Long-Term Results of Periacetabular Rotational Osteotomy Concomitantly With Arthroscopy in Adult Acetabular Dysplasia

BackgroundAlthough the long-term results of periacetabular osteotomy in acetabular dysplasia have been well documented, there is paucity in reports on the long-term outcomes of periacetabular osteotomy with simultaneous hip arthroscopy. This study aimed to assess the cumulative 10-year outcomes of periacetabular rotational osteotomy with concomitant hip arthroscopy.MethodsThrough an arthroscopic procedure, the status of the labrum was assessed, and torn labrum was debrided. Evaluations on survival from conversion to total hip arthroplasty and success in radiographic and clinical long-term results were completed in 39 hips (36 patients). Acetabular parameters (center-edge angle, Sharp angle, acetabular-head index, and head lateralization index), Tönnis grades on radiograph, Harris Hip Score, and range of motion of the hip were evaluated. Survivorship analyses were evaluated with the Kaplan-Meier method.ResultsThirty-eight hips (97.4%, 95% confidence interval 0.832-0.996) were preserved for 12.8 ± 1.7 years on average, and only 1 hip was converted to total hip arthroplasty at 7.8 years. All the acetabular parameters were improved (P < .001). Twenty-eight hips (71.8%) showed unchanged or improved Tönnis grades at the latest follow-up. The average Harris Hip Score was significantly better than the preoperative value (P < .001), and range of motion was not significantly different until the latest follow-up.ConclusionSufficient acetabular reorientation, such as periacetabular rotational osteotomy, with concomitant arthroscopic debridement showed successful long-term outcomes for acetabular dysplasia in adults.     

Rotational Acetabular Osteotomy for Secondary Osteoarthritis After Surgery for Developmental Dysplasia of the Hip

The treatment of residual deformity following surgery for developmental dysplasia of the hip remains controversial. The rationale for the use of the rotational acetabular osteotomy (RAO) is that it increases the weight-bearing area by shifting the osteotomized acetabulum to cover the femoral head. This can improve joint function as well as achieve relief of pain. However, it is unclear if this osteotomy can improve a compromised hip when performed for the treatment of residual deformity and acetabular dysplasia after surgery for developmental dysplasia of the hip. We aimed to report the clinical outcome as assessed by need for total hip arthroplasty (THA) and by the Merle d’Aubigné and Postel scores. In addition, we tried to assess the radiographic outcomes as assessed by Tönnis’s classification. Only two hips required THA, which was performed in two patients at 11 and 12 years after RAO, respectively. The mean Merle d’Aubigné clinical score improved from 14.1 ± 2.3 points (range, 10 to 17) preoperatively to 15.8 ± 2.9 points (8 to 18) at final follow-up (p < 0.02). Radiological assessment at final follow-up showed the obvious progression of osteoarthritis in five hips. One patient in grade 1 preoperatively progressed into grade 3 at final follow-up; four patients in grade 2 preoperatively progressed into grade 3. In our study, this osteotomy prolonged the functional life of the hip, and only two hips needed THA after a mean follow-up of 11 years. We found that advanced arthritis pre-osteotomy is associated with progression of radiologic changes     

Total Hip Arthroplasty After Periacetabular and Intertrochanteric Valgus Osteotomy

Background

We performed periacetabular osteotomy (PAO) combined with intertrochanteric valgus osteotomy (TVO) to obtain better congruity for patients with acetabular dysplasia and nonspherical femoral head. These patients with PAO-combined TVO demonstrate long-term progression of osteoarthritis, thereby, needing conversion to total hip arthroplasty (THA) and is difficult due to morphological changes. The objective of the present study was to investigate outcomes of patients who underwent THA after PAO-combined TVO.

髋臼旋转截骨术治疗成人髋臼发育不良

目的　评估髋臼旋转截骨术治疗成人髋臼发育不良的近、远期疗效。　方法　42例(50侧髋)髋臼发育不良的成年病人均接受髋臼旋转截骨术治疗,分别测定术前和术后JOA评分、中心边缘角和Sharp角。术前骨性关节炎分期:前期32侧髋,早期17侧髋,进展期1侧髋。　结果　术后平均随访7. 4年, 49侧髋的骨性关节炎得到明显改善(98. 0% ); 1侧无明显变化(2. 0% ); 无一例患髋的骨性关节炎病变继续恶化。JOA评分术前平均为76. 4分, 术后为96. 3分; 中心边缘角术前、术后平均为-14. 5°和30. 0°;Sharp角术前平均为50. 5°,术后为36. 3°,术前、术后比较具有显著性差异(P<0. 05)。结论　髋臼旋转截骨术能使发育不良的髋臼对股骨头的包容得到有效的改善,使疼痛症状得到缓解,并使骨性关节炎的过程得到有效遏制。     

