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Staged total hip arthroplasty in a patient with hip dysplasia and a large pertrochanteric bone cyst.

ABSTRACT: Hip arthroplasty in young patients requires thoughtful preoperative planning. Patients with proximal femoral bone loss complicate this planning and may require a staged procedure to optimize implant insertion. We report on a case of a 26-year-old woman with secondary hip arthritis from developmental dysplasia of the hip and a large pertrochanteric bone cyst that was treated with staged total hip arthroplasty. The cyst was decompressed and filled with an osteoconductive and osteoinductive bone graft substitute called EquivaBone. One year later, the patient underwent a successful primary total hip arthroplasty. Fifteen-month follow-up after her hip replacement revealed resolution of postoperative pain and significant functional improvement.

SUBMITTER: Langston JR

PROVIDER: S-EPMC4957267 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

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Staged total hip arthroplasty in a patient with hip dysplasia and a large pertrochanteric bone cyst.

Langston Joseph R JR DeHaan Alexander M AM Huff Thomas W TW

Arthroplasty today 20160524 2

Hip arthroplasty in young patients requires thoughtful preoperative planning. Patients with proximal femoral bone loss complicate this planning and may require a staged procedure to optimize implant insertion. We report on a case of a 26-year-old woman with secondary hip arthritis from developmental dysplasia of the hip and a large pertrochanteric bone cyst that was treated with staged total hip arthroplasty. The cyst was decompressed and filled with an osteoconductive and osteoinductive bone gr ...[more]

PMID: 28326400

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Total hip arthroplasty for developmental hip dysplasia.

Project description:We reviewed 38 hip replacements in 33 female patients (mean age 55.3 years) with developmental hip dysplasia. One patient had died and the remaining 32 patients (36 hips) had a mean follow-up of 12.2 years (range 8-19 years). All hips were replaced using the Müller cemented implant, and in 32 hips bulk femoral head autograft was used. In 33 hips the socket was reconstructed at the level of the true acetabulum. Complications included one intra-operative femoral fracture and two early dislocations. Correction of leg length discrepancy was possible in 30 patients. The post-operative mean modified Merle d'Aubigne and Postel scores for pain, movement and walking were 5.9, 5, and 5.3 respectively. One cup was revised due to aseptic loosening at ten years. All grafts united, but minor graft resorption was noticed in 24 hips, moderate in 2 hips and major in 1 hip.

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A case of bilateral hip mechanically assisted crevice corrosion after staged total hip arthroplasty.

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| S-EPMC6123318 | biostudies-literature

Endoscopic Shelf Acetabuloplasty for Treating Acetabular Large Bone Cyst in Patient With Dysplasia.

Project description:Acetabular bone cyst is usually associated with dysplastic secondary osteoarthritis of the hip joint. Acetabular reorientation osteotomy is one of the most common therapeutic options for treating patients with hip dysplasia. However, it may be too invasive for athletes and can also lead to some complications including intraoperative fracture and postoperative bone necrosis especially in patients with acetabular large bone cysts. Endoscopic shelf acetabuloplasty offers a less invasive option for athletic patients with dysplasia of severity greater than those indicated for isolated hip arthroscopy. This Technical Note demonstrates endoscopic shelf acetabuloplasty with bone grafting, simultaneously addressing a large bone cyst and acetabular undercoverage, as part of a comprehensive approach addressing chondrolabral pathology while restoring capsular integrity in an athlete with moderate dysplasia.

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| S-EPMC6123321 | biostudies-literature

The Use of Robotic-Assisted Total Hip Arthroplasty in Developmental Dysplasia of the Hip.

Project description:BackgroundTotal hip arthroplasty (THA) is an effective operation for patients with hip osteoarthritis; however, patients with hip dysplasia present a particular challenge. Our novel study examined the effect of robot-assisted THA in patients with hip dysplasia.MethodsWe retrospectively reviewed patients with developmental dysplasia of the hip undergoing primary THA using robotic arm assistance at 2 institutions from January 2010 to January 2017. Patients undergoing revision arthroplasty were excluded. Preoperatively, all patients underwent a computed tomography scan so that 3-dimensional templating could be performed. Hip range of motion (ROM) and clinical leg length discrepancy were recorded preoperatively. Two independent observers calculated Crowe and Hartofilakidis grades for each operative hip. At the final follow-up, hip ROM, postoperative complications, and modified Harris Hip scores were obtained.ResultsSeventy-nine patients underwent THA because of degenerative joint disease in the setting of developmental dysplasia of the hip. There were 56 females and 23 males with a mean age of 45 years (range: 26-64 years). We found that components were placed according to the preoperative plan, that there was an improvement in the modified Harris hip score from 29 to 86 (P < .001), an improvement in the hip ROM (flexion improvement from 66° to 91°, P < .0001), and a correction of leg length discrepancy (17.1 vs 4 mm, P < .0002). There were no complications during the short-term interim follow-up (mean: 3.1 years).ConclusionsRobot-assisted THA can be a useful method to ensure adequate component positioning and excellent outcomes in patients with hip dysplasia.Level of evidenceLevel III, Retrospective.

| S-EPMC7490591 | biostudies-literature

Acetabular Bone Defect in Total Hip Arthroplasty for Crowe II or III Developmental Dysplasia of the Hip: A Finite Element Study.

