Biological prosthesis for total hip arthroplasty in treatment of adult developmental dysplasia of the hip.
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ABSTRACT:
SUBMITTER: Xie ZG
PROVIDER: S-EPMC6583152 | biostudies-literature | 2014 Aug
REPOSITORIES: biostudies-literature
Publications
Biological prosthesis for total hip arthroplasty in treatment of adult developmental dysplasia of the hip.
Xie Zong-gang ZG Dong Qi-rong QR Xie Ye Y
Orthopaedic surgery 20140801 3
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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.
| S-EPMC2254666 | biostudies-other
Project description:This case describes the challenges associated with total hip arthroplasty in a patient with unique anatomy, including developmental dysplasia of the hip, pelvic dysmorphism, and unilateral sacroiliac joint autofusion. A 30-year-old female, with a history of developmental dysplasia of the hip treated with presumed pelvic osteotomy complicated by postoperative infection, presented with hip pain refractory to conservative management. Radiographic studies demonstrated a 10-cm leg length discrepancy, 20° of acetabular retroversion, severe hemipelvic dysmorphism, ipsilateral sacroiliac joint autofusion, and significant femoral head dysplasia. Total hip arthroplasty was performed using a revision acetabular component and modular femoral component, resulting in improvement in the postoperative leg length discrepancy. There were no neurovascular or other perioperative complications, and the patient was ambulating without pain or assistive devices at 1-year follow-up.
| S-EPMC7083716 | biostudies-literature
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
Project description: Not available
| S-EPMC6583536 | biostudies-literature
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.
| S-EPMC7502580 | biostudies-literature
Project description:BackgroundTotal hip arthroplasty (THA) for developmental hip dysplasia (DDH) often requires a subtrochanteric shortening derotational osteotomy (SDO) to limit leg lengthening, mitigate risk of peripheral nerve palsy, and reduce excessive femoral anteversion. Few studies exist detailing long-term clinical outcomes and survivorship. The aim of this study is to analyze the long-term outcomes and survivorship of an SDO-THA cohort.MethodsWe retrospectively reviewed all patients who underwent cementless THA with femoral osteotomy due to Crowe I-IV DDH between 1991 and 2001. Primary outcome measures included revision surgery for any reason and functional outcome measures using modified Harris Hip scores. Secondary outcome measures included mode of implant failure and radiographic assessment for osteotomy union, polyethylene wear, osteolysis, and implant loosening.ResultsOur review resulted in 24 SDO-THA cases in 20 patients with a mean follow-up of 19 years (range, 8-27 years). Overall survivorship was 67%. All 8 failures were treated with acetabular revision at a mean time to revision of 11 years (range, 1-25 years). Of the failures, there were 5 cases due to polyethylene wear (62.5%), 2 cases due to acetabular loosening (25%), and 1 case due to recurrent instability (12.5%). The mean postoperative modified Harris Hip score was 76 (range, 52-91) with long-term improvement of 43 points maintained (P < .001).ConclusionsTHA with SDO can produce durable long-term outcomes for the patient with DDH. It is important to consider some common reasons for revision, namely polyethylene wear and osteolysis, acetabular loosening, and recurrent acetabular dislocations.
| S-EPMC9421178 | biostudies-literature
Project description:BackgroundRestoration of the acetabulum during total hip arthroplasty in adults with developmental dysplasia of the hip (DDH-THA) and resumption of hip function remain major challenges. Herein, a new patient-specific instrument (PSI) was developed that uses the superolateral rim of the acetabulum as a positioning marker to assist surgeons in adult DDH-THA.MethodsFrom January 2017 to October 2018, 104 adult DDH patients were randomized to either the PSI group or conventional operation (CO) group, and further divided into eight subgroups by stratified random sampling using Crowe's classification. Complications, Harris hip scores (HHS), and X-ray results were recorded at 3 and 12 months after surgery.ResultsWith the exception of anteversion in CO-Crowe II group patients, there was no difference in the accuracy of cup placement and orientation between the PSI and CO groups in Crowe I and II DDH patients. With the exception of percentage of acetabular cup coverage (PACC) and the qualification rate of Crowe IV PACC patients, among all Crowe III and IV DDH groups, all postoperative indexes of cup orientation and positioning exhibited significant differences between the PSI and CO groups; however, no significant differences were observed in Crowe I and II DDH patients.ConclusionsCompared with conventional methods, the new PSI-assisted surgical method improved the accuracy of placement and orientation of the acetabulum and cup prosthesis, optimized the surgical process, reduced complications, and contributed to quicker recovery of hip function after surgery in adults with Crowe III and IV DDH-THA, but little difference was noted for those with Crowe I and II DDH.
