scholarly journals Total hip arthroplasty with modular stem for Crowe I and II developmental dysplasia of the hip

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Xiangpeng Kong ◽  
Yunming Sun ◽  
Minzhi Yang ◽  
Yonggang Zhou ◽  
Jiying Chen ◽  
...  
Keyword(s):  
Operating Time ◽  
Femoral Anteversion ◽  
Developmental Dysplasia ◽  
Harris Hip Score ◽  
Leg Length ◽  
Intraoperative Complication ◽  
Modular Stem ◽  
Significant Difference ◽  
Tapered Stem ◽  
Dysplasia Of The Hip

Abstract Background The variation of femoral anteversion is not completely consistent with the grade of developmental dysplasia of the hip (DDH), which poses challenges to hip replacement with the non-modular tapered stem. Currently, whether the modular stem should be used in Crowe I and II DDH is still controversial. The aim of this study is to compare the clinical efficacy of the modular stem and the non-modular tapered stem in Crowe I and II DDH patients. Methods We retrospective analyzed the clinical data of 196 patients with unilateral Crowe I and II DDH from January 2015 to January 2017. One hundred patients were operated by an experienced surgeon with the modular stems; the remaining 96 patient was operated by another equivalent surgeon with the non-modular tapered stems. The preoperative basic information, operating time, intraoperative and postoperative complications, postoperative leg length discrepancy (LLD) and offset, Harris hip score (HHS), and forgotten joint score (FJS) in postoperative 2 years were collected and analyzed. Results Postoperative LLD (P = 0.010) and FJS (P = 0.001) had significant difference between two groups. Concurrent acceptable LLD and offset were achieved in 87% of patients with the modular stem and in 68% of patients with the non-modular stem (P = 0.001). There was no significant difference in the operating time (P = 0.086), intraoperative complication (P = 0.096), postoperative dislocation rate (P = 0.056), postoperative offset difference (P = 0.108), and Harris score (P = 0.877) between two groups. Conclusions Compared with the non-modular tapered stem, the modular stem was more likely to provide accurate reconstruction and forgotten artificial hip for Crowe I and II DDH patients. We recommend the modular stem as routine choice for these patients.

scholarly journals Robotic-arm assisted THA can achieve precise cup positioning in developmental dysplasia of the hip

2021 ◽  
Vol 10 (10) ◽  
pp. 629-638
Author(s):  
Shinya Hayashi ◽  
Shingo Hashimoto ◽  
Yuichi Kuroda ◽  
Naoki Nakano ◽  
Tomoyuki Matsumoto ◽  
...  
Keyword(s):  
Developmental Dysplasia ◽  
Robotic Arm ◽  
Consecutive Series ◽  
Leg Length ◽  
Mean Values ◽  
Significant Difference ◽  
The Mean ◽  
Ct Data ◽  
Dysplasia Of The Hip ◽  
Cup Positioning

Aims This study aimed to evaluate the accuracy of implant placement with robotic-arm assisted total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). Methods The study analyzed a consecutive series of 69 patients who underwent robotic-arm assisted THA between September 2018 and December 2019. Of these, 30 patients had DDH and were classified according to the Crowe type. Acetabular component alignment and 3D positions were measured using pre- and postoperative CT data. The absolute differences of cup alignment and 3D position were compared between DDH and non-DDH patients. Moreover, these differences were analyzed in relation to the severity of DDH. The discrepancy of leg length and combined offset compared with contralateral hip were measured. Results The mean values of absolute differences (postoperative CT-preoperative plan) were 1.7° (standard deviation (SD) 2.0) (inclination) and 2.5° (SD 2.1°) (anteversion) in DDH patients, and no significant differences were found between non-DDH and DDH patients. The mean absolute differences for 3D cup position were 1.1 mm (SD 1.0) (coronal plane) and 1.2 mm (SD 2.1) (axial plane) in DDH patients, and no significant differences were found between two groups. No significant difference was found either in cup alignment between postoperative CT and navigation record after cup screws or in the severity of DDH. Excellent restoration of leg length and combined offset were achieved in both groups. Conclusion We demonstrated that robotic-assisted THA may achieve precise cup positioning in DDH patients, and may be useful in those with severe DDH. Cite this article: Bone Joint Res 2021;10(10):629–638.

