Cup Positioning in True or False Acetabulum in Total Hip Arthroplasty: Which one is More Effective: A Randomized Clinical Trial on Patients with Crowe type 3 and 4 Dysplastic Hip

Abstract Background and objectives: Hip dysplasia is a common hip disease which could be diagnosed in different ages and Total hip arthroplasty (THA) is a common surgical procedure for dysplastic hip in adults. Cup placement in patients with false acetabulum formation could be performed in true or false acetabulum. The current study aimed at evaluating and comparing the effectiveness of these two procedures in patients with Crowe type 3 or 4 dysplastic hip underwent THA. Methods: In this randomized open label parallel group clinical trial 67 patients/71 hips with crowe type 3 or 4 dysplastic hip undergoing THA were assigned to Group 1: patients with cup placement in true acetabulum or group 2: patients with cup placement in false acetabulum. Severity of pain was assessed using visual analogue scale (VAS), range of motion (ROM), limb discrepancy, gait ability, need for repeated joint replacement and also Harris hip score. Data were collected and analyzed using SPSS software version 20.Results: 67 patients/71hips entered the current study with the mean age of 50.51± 9.94 years. Two study groups were comparable in terms of basic characteristics (P> 0.05). No significant differences were observed between two groups regarding mean values of VAS, ROM, limb discrepancy and Harris hip score (P> 0.05). Conclusion: Cup placements in true or false acetabulum showed comparable effectiveness on all studied main orthopedics outcomes which are clinically important. We recommend more clinical trial studies with larger sample size for confirming our study results.

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Pre-Operative Planning of Total Hip Arthroplasty on Dysplastic Acetabuli

Hip International ◽

10.5301/hipint.5000419 ◽

2016 ◽

Vol 27 (1) ◽

pp. 55-59 ◽

Cited By ~ 3

Author(s):

Dror Lakstein ◽

Zachary Tan ◽

Nugzar Oren ◽

Tatu Johannes Mäkinen ◽

Allan E. Gross ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Weighted Kappa ◽

Valuable Insight ◽

High Porosity ◽

Total Hip ◽

Structural Support ◽

Operative Planning ◽

Type 3 ◽

Dysplastic Hip

Background When performing total hip arthroplasty (THA) on a dysplastic hip, proper positioning of the acetabular component may not allow for more than 70% coverage. Structural support in the form of an autograft or a high porosity metal augment may be necessary. The purpose of the study was to investigate the value of pre-operative templating and deformity classification in predicting cup coverage and the need for structural support. Methods 65 cases of THA for DDH were retrospectively analysed. 2 observers independently classified each dysplastic hip according to Hartofilakidis and determined the extent of cup coverage via templating software on pre-operative digital AP pelvic radiographs. Results Weighted kappa interobserver agreement was 0.68 for cup coverage and 0.76 for Hartofilakidis type. Structural support was necessary in 10 hips. No structural support was necessary in Hartofilakidis type 1, dysplasia cases. However, 27-30% of cases with type 2 or type 3 dysplasia required structural support. All cases with templated cup coverage of 65% or less required structural support. Templated coverage within 65-75% and over 75% resulted in 20% and 10% of patients receiving structural augmentation, respectively. Conclusions Pre-Operative planning for THA in the setting of hip dysplasia is crucial and can provide valuable insight to the need for column augmentation. However, the 3-D severity of the deformity may be underestimated in the 2-D radiographs.

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Intracavitary and Extracavitary Iliac Extended Fixation Using Porous Metal Augments for Paprosky Type 3 Acetabular Defects in Revision Total Hip Arthroplasty: A Minimum 2 Years Follow-up

10.21203/rs.2.17840/v2 ◽

2019 ◽

Author(s):

