Cementless total hip arthroplasty with femoral head bone grafting for hip dysplasia

doi:10.1016/S0883-5403(08)80077-0

The Journal of Arthroplasty

Volume 5, Issue 3, September 1990, Pages 231-240

https://doi.org/10.1016/S0883-5403(08)80077-0 Get rights and content

Abstract

Femoral head bone grafting was required to augment acetabular bone stock in 19 cases of hip dysplasia treated with cementless total hip arthroplasty. All acetabular grafts provided mechanical support for the cementless acetabular component. Radiographic evaluation of the fixation of the femoral components at an average of 3 years after surgery revealed an optimum appearance in all cases. All porous-coated acetabular components remained stable, but only one of six (17%) nonporous threaded acetabular components maintained stability. One threaded acetabular component has been revised for symptomatic loosening. Acetabular graft healing was suspected in 18 of 19 cases (95%). Significant graft resorption was observed only in the cases with unstable threaded acetabular components. The clinical scores were high. Cementless total hip arthroplasty with structural acetabular grafting and porous acetabular components appears to produce satisfactory short-term results.

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Cited by (60)

Three-Dimensional Host Bone Coverage in Total Hip Arthroplasty for Crowe Types II and III Developmental Dysplasia of the Hip
2017, Journal of Arthroplasty
Citation Excerpt :
Acetabular cup coverage is an important tool to help surgeons evaluate periacetabular bone defects, make preoperative and intraoperative decisions regarding cup placement and additional support, and predict the survival of cementless cups [5,6,14,15,17-19]. Various cup coverage measuring techniques have been proposed [16,20-22]; however, all of these techniques were based on 2D pelvic radiographs, which cannot provide precise information on the bone defect around the dysplastic acetabulum and may produce misleading measurements of the real 3D cup coverage [16]. In the present study, we accurately reproduced the complex anatomic geometry around the dysplastic acetabulum and the results of the 3D measurement of cup coverage were very close to the ground truth.
Recommendations for minimum cup coverage based on anteroposterior radiographs are widely used as an intraoperative guide in total hip arthroplasty for patients with developmental dysplasia of the hip. The purpose of this study was to examine the validity of two-dimensional (2D) measurement of coverage with three-dimensional (3D) coverage and to identify parameters for determining the 3D coverage during surgery.
We developed a technique to accurately reproduce the intraoperative anatomic geometry of the dysplastic acetabulum and measure the 3D cup coverage postoperatively. With this technique, we retrospectively analyzed the difference and correlation between 2D and 3D measurements of native bone coverage in 35 patients (45 hips) with Crowe II or III DDH. Linear regression analysis was performed to examine the intraoperative parameters related to coverage. The mean follow-up period was 7.64 years (range, 6.1-9.5 years).
There was a significant difference and a fair correlation between 2D and 3D measurements. The 2D measurement underestimated the 3D cup coverage by approximately 13%. An excellent linear relationship was noted between the 3D coverage/uncoverage and the height of the uncovered portion (R² = 0.8440, P < .0001). There was no case of loosening or revision during the follow-up.
Current minimum cup coverage recommendations based on 2D radiograph measurements should not be used as a direct intraoperative guide. The height of the uncovered portion is a useful parameter to determine the 3D coverage during surgery.
(iii) Surgical tactics in the difficult primary hip replacement
2013, Orthopaedics and Trauma
The term complex primary total hip arthroplasty (THA) is used when THA is performed on patients with any combination of abnormal anatomy, bone loss and compromised soft tissues. This is often as a result of the development of secondary osteoarthritis complicating an underlying primary pathology. Those most commonly associated are developmental hip dysplasia, protrusio acetabuli, skeletal dysplasias, previous fractures or surgical procedures about the hip and neuromuscular conditions, but this is by no means an exhaustive list. The importance of preoperative planning and the use of reconstructive techniques including bone grafting, as well as the use of modular and customized implants to overcome these significant surgical challenges, are discussed.
Two-Dimensional and Three-Dimensional Cup Coverage in Total Hip Arthroplasty with Developmental Dysplasia of the Hip
2013, Journal of Biomechanics
Citation Excerpt :
Thus, insufficient cup coverage is considered to be a negative factor leading to cup loosening (Chougle et al., 2005; Hartofilakidis and Karachalios, 2004; Hartofilakidis et al., 1998) Various radiographic evaluation techniques of cup coverage have been proposed based on the measurement on anteroposterior (AP) pelvic radiographs (Anwar et al., 1993; Sarmiento et al., 1990; Silber and Engh, 1990; Sugano et al., 1995). In Silber's study, the percentage of the coverage provided by the autograft was determined by measuring the circumference of the cup in contact with the graft on an AP pelvic radiograph.
