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 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

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

Usefulness of Measuring Acetabular Anterior Coverage Using a Tomosynthesis Imaging System

2017 ◽  
Vol 27 (1) ◽  
pp. 87-91
Author(s):  
Tadahiko Ohtsuru ◽  
Yasuyuki Morita ◽  
Yuhei Horiuchi ◽  
Yasuaki Murata ◽  
Shuji Shimamoto ◽  
...  
Keyword(s):  
Anterior Margin ◽  
Sagittal Plane ◽  
Imaging System ◽  
Early Stage ◽  
Intraclass Correlation ◽  
Standing Position ◽  
Developmental Dysplasia ◽  
Strong Positive Correlation ◽  
Effective Doses ◽  
Dysplasia Of The Hip

Purpose The purpose of this study was to compare the usefulness of measuring acetabular anterior coverage by tomosynthesis and false profile (FP) radiography. Methods 70 hips in 35 patients who were diagnosed with early stage osteoarthritis of the hip, and 60 hips from 30 healthy volunteers were analysed. Plain FP radiographs were taken, and vertical-centre-anterior margin (FP-VCA) angles were measured. Acetabular anterior coverage was measured in the natural standing position using a tomosynthesis imaging system in the sagittal plane. As with FP radiography, we measured vertical-centre-anterior margin (TS-VCA) angles. Results The median values of the FP-VCA angle, and TS-VCA angle were 43.8°, 54.4°, respectively. The TS-VCA angle was significantly larger than the FP-VCA angle. For FP radiographs, the intraobserver intraclass correlation coefficient (ICC) was 0.68, and the interobserver ICC was 0.79. For tomosynthesis sagittal images, the intraobserver ICC was 0.85, and the interobserver ICC was 0.92. There was a strong positive correlation between the TS-VCA angle and the FP-VCA angle. When the FP-VCA angle was 25°, the TS-VCA angle was 35° in regression analysis. Conclusions Measuring acetabular anterior coverage using sagittal plane tomosynthesis correlates well with FP radiography. Regardless of the presence of acetabular deformities, tomosynthesis demonstrated high reproducibility, simple posture setting, low effective doses, and high versatility. A cut-off value of 35° was useful for the detection of developmental dysplasia of the hip joint using the TS-VCA angle.

Anatomical parameters of and differences in the proximal femoral cavity in adult patients with developmental hip dysplasia

2021 ◽  
pp. 1-12
Author(s):  
Ran Zhao ◽  
Hong Cai ◽  
Hua Tian ◽  
Ke Zhang ◽  
Admin
Keyword(s):  
Femoral Head ◽  
Developmental Dysplasia ◽  
Adult Patients ◽  
Control Group ◽  
Marrow Cavity ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Dysplasia Of The Hip ◽  
Anatomical Parameters

Objective: To explore the anatomical parameters proximal femoral cavity and developmental dysplasia of the hip. Methods: The retrospective study was conducted at Peking University Third Hospital, Beijing, China, and comprised data of adult patients of either gender who underwent total hip arthroplasty from January 2009 to August 2015. Paients with a diagnosis of primary osteoarthrosis or aseptic necrosis of the femoral head were taken as the control group A, while patients with developmental dysplasia of the hip in group B were graded into subgroups I-IV using the Crowe classification. For each patient, the inner diameter of the proximal femoral medullary cavity was measured on preoperative radiographs using Noble’s technique. Data was analysed using SPSS 20. Results: Of the 835 hips, 571(68.4%) were in group A and 264(31.6%) in group B. The mean age of the patients at the time of surgery was 58.3 ± 12.3 years. Overall, there were 404(48.4%) hips of male patients; 59(22.3%) in group B. There were 431(51.6%) hips of female patients; 205(77.7%) in group B. In group B, 186(70.5%) hips were graded I, 38(14.4%)grade II, 22(8.3%)grade III, and 18(6.8%) hips were graded IV. There were significant differences in femoral offset, height of the femoral head, and canal flare index of the metaphysis between groups A and B (p<0.05). There was no significant difference in the morphology of the marrow cavity between subgroups II and III.

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 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.