Long-Term Outcomes of Total Hip Arthroplasty With Transverse Subtrochanteric Shortening Osteotomy and Modular Stem in Crowe IV Developmental Dysplasia

BackgroundThe reconstruction of high dislocation related to developmental dysplasia of the hip (DDH) remains challenging for joint surgeons. The aim of this study is to evaluate the rate of union, the revision rate, functional scores, and complications in patients with Crowe IV DDH treated with total hip arthroplasty, transverse subtrochanteric shortening osteotomy, and modular stem in an average 10-year follow-up.MethodsTwenty-eight patients (33 hips) with Crowe IV DDH who were operated on between 2008 and 2013 were followed. All patients underwent uncemented total hip arthroplasty with transverse subtrochanteric shortening osteotomy and anatomical acetabular cup implantation. The mean age was 36.6 years, and the mean follow-up period was 121 months. Clinical and radiological outcomes were evaluated.ResultsThe mean Harris Hip Score significantly improved from 47.0 preoperatively to 89.6 postoperatively. The mean limb length discrepancy was significantly reduced from 3.8 to 0.8 cm. The mean osteotomy union time was 6.8 months. At the mean follow-up of 121 months, there were 3 cases of postoperative dislocation, 2 cases of intraoperative fracture, and 1 case of posterior tibial venous thrombosis. No revision occurred, and no signs of component loosening or migration were observed at the last follow-up.ConclusionCrowe IV DDH patients treated with transverse subtrochanteric shortening osteotomy, modular stem, and anatomic acetabular component insertion can have satisfactory and reliable 10-year clinical outcomes.     

Residual Acetabular Dysplasia in the Reduced Hip

BackgroundResidual acetabular dysplasia occurs in up to a third of patients treated successfully for developmental dysplasia of the hip (DDH) and has been found to be a significant risk factor for early hip osteoarthritis (OA).DiscussionAge at the time of initial reduction and the initial severity of DDH have been linked to residual acetabular dysplasia. An anteroposterior pelvic radiograph is the main diagnostic modality, but MRI also provides valuable information, particularly in equivocal cases. The literature supports intervening when significant residual acetabular dysplasia persists at 4–5 years of age, and common surgical indications include acetabular index (AI) > 25°–30°, lateral center–edge angle (LCEA) < 8°–10°, and a broken Shenton’s line on radiographs; and a cartilaginous acetabular angle (CAI) > 18°, cartilaginous center–edge angle (CCE) < 13°, and/or the presence of high-signal intensity areas on MRI. Surgical options include redirectional pelvic osteotomies and reshaping acetabuloplasties, which provide comparable radiographic and clinical results.ConclusionRAD is common after treatment of DDH and requires regular follow-up for diagnosis and appropriate management to decrease the long-term risk of OA. Long-term outcomes of patients treated with pelvic osteotomies are generally favorable, and the risk of OA can be decreased, although the risk of total hip replacement in the long-term remains.     

Chiari联合Staheli手术治疗儿童髋关节发育不良

目的：介绍Chiari联合Staheli手术治疗儿童髋关节发育不良的手术方法和随访结果。方法：对22例髋臼发育不良的患儿施行改良Chiari联合Staheli手术，其中男6例，女16例，手术时年龄6－15岁，平均12岁，随访1－10岁，平均5年，部分患儿进行Chiari联合Staheli手术的同时施行关节囊成形术，股骨近端短缩或／和旋转截骨术，结果：根据Mckay临床疗效评定和Severin X线片评定标准，对本文病例进行疗效评价。其临床优良率为86％，X线优良率为78％，结论：Chiari联合Staheli手术是治疗儿童髋关节发育不良确实有效的手术方法。     

Long-Term Results of Cementless Total Hip Arthroplasty With Subtrochanteric Shortening Osteotomy in Crowe Type IV Developmental Dysplasia

Background

When surgeons reconstruct hips with a high dislocation related to severe developmental dysplasia of the hip (DDH) in total hip arthroplasty (THA), archiving long-term stable implant fixation and improving patient function and satisfaction remain challenging. The purpose of this study was to evaluate the 10-year outcomes of transverse subtrochanteric shortening osteotomy in cementless, modular THA in Crowe type IV-Hartofilakidis type III DDH.