Relationship between femoral anteversion and tibial torsion: CT evaluation of 38 unilateral developmental dysplasia of the hip patients

2018 ◽  
Vol 28 (5) ◽  
pp. 548-553
Author(s):  
Kyu-Jin Cho ◽  
Kyung-Soon Park ◽  
Young-Rok Shin ◽  
Hong-Yeol Yang ◽  
Taek-Rim Yoon
Keyword(s):  
Wide Spectrum ◽  
Group Analysis ◽  
Femoral Anteversion ◽  
Developmental Dysplasia ◽  
Tibial Torsion ◽  
Individual Comparison ◽  
Significant Difference ◽  
Ct Evaluation ◽  
Group B ◽  
Dysplasia Of The Hip

Introduction: Patients with developmental dysplasia of the hip (DDH) present with a wide spectrum of deformities. Few studies have assessed the relationship between femoral anteversion (FA) and rotational profile. The aim of this study is to evaluate the influence of FA on the lower extremity rotational profile by comparing tibial torsion (TT) between the extremities on both sides in patients with unilateral DDH, using computed tomography (CT). Patients and methods: Thirty eight patients with unilateral developmental dysplasia of the hip, who underwent a preoperative rotational profile CT scan at our institution, were evaluated. 3D rotational profile CT was performed, and FA and TT of the extremities on both sides were measured. Results: On individual comparison of the rotational profile, mean FA of the affected extremity showed a significantly higher value ( p = 0.006). But, there was no significant difference in mean TT between the 2 extremities. On group analysis, the excessive FA group (group B) showed significantly higher values of tibial torsion and tibial torsion side-to-side difference compared to the normal FA group (group A) ( p = 0.000, p = 0.011, respectively). Conclusions: Our study suggests that patients with DDH can present with excessive FA. Therefore, while treating patients who show excessive FA, surgeons must consider the possibility of a higher rotational profile of the affected extremity, before performing surgical treatments for DDH.

scholarly journals Mid-term results of total hip arthroplasty with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jing-Yao Jin ◽  
Taek-Rim Yoon ◽  
Kyung-Soon Park ◽  
Sheng-Yu Jin ◽  
Dong-Min Jung ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Developmental Dysplasia ◽  
Harris Hip Score ◽  
Trochanteric Osteotomy ◽  
Leg Length ◽  
Total Hip ◽  
Type Iv ◽  
The Mean ◽  
Dysplasia Of The Hip

Abstract Background This study aimed to explore mid-term clinical results of cementless total hip arthroplasty (THA) with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip (DDH). Methods Thirteen patients (13 hips) with Crowe type IV DDH who underwent THA with modified trochanteric osteotomy between May 2013 and October 2015 were retrospectively analyzed. The mean follow-up duration was 5.2 years (range, 4.9–6.1 years). Results The mean Harris Hip Score (HHS) significantly (p < 0.05) improved from 30.7 (range, 22–38) to 87.5 (range, 83–93). The mean leg length discrepancy (LLD) was 53.4 mm (range, 42.1–68.5 mm) preoperatively. The final LLD was 5.6 mm (range, 2.4–9.1 mm; p < 0.05). The mean leg length after surgery was 47.4 mm (range, 33.6–67.2 mm) and the femur shortening distance was 43.8 mm (range, 31.2–53.4 mm). The average duration of bone union for the greater trochanter (GT) was 2.5 months (range, 1.5–3.6 months). There was no infection, GT non-union, or loosening (septic or aseptic) of the stem or cup in any case. Conclusions THA with modified trochanteric osteotomy with a cementless cup is an effective treatment for Crowe type IV DDH. It can rebuild complex biomechanics and biology of hip dysplasia without increasing complications.

scholarly journals Mid-term results of total hip arthroplasty with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip

2020 ◽  
Author(s):  
Jing Yao Jin ◽  
Taek Rim Yoon ◽  
Kyung Soon Park ◽  
Sheng Yu Jin ◽  
Yue Ju Liu ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Developmental Dysplasia ◽  
Harris Hip Score ◽  
Trochanteric Osteotomy ◽  
Leg Length ◽  
Total Hip ◽  
Type Iv ◽  
The Mean ◽  
Dysplasia Of The Hip

Abstract Introduction: The objective of this study was to explore mid-term clinical results of cementless total hip arthroplasty (THA) with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip (DDH).Patients and method: Thirteen patients (13 hips) with Crowe type IV DDH who underwent THA used modified trochanteric osteotomy between May 2013 and October 2019 were retrospectively analyzed. Mean follow-up was 5.2 ± 0.8 years (range, 4.9-6.1 years).Results: Mean Harris Hip Score (HHS) significantly (p < 0.05) improved from 30.7 ± 5.8 (range, 22-38) to 87.5 ± 3.6 (range, 83-93). The mean leg length discrepancy (LLD) was 53.4 ± 9.1 mm (range, 42.1-68.5 mm) preoperatively. The final LLD was 5.6 ± 2.4 mm (range, 2.4-9.1 mm). The mean leg length after surgery was 47.4 ± 10 mm (range, 33.6-67.2 mm). The average duration of bone union for greater trochanter (GT) was 2.5 ± 0.6 months (range, 1.5-3.6 months). There was no infection, GT non-union, or loosening (septic or aseptic) of the stem or cup in any case.Conclusions: THA with modified trochanteric osteotomy with cementless cup is an effective treatment for Crowe type IV developmental dysplasia of the hip. It can rebuild complex biomechanics and biology of hip dysplasia without increasing complications.