Combined Anteversion Technique in Total Hip Arthroplasty for Crowe IV Developmental Dysplasia of the Hip

2017 ◽  
Vol 27 (6) ◽  
pp. 589-594 ◽  
Author(s):  
Biao Zhu ◽  
Changzheng Su ◽  
Yeteng He ◽  
Xingyu Chai ◽  
Zhen Li ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Anteversion ◽  
Safe Zone ◽  
Developmental Dysplasia ◽  
Acetabular Anteversion ◽  
Combined Anteversion ◽  
The Mean ◽  
Postoperative Dislocation ◽  
Dysplasia Of The Hip

Background A high rate of postoperative dislocation in total hip arthroplasty (THA) for Crowe IV developmental dysplasia of the hip (DDH) has been reported, 1 of the main reasons being higher true acetabular anteversion. If the cup is fixed with normal anteversion, the anterior rim will be excessively exposed, which reduces the contact areas of the cup and bone, affects prosthesis stability, and leads to iliopsoas tendinitis and persistent hip pain after THA. The aim of this study was to demonstrate that when cup anteversion is larger, adjusting femoral anteversion to bring the combined anteversion (CA) into the “safe zone” might prevent dislocation. Methods After having fixed the cup in the acetabulum according to the patients’ native acetabular anteversion, we shortened and rotated the proximal femur to reduce femoral anteversion, adjusting the CA into the “safe zone”. The Harris Hip Score (HHS) was used to evaluate hip joint function. Computerised tomography scanning was used to measure the anteversion angles. Results All patients were followed up without any dislocation. Preoperative and 12 months after surgery, the mean HHS were 43.3 ± 2.6 (38-47) and 88.1 ± 3.3 (78-92) respectively. Pre- and post-operation, the mean CA angles were 88.6° ± 9.4° (80.3°-119.4°) and 49.2° ± 2.6° (43.4°-54.4°) respectively. The bone healing time of femoral osteotomy ranged from 4 to 14 months, with a mean time of 7.5 months. Conclusions This CA technique in THA for Crowe IV DDH can effectively prevent postoperative dislocation and provide good hip function.

scholarly journals The Three-Dimensional Morphology of Femoral Medullary Cavity in the Developmental Dysplasia of the Hip

2021 ◽  
Vol 9 ◽  
Author(s):  
Min Zhang ◽  
Bo-Lun Liu ◽  
Xin-Zheng Qi ◽  
Qing-Qing Yang ◽  
Jing-Yang Sun ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Femoral Stem ◽  
Developmental Dysplasia ◽  
Medullary Canal ◽  
Medullary Cavity ◽  
Cylindrical Shape ◽  
Lesser Trochanter ◽  
Computed Tomography Images ◽  
Canal Diameter ◽  
Dysplasia Of The Hip

ObjectiveThis study aimed to assess the morphology of the femoral medullary canal in subjects with developmental dysplasia of the hip (DDH) with the intent of improving the design of femoral stems in total hip arthroplasty.MethodsComputed tomography images of 56 DDH hips, which were classified into Crowe I to Crowe IV, and 30 normal hips were collected and used to reconstruct three-dimensional morphology of the femoral medullary cavity. Images of twenty-one cross sections were taken from 20 mm above the apex of the lesser trochanter to the isthmus. The morphology of femoral cavity was evaluated on each cross section for the longest canal diameter, the femoral medullary torsion angle (FMTA), and the femoral medullary roundness index (FMRI).ResultsThe Crowe IV group displayed the narrowest medullary canal in the region superior to the end of the lesser trochanter, but then gradually aligned with the medullary diameter of the other groups down to the isthmus. The FMTA along the femoral cavity increased with the severity of DDH, but the rate of variation of FMTA along the femoral canal was consistent in the DDH groups. The DDH hips generally showed a larger FMRI than the normal hips, indicating more elliptical shapes.ConclusionA femoral stem with a cone shape in the proximal femur and a cylindrical shape for the remainder down to the isthmus may benefit the subjects with severe DDH. This design could protect bone, recover excessive femoral anteversion and facilitate the implantation in the narrow medullary canal.

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