mean time of 6.5 months, which is comparable to alternative surgical approaches [ 3 , 4 ], with no evidence of component loosening or graft collapse.…”

“…With improvements in surgical technique and the use of highly porous-coated acetabular components, several recent studies have shown promising long-term outcomes of bulk FHA in THA using posterolateral or direct lateral approaches [ [3] , [4] , [5] , [18] , [19] , [20] , [21] , [22] ]; however, limited data exist on its efficacy through a direct anterior approach (DAA). The DAA has become increasingly popular for THA, largely due to minimizing soft-tissue trauma through the use of true intermuscular planes [ 23 ].…”

Mid‐Term Outcomes of Cemented Stem and Subtrochanteric Shortening Derotational Osteotomy in Total Hip Arthroplasty for Crowe IV Developmental Dysplasia

“…In order to improve the initial cup stability, an acetabular cup should be used to ensure a coverage of at least 70% 6 ; if this is not achieved, other methods should then be considered, including structural autograft with bulk femoral head, 28 controlled fracture of the medial wall, 29 medial protrusion technique, 30 and use of extra‐small cups 31 . The structural autograft technique may result in bone graft nonunion, collapse, and absorption, however some studies had reported this technique provided encouraging long‐term clinical results 32,33 . For this study, the structural autograft technique was applied in one patient, the medial protrusion technique was used in some patients, whereas others underwent routine surgery without using the above methods; additionally, all cups were not less than 44 mm in size.…”

Are outpatient total hip and knee arthroplasties safe?

“…[3] Arthroplasty articles submitted to our journal from European countries are only inpatient reports. [4][5][6][7][8][9] However, outpatient arthroplasty has gained popularity over time, as the fast-track concept has evolved with perioperative treatment with rapid recovery protocols, leading to enhanced recovery after surgery and reduced length of hospital stay and cost.…”