How to equalize the leg length in total hip arthroplasty for patients with unilateral Crowe type IV developmental dysplasia of the hip

2020 ◽  
Author(s):  
Yinqiao Du ◽  
Jingyang Sun ◽  
Haiyang Ma ◽  
Sen Wang ◽  
Ming Ni ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Developmental Dysplasia ◽  
Leg Length ◽  
Greater Trochanter ◽  
Femoral Length ◽  
Total Hip ◽  
Type Iv ◽  
The Mean ◽  
Dysplasia Of The Hip

Abstract Background: The purpose of this study was to explore that how to equalize the leg length in total hip arthroplasty (THA) with shortening subtrochanteric osteotomy (SSTO) or not for unilateral Crowe type IV developmental dysplasia of the hip (DDH) through the evaluation of the postoperative full-length anteroposterior radiographs. Methods: The postoperative radiographs of 60 patients with unilateral Crowe type IV DDH from July 2012 to May 2019 were retrospectively reviewed. These data included leg length, femoral length, height of center of rotation (COR) of hip, height of greater trochanter, and depth of the sleeve or cone. Patients with leg length discrepancy (LLD) < 10 mm were defined as the non-LLD group. Results: In the non LLD group (26 patients of SSTO and 22 of non-SSTO), the femoral length both SSTO and non-SSTO groups were significantly shorter on operated side, compared with the contralateral side, and the mean discrepancy in SSTO group was approximately equal to the mean length of SSTO. The mean height of COR of hip on operated sides both SSTO and non-SSTO groups were 13.2 mm, and the contralateral sides were 15.2 mm and 15.5 mm, respectively. The depth of the sleeve or cone between SSTO and non-SSTO groups were 21.7 mm and 30.6 mm, respectively. The depth of the sleeve or cone in SSTO group was negatively correlated with the length of SSTO. The height of the greater trochanter of the operated and contralateral sides were 5.3 mm and 16.6 mm in SSTO group, and those in the non-SSTO group were 13.2 mm and 17.2 mm. Conclusions: SSTO leaded to femoral shortening on the operated side for patients with unilateral Crowe type IV DDH. The position of sleeve or cone should be close to the apex of greater trochanter to compensate the lengh of SSTO.

scholarly journals Effect of altered proximal femoral geometry on predicting femoral stem anteversion in patients with developmental dysplasia of the hip

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Chenhui Huang ◽  
Haitao Tan ◽  
Willem Alexander Kernkamp ◽  
Rongshan Cheng ◽  
Junjie Liang ◽  
...  
Keyword(s):  
Femoral Stem ◽  
Femoral Anteversion ◽  
Developmental Dysplasia ◽  
Prediction Errors ◽  
Strong Positive Correlation ◽  
Positive Correlation ◽  
Press Fit ◽  
Preoperative Ct ◽  
Dysplasia Of The Hip ◽  
Anatomical Parameters

Abstract Background The deformity of the proximal femur and acetabular in patients with developmental dysplasia of the hip (DDH) renders an intraoperative decision for ideal component placement challenging. We hypothesized that the altered morphology of calcar femorale (CF) in DDH patients changed the fixation mechanism of the cementless metaphyseal-filling stem and aimed to predict stem anteversion using proximal femoral anatomical parameters from preoperative CT. Methods Preoperative and postoperative CT scans of 34 DDHs with a metaphyseal-filling stem in THA were retrospectively analyzed. Proximal femoral anatomical parameters, including the femoral anteversion (FA) and the CF angles at the low femoral neck (LFN) and the center of the lesser trochanter (CLT) levels (FA-LFN, FA-CLT, CF-LFN, and CF-CLT) were measured. The dysplastic hips were divided into the CF group (n = 21) and the non-CF group (n = 13) according to the presence of the CF-LFN. The association between the anatomical parameters and the postoperative stem anteversion was statistically analyzed, and the predicted stem anteversion was compared with postoperative stem anteversion. Results In the CF group, the combination of the CF-LFN and FA-CLT exhibited a strong positive correlation (R = 0.870, p < 0.001) with the postoperative stem anteversion. In the non-CF group, only the FA-LFN had a strong positive correlation (R = 0.864, p < 0.001). Average prediction errors were 5.9° and 6.4° in the CF and non-CF groups. Conclusions The presence of CF-LFN is related to the press-fit mechanism of the metaphyseal-filling stem, and the preoperative measurements from CT images can be employed as a tool to predict postoperative stem anteversion in DDH patients.