Hao Tang ◽

Yixin Zhou ◽

Zhuyi Ma ◽

Yong Huang ◽

Shengjie Guo

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Porous Metal ◽

Harris Hip Score ◽

Revision Total Hip Arthroplasty ◽

Total Hip ◽

Fixation Group ◽

Acetabular Defects ◽

Type 3

Abstract Background: We proposed a new concept of “iliac extended fixation” in revision total hip arthroplasty (THA) as fixation extending superiorly 2 cm beyond the original acetabular rim with porous metal augments, which was further classified into intracavitary and extracavitary fixation. This study reports the minimum 2 years outcome of the iliac extended fixation technique in patients with Paprosky type 3 acetabular defects. Methods: Thirty two revision THA patients were retrospectively reviewed who underwent reconstruction with the concept of iliac extended fixation from 2014 to 2016 in our hospital. Patients were assessed using the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index score (WOMAC). In addition, radiographs were assessed and patient reported satisfaction was collected. Results: At an average follow-up of 40 months (range 25 – 64 months), the postoperative HHS and WOMAC scores were significantly improved at the last follow-up (p < 0.001). The postoperative horizontal and vertical locations of the COR were significantly improved from the preoperative measurements (p < 0.05). Two (6.3 %) patients were dissatisfied with the outcome. The extracavitary iliac extended fixation group had significantly more horizontal screws fixation (4.6 ± 25.7° vs 41.9 ± 37.8°, p < 0.001) and higher rate of osteointegration in zone 1A (91.7% vs 50.0%, p = 0.023) than the intracavitary iliac extended fixation group. Conclusions: Intracavitary and extracavitary iliac extended fixation with porous metal augments and cementless cups are effective in reconstructing severe superior acetabular bone defects, with promising short-term clinical and radiographic outcome.

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Intracavitary and Extracavitary Iliac Extended Fixation Using Porous Metal Augments for Paprosky Type 3 Acetabular Defects in Revision Total Hip Arthroplasty: A Minimum 2 Years Follow-up

10.21203/rs.2.17840/v1 ◽

2019 ◽

Author(s):

Hao Tang ◽

Yixin Zhou ◽

Zhuyi Ma ◽

Yong Huang ◽

Shengjie Guo

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Porous Metal ◽

Harris Hip Score ◽

Revision Total Hip Arthroplasty ◽

Total Hip ◽

Fixation Group ◽

Acetabular Defects ◽

Type 3

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Mid-term results of bilateral synchronous total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02258-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Lei Han ◽

Renfu Quan ◽

Zhenle Pei ◽

Guoping Cao ◽

Yungen Hu ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Heterotopic Bone ◽

Heterotopic Bone Formation ◽

Total Hip ◽

Vas Score ◽

Mid Term Results ◽

Bony Ankylosis

Abstract Background Total hip arthroplasty (THA) for bony ankylosis is technically challenging in patients with ankylosing spondylitis (AS). This study aimed to determine the mid-term results of bilateral synchronous THA for bony ankylosis in patients with AS. Methods Nineteen cases of bony ankylosis in patients with AS who received bilateral synchronous THA were included in this study (17 males and 2 females, mean age 49.2 years). Disease duration was 5–38 years (mean 18 years and 6 months). All patients received cementless THA. Intraoperative blood loss, visual analog scale (VAS) score, and complications were assessed. Harris hip scores evaluated the clinical effect. Results Patients were followed up for 62–98 months (mean 82.5 months). VAS score decreased from 7.42 ± 0.92 to 2.42 ± 0.83, Harris hip score improved from 21.8 ± 7.2 to 80.3 ± 6.5, and the flexion-extension range of the hip improved from 0 to 142.3 ± 6.2°. One patient with septum bronchiale had a fracture intraoperatively and was treated with wire strapping. One patient had a traction injury of the femoral nerve postoperatively and recovered 1 year after the operation. Loosening and subsidence were not observed in all patients. Heterotopic bone formation was noted in 3 patients. No complications such as joint dislocation, acute infection, and deep vein thrombosis were found. Conclusion Bilateral synchronous THA was effective for bony ankylosis of the hip in patients with AS because it improved patients’ quality of life and had satisfactory mid-term outcomes.

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Excellent Functional Outcome and Quality of Life after Primary Cementless Total Hip Arthroplasty (THA) Using an Enhanced Recovery Setup

Journal of Clinical Medicine ◽

10.3390/jcm10040621 ◽

2021 ◽

Vol 10 (4) ◽

pp. 621

Author(s):

Franziska Leiss ◽

Julia Sabrina Götz ◽

Günther Maderbacher ◽

Matthias Meyer ◽

Jan Reinhard ◽

...