We analyzed the mean difference and correlation between 2D cup coverage measured from different projections and three-dimensional (3D) cup coverage to investigate their precise relationship in total hip arthroplasty (THA) among patients with developmental dysplasia of the hip (DDH). We created DDH–THA models on six foam pelvic models. 3D cup coverage was measured using a motion capture system and imaging software. Digitally reconstructed radiographs with predetermined pelvic rotations were simulated using image processing software at three different angles of rotation around the long body axis (0°, 25° and 45°). 2D cup coverage was then measured on these reconstructed radiographs. The 3D technique showed excellent intra-observer (κ>0.98) and inter-observer (κ>0.99) reliability. The 2D technique tended to overestimate the real cup coverage by about 15%. The smallest difference between 2D and 3D cup coverage occurred when 2D measurement was performed on the radiographs with 45° of pelvic rotation toward the operated side (14.50%, P<0.0001), meanwhile, the highest correlation coefficient between 2D and 3D cup coverage was also observed when the 2D measurement was performed on the radiographs at this same pelvic rotation (r=0.67, P=0.0003). Published recommendations regarding the minimum cup coverage based on 2D measurement should be interpreted cautiously. The minimal cup coverage, as an intra-operative 3D parameter related to the long term fixation of the cup component, should be more accurately determined with intra-operative measurement.
Effect of cementless acetabular component orientation, position, and containment in total hip arthroplasty for congenital hip disease
2010, Journal of Arthroplasty
We evaluated the effect of the inclination angle, position, and containment of 53 cementless cups inserted in patients with congenital hip disease (CHD), after a minimum of 10 years of follow-up. The polyethylene wear rate was significantly greater when the cup was placed in more than 45° inclination (P = .045) or if the cup was placed lateral to the teardrop position by more than 25 mm (P = .001). Aseptic loosening of the femoral component was significantly greater when the cup was placed more than 25 mm superiorly to the teardrop (P = .049). Cup placement of more than 25 mm lateral to the teardrop affected significantly periacetabular osteolysis (P = .032). In CHD cases, it is preferable to avoid excessive vertical inclination, lateral, and superior placement of cementless cups in an attempt to obtain better containment.
Midterm Results of Hybrid Total Hip Arthroplasty for Treatment of Osteoarthritis Secondary to Developmental Dysplasia of the Hip-Chinese Experience
2009, Journal of Arthroplasty
This study was designed to evaluate the midterm results of hybrid total hip arthroplasty in a consecutive series of 45 Chinese patients with osteoarthritis secondary to dysplastic hip. The average follow-up was 6.6 years. A total of 24 hips were classified as dysplasia, 20 hips as low dislocation, and 13 hips as high dislocation. The preoperative Harris score was 46.19 ± 18.01, which improved to 91.78 ± 3.52 at the final follow-up. The rate of polyethylene liner wear was 0.27 mm/y. Osteolysis was identified around 5 acetabular components and 13 femoral components. With the use of loosening or revision as the end point for failure, the survival rate was 1.0. We suggest that hybrid total hip arthroplasty in Chinese developmental dysplasia of hip patients has favorable results at midterm follow-up, even though their lifestyle includes more deep flexion of the hip. There is no significant difference of postoperative Harris score with increasing severity of dysplasia.
Deformity
2009, Surgical Treatment of Hip Arthritis: Reconstruction, Replacement, and Revision

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^*: From Anderson Orthopaedic Research Institute, National Hospital for Orthopaedics and Rehabilitation, Arlington, Virginia.

^†: From Georgetown University, Washington, D.C., and University of Maryland, Baltimore, Maryland.

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Cementless total hip arthroplasty with femoral head bone grafting for hip dysplasia

Abstract

J Arthroplasty

J Arthroplasty

Low-friction arthroplasty of the hip: theory and practice

Low-friction arthroplasty in congenital subluxation of the hip

Clin Orthop

Total hip arthroplasty in the adult with complete congenital dislocation

Total hip replacement in congenital dislocation and dysplasia of the hip

J Bone Joint Surg

Mechanical results of hip arthroplasty with acrylic prostheses

J Bone Joint Surg

Total hip reconstruction in chronically dislocated hips

J Bone Joint Surg

Biological fixation in total hip arthroplasty

Total hip replacement in congenital dislocation of the hip

Acta Orthop Scand