scholarly journals Total hip arthroplasty for high-riding hips: A retrospective analysis of 79 cases and proposal of a new classification

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902092416
Author(s):  
İsmail Demirkale ◽  
Yüksel Uğur Yaradılmış ◽  
Ahmet Ateş ◽  
Murat Altay
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Classification System ◽  
Operating Time ◽  
Limb Length Discrepancy ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
Total Hip ◽  
Significant Difference ◽  
Functional Scores

Purpose: Total hip arthroplasty (THA) for high-riding hips is a complex procedure and the requirement for subtrochanteric osteotomy (STO) is an important decision that needs to be taken preoperatively. STO renders this complex surgery even more complicated and there are no guidelines to determine the STO requirement. In this study, the outcomes of THA for patients with high-riding hips were evaluated and a practical classification system is proposed to predict any osteotomy requirement. Methods: A retrospective evaluation was made of 79 hips of 76 patients who underwent THA for high-riding hip dysplasia. The amount of shortening in patients with STO and in patients without STO was compared. All patients were evaluated in respect of Harris hip score, operating time, erythrocyte suspension need, and actual limb length discrepancy. Preoperative radiographs were classified into four types according to the ratio of the distance between the lesser trochanter and the ischial tuberosity with pelvic height (LT-IT/P) to grade the degree of dislocation. Results: The mean follow-up was 30 ± 6.54 months. STO was applied to 47 (60%) hips and not to 32 (40%). There was no statistically significant difference between the groups in respect of the functional scores. STO prolonged the operating time and increased the need for blood transfusion ( p = 0.026, p < 0.001, respectively). When the LT-IT/P index was <0.19 (type 1), no additional surgical approach was required for reduction, at 0.19–0.29 (type 2), the head can be safely reduced with additional reduction methods, and when >0.3 (type 3), a shortening osteotomy will most likely be required. The rate of complications is increased if LT-IT/P is >0.4 (type 4). Conclusion: STO adjunct to THA increases the rate of complications. This practical classification system may guide the surgeon in the decision of whether an STO should be added to the procedure or not. Level of evidence: Level III, clinical trial

scholarly journals Biomechanical evaluation of femoral anteversion in developmental dysplasia of the hip and potential implications for closed reduction

2020 ◽  
Vol 72 ◽  
pp. 179-185
Author(s):  
Victor Huayamave ◽  
Blake Lozinski ◽  
Christopher Rose ◽  
Hessein Ali ◽  
Alain Kassab ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Femoral Anteversion ◽  
Developmental Dysplasia ◽  
Biomechanical Evaluation ◽  
Dysplasia Of The Hip

scholarly journals The positive predictive value of asymmetrical skin creases in the diagnosis of pathological developmental dysplasia of the hip

2018 ◽  
Vol 100-B (5) ◽  
pp. 675-679 ◽  
Author(s):  
M. J. Anderton ◽  
G. R. Hastie ◽  
R. W. Paton
Keyword(s):  
Risk Factors ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Clinical Signs ◽  
Senior Author ◽  
Developmental Dysplasia ◽  
Inclusion Criteria ◽  
Leg Length ◽  
One Stop ◽  
Dysplasia Of The Hip

Aims The aim of this study was to identify the association between asymmetrical skin creases of the thigh, buttock or inguinal region and pathological developmental dysplasia of the hip (DDH). Patients and Methods Between 1 January 1996 and 31 December 2016, all patients referred to our unit from primary or secondary care with risk factors for DDH were assessed in a “one stop” clinic. All had clinical and sonographic assessment by the senior author (RWP) with the results being recorded prospectively. The inclusion criteria for this study were babies and children referred with asymmetrical skin creases. Those with a neurological cause of DDH were excluded. The positive predictive value (PPV) for pathological DDH was calculated. Results A total of 105 patients met the inclusion criteria. There were 71 girls and 34 boys. Only two were found to have pathological DDH. Both also had unilateral limited abduction of the hip in flexion and a positive Galeazzi sign with apparent leg-length discrepancy. Thus, if the specialist examination of a patient with asymmetrical skin creases was normal, the PPV for DDH was 0%. Conclusion Isolated asymmetrical skin creases are an unreliable clinical sign in the diagnosis of pathological DDH. Greater emphasis should be placed on the presence of additional clinical signs to guide radiological screening in babies and children. Cite this article: Bone Joint J 2018;100-B:675–9.

Femoral Anteversion in Developmental Dysplasia of the Hip

2009 ◽  
Vol 29 (8) ◽  
pp. 885-888 ◽  
Author(s):  
Wudbhav N. Sankar ◽  
Christopher O. Neubuerger ◽  
Colin F. Moseley
Keyword(s):  
Femoral Anteversion ◽  
Developmental Dysplasia ◽  
Dysplasia Of The Hip
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