Project description:Background:The purpose of this study was to establish the finite element analysis (FEA) model of acetabular bone defect in Crowe type II or III developmental dysplasia of the hip (DDH), which could evaluate the stability of the acetabular cup with different types of bone defects, different diameters of femoral ceramic heads, and the use of screws and analyze the stress distribution of screws. Methods:The FEA model was based on the CT scan of a female patient without any acetabular bone defect. The model of acetabular bone defect in total hip arthroplasty for Crowe II or III DDH was made by the increasing superolateral bone defect area of the acetabular cup. Point A was located in the most medial part of the acetabular bone defect. A 52?mm PINNACLE cup with POROCOAT Porous coating was implanted, and two screws (the lengths were 25?mm and 40?mm) were implanted to fix the acetabular cup. The stability of the acetabular cup and the von Mises stress of point A and screws were analyzed by a single-legged stance loading applied in 1948?N (normal working). The different diameters of the femoral ceramic head (28?mm, 32?mm, and 36?mm) were also analyzed. Results:The von Mises stress of point A was gradually increased with the increasing uncoverage values. When the uncoverage values exceeded 24.5%, the von Mises stress of point A without screws increased significantly, leading to instability of the cup. Screws could effectively reduce the von Mises stress of point A with uncoverage values of more than 24.5%. However, the peak von Mises stress in the screws with the uncoverage values that exceeded 24.5% was considerably increased. The diameter of the femoral ceramic head had no significant effect on the von Mises stress and the stability of the acetabular cup. Conclusions:We recommend that uncoverage values of less than 24.5% with or without screw is safe for patients with Crowe II or III DDH.

| S-EPMC7468597 | biostudies-literature

Total Hip Arthroplasty for Developmental Dysplasia of Hip vs Osteoarthritis: A Propensity Matched Pair Analysis.

Project description:BackgroundThe purpose of this study was to use the American College of Surgeons National Surgical Quality Improvement Program to compare the perioperative and postoperative outcomes after total hip arthroplasty (THA) for DDH and primary OA via a propensity-matched pair analysis and the valuation of THA between both groups.Material and methodsAll patients who underwent THA between 2008 and 2016 were identified from National Surgical Quality Improvement Program database via the current procedural terminology (CPT) code. Patients were further identified and stratified based on International Statistical Classification of Diseases and Related Health Problems-9/International Statistical Classification of Diseases and Related Health Problems-10 diagnosis codes for primary OA (n = 115,166) and DDH (n = 603), which included codes for congenital hip dislocation, hip dysplasia, or juvenile osteochondrosis. Demographic variables were used to create 557 propensity-matched pairs.ResultsThe DDH group was associated with a significantly longer operative time (120.3 vs 95.9 min), higher postoperative transfusion rate (12% vs 6.6%), and longer hospital length of stay (2.8 vs 2.5 days) compared with the primary OA group (P < .001, P < .001, and P = .002, respectively). There were no statistically significant differences found between the two groups with respect to inpatient complications, discharge disposition (P = .123), readmissions (P = .615), or reoperations (P = .404).ConclusionsHealth policy makers should be cognizant of the higher complexity of THA for DDH when determining whether DDH and primary OA should be in the same bundle. Owing to the limitations of our data set, all the observed associations are likely an underestimate of the true risk posed to patients with severe DDH, as these patients were unable to be stratified in the present analysis.

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Direct anterior approach total hip arthroplasty for Crowe III and IV dysplasia.

Project description:High-dislocated hip dysplasia is challenging to treat with total hip arthroplasty via the direct anterior approach (DAA). The DAA has potential advantages including optimizing component positioning, enhanced hip stability, and a more rapid postoperative recovery. We present a surgical technique for DAA total hip arthroplasty for hip dysplasia that includes preoperative planning, soft tissue releases, subtrochanteric osteotomy, component placement, and intraoperative nerve monitoring and imaging. This technique provides detailed technical instructions, specifically including pearls and pitfalls, and complication prevention strategies.

| S-EPMC7303477 | biostudies-literature

A Comparative Study of Patients' Subjective Feelings Toward Total Hip Arthroplasty with Patient-Specific Instruments and Traditional Total Hip Arthroplasty.

Project description:OBJECTIVE:To determine whether differences exist in patients' subjective feelings, daily life, and surgical satisfaction between those who underwent surgery for developmental dysplasia of the hip (DDH) using patient-specific instruments (PSIs) and those who underwent traditional surgical total hip arthroplasty (THA). METHODS:We selected 30 adult patients with various types of DDH who underwent surgery during 2016-2017 at our hospital. The patients were divided into PSI surgery group and the traditional surgery group. All patients underwent follow-up, and we collected data on the Harris Hip Score, Oxford University Hip Score (OHS), Forgotten Joint Score (FJS-12), Visual Analogue Scale (VAS) score, patient satisfaction score, intraoperative surgical time, amount of bleeding and postoperative complications incidence for both groups. We then performed statistical analyses on the data. RESULTS:The Harris Hip Score, OHS, VAS score, patient satisfaction score, and mean bleeding volume did not differ statistically significantly (t-tests, P?>?0.05). No statistically significant differences were found between surgical groups in the incidence of complication and sub-trochanteric osteotomy, or in the surgical side (chi-square tests, P?>?0.05). For the experimental group, the FJS-12 score was 80.0?±?12.0, and for the control group the score was 68.5?±?16.1. The operative time of the experimental group was 138.4?±?32.2?min, while that of the control group was 88.9?±?26.8?min. The values of these data differed significantly (t-tests, P?<?0.05). CONCLUSIONS:The novel PSI designed by our group has certain advantages for the short-term subjective feelings of patients after THA, but it may cause prolonged operative times.

| S-EPMC7031611 | biostudies-literature

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