Keyword(s):

Quality Of Life ◽

Patient Satisfaction ◽

Total Hip Arthroplasty ◽

Functional Outcome ◽

Hip Arthroplasty ◽

Enhanced Recovery ◽

Harris Hip Score ◽

Total Hip ◽

Cementless Total Hip Arthroplasty

Background: Total hip arthroplasty combined with the concept of enhanced recovery is of continued worldwide interest, as it is reported to improve early functional outcome and treatment quality without increasing complications. The aim of the study was to investigate functional outcome and quality of life 4 weeks and 12 months after cementless total hip arthroplasty in combination with an enhanced recovery concept. Methods: A total of 109 patients underwent primary cementless Total Hip Arthroplasty (THA) in an enhanced recovery concept and were retrospectively analyzed. After 4 weeks and 12 months, clinical examination was analyzed regarding function, pain and satisfaction; results were evaluated using Harris Hip score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EQ-5D-5L, EQ-VAS and subjective patient-related outcome measures (PROMs). Preoperatively, HADS (Hospital Anxiety and Depression Scale) was collected. A correlation analysis of age, American Society of Anesthesiologists (ASA), HADS and comorbidities (diabetes mellitus, art. hypertension, cardiovascular disease) with WOMAC, Harris Hip score (HHS) and EQ-5D was performed. Results: Patients showed a significant improvement in Harris Hip score 4 weeks and 12 months postoperatively (p < 0.001). WOMAC total score, subscale pain, subscale stiffness and subscale function improved significantly from preoperative to 12 months postoperative (p < 0.001). EQ-5D showed a significant improvement preoperative to postoperative (p < 0.001). The influence of anxiety or depression (HADS-A or HADS-D) on functional outcome could not be determined. There was a high patient satisfaction postoperatively, and almost 100% of patients would choose enhanced recovery surgery again. Conclusion: Cementless THA with the concept of enhanced recovery improves early clinical function and quality of life. PROMs showed a continuous improvement over a follow-up of 12 months after surgery. PROMs can help patients and surgeons to modify expectations and improve patient satisfaction.

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Abductor Muscle Force after Straight-Stem Compared to Short-Stem Total Hip Arthroplasty through a Modified Direct Lateral Approach: Functional Assessment of 70 Consecutive Patients of a Randomized Controlled Clinical Trial

Journal of Clinical Medicine ◽

10.3390/jcm10061235 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1235

Author(s):

Michael Fuchs ◽

Marie-Anne Hein ◽

Martin Faschingbauer ◽

Mirco Sgroi ◽

Ralf Bieger ◽

...

Keyword(s):

Clinical Trial ◽

Muscle Strength ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Lateral Approach ◽

Short Stem ◽

Abductor Muscle ◽

Total Hip ◽

Straight Stem ◽

Direct Lateral Approach

Because of preservation of proximal femoral bone stock and minimized soft tissue trauma, short-stem implants are becoming increasingly important in total hip arthroplasty (THA). The postulated advantage regarding the functional outcome has not been verified. We hypothesized an increased abductor muscle strength by the use of a short-stem design. Seventy consecutive patients of a randomized clinical trial were included. Of these, 67 patients met the inclusion criteria after 12 months. Thirty-five patients received a standard straight stem and 32 patients a short-stem femoral component. All surgeries were performed by a modified direct lateral approach. Isometric muscle strength of the hip abductors was evaluated preoperatively 3 and 12 months after surgery. Harris hip score (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated. After three months, there were no differences between the two groups; the abductor force was comparable to the preoperative initial values. After 12 months, a significant increase in muscle strength for the short stem patient group compared to preoperative baseline values was measured (straight-stem THA, 0.09 Nm/kg ± 0.4, p = 0.32; short-stem THA, 0.2 Nm/kg ± 0.3, p = 0.004). Comparison of the 12-month postoperative total HHS and WOMAC revealed no significant differences between both groups. A significant increase in hip abductor muscle strength 12 months after short-stem THA compared to conventional-stem THA was observed.