Primary Total Hip Arthroplasty With a Spongy Metal Surface Acetabular Component for Hip Dysplasia

We evaluated the clinical and radiographic results of primary total hip arthroplasty for 81 dysplastic hips (71 patients) using cementless Spongiosa Metal II cups (ESKA Implants, Lübeck, Germany). The mean follow-up period was 6.4 years (minimum 5 years), and the preoperative mean Japanese Orthopaedic Association hip score had improved from 45.2 to 87.4 points at the latest follow-up. The radiographic outcome was no aseptic loosening in all 81 hips. The hip center was located significantly more superior than in the contralateral normal hip in 45 patients, but the difference was less than 10 mm; however, there was no significant difference in the lateral position of the hip center. The use of a Spongiosa Metal II cup for dysplastic hips provided satisfactory 5- to 10-year clinical and radiographic results.     

Total Hip Arthroplasty After Previous Transtrochanteric Anterior Rotational Osteotomy for Femoral Head Osteonecrosis

We compared the perioperative morbidity, position of the implants, implant stability, and clinical results of 14 conversion total hip arthroplasties after previous transtrochanteric anterior rotational osteotomy with those of a matched control group of 28 primary total hip arthroplasties. The operation time was prolonged, perioperative blood loss increased, and the risk of stem or cup malposition was increased in the conversion group. However, there were no significant differences in the postoperative complications, clinical results, and implant stability between the 2 groups. None of the implants were loose in both groups. Transtrochanteric anterior rotational osteotomy should be advised, planned, and executed bearing in mind the operative morbidity and technically demanding nature of the conversion total hip arthroplasty.     

A Reliable Femoral Osteotomy in Total Hip Arthroplasty for Hartofilakidis Type C Developmental Dysplasia of the Hip: Proximal Femoral Reconstruction

BackgroundProcedure of the femur is extremely challenging during total hip arthroplasty (THA) for Hartofilakidis type C developmental dysplasia of the hip. The main purpose of this study is to compare the clinical effectiveness of proximal femoral reconstruction (PFR) with subtrochanteric transverse osteotomy (STO).MethodsBetween 2006 and 2015, 33 primary THAs in 26 patients were performed with PFR and 16 hips in 13 patients underwent STO. The mean follow-up was 4.2 (range, 2.2-10.8) years in PFR group and 5.9 (range, 3.5-11.3) years in STO group. At the final follow-up, clinical scores and radiographic results were evaluated for 33 hips in PFR group and 15 hips in STO group.ResultsPostoperative Harris hip scores and implant position did not differ between the treatment groups. The mean length of the oblique osteotomy line at proximal femur was 6.9 cm (range, 5.8-7.6 cm) in PFR group. The amount of bone union occurred within 6 months after surgery was 24 (72.7%) hips in PFR group and 9 (60.0%) in STO group. Three major postoperative complications occurred in PFR group, and medial femoral calcar erosion was noted in 1 hip in STO group.ConclusionSimilar with STO, the clinical results of PFR technique are a reliable solution for femoral procedure during THA in patients with Hartofilakidis type C developmental dysplasia of the hip.     

Computer-Assisted Rotational Acetabular Osteotomy for Patients with Acetabular Dysplasia

Rotational acetabular osteotomy (RAO) is a well-established surgical procedure for patients with acetabular dysplasia, and excellent long-term results have been reported. However, RAO is technically demanding and precise execution of this procedure requires experience with this surgery. The usefulness of computer navigation in RAO includes its ability to perform three-dimensional (3D) preoperative planning, enable safe osteotomy even with a poor visual field, reduce exposure to radiation from intraoperative fluoroscopy, and display the tip position of the chisel in real time, which is educationally useful as it allows staff other than the operator to follow the progress of the surgery. In our results comparing 23 hips that underwent RAO with navigation and 23 hips operated on without navigation, no significant difference in radiological assessment was observed. However, no perioperative complications were observed in the navigation group whereas one case of transient femoral nerve palsy was observed in non-navigation group. A more accurate and safer RAO can be performed using 3D preoperative planning and intraoperative assistance with a computed tomography-based navigation system.     