| S-EPMC7940928 | biostudies-literature
Project description:BackgroundWhen reconstructing a hip with developmental dysplasia and high dislocation, sub-trochanteric shortening osteotomy is typically needed for placing the acetabular component in the appropriate anatomical position. However, the procedure can result in complications such as non-union of the osteotomy. We evaluated the contact area and the coincidence rate between the proximal and distal fragments at different femoral osteotomy levels and lengths. We then determined the optimal location of subtrochanteric femoral shortening transverse osteotomy in patients with unilateral Crowe type IV developmental dysplasia of the hip (DDH). The consistency between the proximal and distal segments was assessed as a possible predictive indicator of the union at the osteotomy site.MethodsWe retrospectively reviewed 57 patients with unilateral Crowe type IV DDH who underwent X-ray imaging of both hip joints. We labelled the inner and outer diameters of the circular ring as N (mm) and M (mm), respectively. We defined the overlapped area between the proximal and distal ring as contact area S (mm2), and the ratio of contact area to distal ring area as coincidence rate R.ResultsN varied from 9.8-15.2 mm and M varied from 20.7-24 mm, both demonstrated a decreasing trend in the proximal to distal direction. At osteotomy lengths ranging from 0.5-2 cm, there were no differences in S between the different levels of osteotomy in each group. At osteotomy lengths ≤2.5 cm, a significant higher coincidence rate was noted from 2 cm below the lesser trochanter to other positions below the level. At osteotomy lengths from 3 to 5.5 cm, a significantly higher coincidence rate was observed from the level of 1.5 cm below the lesser trochanter to other positions below the level.ConclusionsOur findings suggest that femoral shortening transverse osteotomy at the optimal subtrochanteric level can predictably increase the contact area and coincidence rate, which may contribute to the union at the osteotomy site. Considering the stability of the prostheses, it appears appropriate that osteotomy location should be shifted slightly distally.Trial registrationRetrospectively registered.
| S-EPMC7137204 | biostudies-literature
Project description:Adult hip dysplasia provides many challenges for joint surgeons. Due to the abnormal bone morphology and altered biomechanics of the hip, surgeons must ensure accurate implant positioning to avoid postoperative complications. We present a 56-year-old female with a history of bilateral Legg-Calve-Perthes disease and subsequent dysplasia who underwent bilateral total hip arthroplasty using robotic navigation. We highlight the utility of robotic navigation in adult hip dysplasia to improve implant positioning and ensure optimal patient outcomes.
| S-EPMC10679762 | biostudies-literature
Project description:BackgroundTotal hip arthroplasty (THA) stands as the standard treatment in neglected developmental dysplasia of the hip (DDH), and its application in severe cases may be linked to debilitating outcomes, including nerve damage. Here, we aimed to report the results of intraoperative nerve monitoring (IONM) via an active method.MethodsIn this retrospective cohort study, we recruited patients with Crowe types III and IV DDH, who underwent THA. The study comprised 2 cohorts: one without nerve monitoring and the other with active IONM under epidural anesthesia. The primary study outcomes included the incidence of neural complications, the extent of achieved leg lengthening, and the necessity for femoral osteotomy.ResultsA total of 183 patients were included in this study as the cases underwent THA under epidural anesthesia and IONM, along with 156 historical cohorts of controls. In the group with IONM, no clinically postoperative nerve injury was detected, while in the control group, 6 (3.8%) patients experienced neural complications (P = .08). The mean achieved limb lengthening was significantly greater in the monitoring group as 4.2 cm (range = 2.4-5.6) than in the control group as 3.56 cm (range = 2.2-5.6) (P = .04). The rate of femoral osteotomy was significantly lower in the monitoring group (13.6%, 25/183) compared to the control group (27.5%, 43/156) (P < .005).ConclusionsThe utilization of active IONM in patients under epidural anesthesia during THA for severe DDH proves to be an effective approach. This method allows for real-time assessment of nerve function throughout the surgical procedure, demonstrating its potential to minimize postoperative complications.
| S-EPMC11786204 | biostudies-literature