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A prospective randomised comparison of earlier function after total hip arthroplasty with a mini posterior approach or supercapsular percutaneously-assisted total hip approach: a gait analysis study

Hip International ◽

10.1177/11207000211018440 ◽

2021 ◽

pp. 112070002110184

Author(s):

Andrey A Korytkin ◽

Younes M El Moudni ◽

Yana S Novikova ◽

Kirill A Kovaldov ◽

Ekaterina A Morozova

Keyword(s):

Total Hip Arthroplasty ◽

Gait Analysis ◽

Hip Arthroplasty ◽

Posterior Approach ◽

Gait Velocity ◽

Harris Hip Score ◽

Kinematic Parameters ◽

Gait Patterns ◽

Total Hip

Background: The supercapsular percutaneously-assisted total hip (SuperPATH) approach is a muscle sparing surgical technique for total hip arthroplasty (THA). The literature reports good clinical and functional results of the SuperPATH technique in the short term. We aimed to compare early outcomes and gait analysis of THA using the mini posterior approach (MPA) and supercapsular percutaneously-assisted total hip (SuperPATH) approach. Methods: 44 patients who underwent THA, were randomly allocated to either MPA or SuperPATH. The data were then collected prospectively (preoperatively and postoperatively at 6 weeks). Plain anteroposterior radiographs of the pelvis and instrumental gait analysis were obtained. The visual analogue scale (VAS), Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Scores (HOOS) were used to assess functional and clinical outcomes. Results: No significant difference was found in patients’ surgical outcomes. Patients in the SuperPATH group had less pain according to the VAS score at follow-up than the MPA group ( p < 0.01). There was also a significant improvement in HHS and HOOS scores for all patients ( p < 0.001) with the SuperPATH group showing superior changes. The comparison of mean differences in gait velocity between preoperative and 6 weeks postoperative result, revealed improvement in the SuperPATH group over the MPA group ( p = 0.06). Limping was more persistent in the MPA group. Kinematic parameters demonstrated improved hip joint excursion slightly higher in the MPA group. There was no significant improvement in kinetic and kinematic parameters at different walking moments for all patients at 6 weeks compared to preoperative gait patterns. Conclusions: SuperPATH and MPA both show excellent results. This study reveals that the SuperPATH technique was associated with lower postoperative pain levels, and higher physical function and quality of life. Improved functional outcomes allowed earlier postoperative rehabilitation and faster recovery. Specific improvement in gait patterns were identified with nonsignificant differences between the 2 approaches at 6 weeks follow-up.

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Letter regarding “Open reduction and internal fixation alone versus open reduction and internal fixation plus total hip arthroplasty for displaced acetabular fractures in patients older than 60 years: A prospective clinical trial”

Injury ◽

10.1016/j.injury.2021.11.056 ◽

2021 ◽

Author(s):

Shiho Oide ◽

Masahiro Banno ◽

Akihiro Saitsu ◽

Natsumi Saka

Keyword(s):

Clinical Trial ◽

Total Hip Arthroplasty ◽

Internal Fixation ◽

Hip Arthroplasty ◽

Open Reduction ◽

Prospective Clinical Trial ◽

Acetabular Fractures ◽

Total Hip

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Excellent Clinical and Radiographic Outcomes with Direct Superior Total Hip Arthroplasty with a Minimum of Two-Year Follow Up

Surgical Technology Online ◽

10.52198/21.sti.38.os1336 ◽

2021 ◽

Author(s):

Moritz Sharabianlou ◽

Prerna Arora ◽

Derek Amanatullah

Keyword(s):

Total Hip Arthroplasty ◽

Functional Recovery ◽

Hip Arthroplasty ◽

Case Series ◽

Harris Hip Score ◽

Timed Up And Go ◽

Total Hip ◽

Radiologic Evaluation ◽

Superior Approach

This study aims to establish the midterm safety and performance for the direct superior approach to minimally invasive surgery total hip arthroplasty (MIS-THA). We used a unicentric, single-surgeon, retrospective, consecutive case series analysis of the first 40 patients who received primary unilateral direct superior MIS-THA. Special attention was given to functional recovery by measuring Harris Hip Score (HHS) and timed-up-and-go (TUG) with a mean follow up of 2.2 ± 0.4 years. A radiologic evaluation was performed. HHS and TUG improved significantly at three months and one year (p < 0.001). All components were placed within the Lewinnek safe zone with no change position or signs of loosening at two years. With a minimum of two years of follow up, the direct superior approach appears to be safe without any obvious or consistent postoperative complications—clinically or radiographically—with excellent functional recovery. Additionally, our subgroup analysis supported no late learning curve effect.

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