全髋置换加转子下截骨治疗髋关节发育不良

目的探讨全髋置换加转子下截骨治疗髋关节发育不良的疗效。方法回顾性分析2005年4月至2007年12月我院收治的18例（23髋）髋关节发育不良患者,男性6例（6髋）,女性12例（17髋）,CroweⅢ型16髋,CroweⅣ型7髋,平均年龄52.4岁（41～67岁）,随访时间3～6年,平均4.5年。采用全髋置换术加转子下横行截骨,部分病例截骨处用钢丝捆扎固定,其他病例截骨处自体松质骨骨泥填充,评估术前术后的临床效果和假体影像学表现。结果 Harris评分由术前平均43.2分提高至最近一次随访时的平均90.7分,最近一次随访示：所有假体都骨性长入稳定,截骨处平均3.2个月（2～6个月）后愈合,无一例发生脱位、感染、神经症状、深静脉血栓的形成和肺栓塞。结论全髋置换加转子下截骨可以纠正增大的前倾角,提供假体良好的抗旋转稳定性和避免复位时引起的神经损伤,临床疗效满意。     

Comparison of Total Hip Arthroplasty With and Without Femoral Shortening Osteotomy for Unilateral Mild to Moderate High Hip Dislocation

Background

This study compares the outcome between THA with and without femoral shortening osteotomy for unilateral mild to moderate high hip dislocation in developmental dysplasia of the hip patients.

Conversion Total Hip Arthroplasty After Previous Transtrochanteric Rotational Osteotomy for Osteonecrosis of the Femoral Head

The results of conversion total hip arthroplasty (THA) after failed transtrochanteric rotational osteotomy (TRO) are still controversial. We retrospectively reviewed 18 patients with ONFHs who had been treated previously by TRO and were later converted to THAs (conversion group). We made a matched control group of 18 primary THAs for ONFH done by same hip surgeon (PTHA group). There was an improvement in the Harris hip score and WOMAC score at the final follow-up but the improvement was not statistically significant between the two groups. Only internal rotation was significantly better in the PTHA group than in the conversion group. THA after TRO provides satisfactory clinical and radiological outcomes with no significant increase in perioperative morbidity in comparison with that in the primary THA.     

High-Riding Congenital Hip Dislocation: THA With Unilateral vs Bilateral Transverse Femoral Shortening Osteotomy

Background

We argue that 1-stage bilaterally total hip arthroplasty (THA) could be acceptable in bilateral coxarthrosis because of high-riding developmental dysplasia of the hip (DDH).

Effect of Acetabular Reinforcement Ring With Hook for Acetabular Dysplasia Clarified by Three-Dimensional Finite Element Analysis

The objective of this study was to biomechanically determine the effect of the severity of acetabular dysplasia, number and positions of screws and type of bone graft material used on the initial fixation strength of the acetabular reinforcement ring with hook (Ganz ring) using the finite element method. Relative micromotion increased as the severity of acetabular dysplasia increased and tended to decrease as the number of screws increased, but varied according to screw placement position. Increased strength of the bone graft material led to decreased relative micromotion. Biomechanically, the Ganz ring can be placed securely using 3 screws in patients with Crowe 1 dysplasia. However, in patients with Crowe 2 or higher dysplasia, it is necessary to spread at least 4 screws across an area of good host bone.     

Long-Term Results of Cemented Total Hip Arthroplasty in Developmental Dysplasia With Acetabular Bulk Bone Grafts After Improving Operative Techniques

We present the long-term results (mean follow-up, 11.8 years; range, 6.3-15.4 years) of cemented total hip arthroplasty with acetabular bulk bone grafting in 147 dysplastic hips using improved surgical techniques. Operations were performed through a direct lateral approach with partial trochanteric osteotomy to avoid nonunion of the greater trochanter. Bioresorbable poly(l-lactide) screws were used for fixation of the acetabular bone grafts to prevent any possible delayed remodeling. Preoperative planning using computer simulation was performed to estimate the optimal size and position of the acetabular component. Analysis predicted rates of survival of the acetabular component of 96% and 91% at 15 years, with revision for aseptic loosening and radiologic loosening as the end points, respectively. Our results indicate excellent long-term clinical and radiographic survivorship of a cemented acetabular component with bulk autograft for acetabular dysplasia.     

Total Hip Arthroplasty After Transtrochanteric Rotational Osteotomy for Osteonecrosis of the Femoral Head: A Mean 10-Year Follow-Up

Background

The objective of the present study was to investigate clinical, quality of life, and radiographic outcomes of patients who underwent total hip arthroplasty (THA) after transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH).