SELECTIVELY UPWARD PLACEMENT OF ACETABULAR IMPLANTS IN PATIENTS WITH ANATOMICALLY ABNORMAL ACETABULUM DURING TOTAL HIP ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGZhiqi ,  LIAOWeiming , HOUChanghe , WUPeihui , KANGYan , ZHANGZiji , ZHAOXiaoyi

Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou Guangdong, 510080, P. R. China;

Corresponding author：

LIAOWeiming, Email: liaoweiming29@163.com

Keywords：

Anatomically abnormal acetabulum; Total hip arthroplasty; Acetabular placement; Selectively upward placement

DOI：

10.7507/1002-1892.20140127

Video：

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Objective To investigate the method and effectiveness of selectively upward placement of acetabular implants in patients with anatomically abnormal acetabulum during total hip arthroplasty (THA). Methods Twenty-six cases (26 hips) of anatomically abnormal acetabulum received THA between January 2005 and December 2010, including 22 cases of developmental dysplasia of the hip, 3 cases of osteonecrosis of the femoral head, and 1 case of post-traumatic arthritis. There were 5 males and 21 females with an average age of 52.3 years (range, 35-67 years). The left hip was involved in 11 cases and the right hip in 15 cases. The preoperative Harris score was 45.85±10.04. The anteroposterior X-ray films and CT scan of the pelvis, anteroposterior and lateral X-ray films of the femur, and TraumaCad analysis were performed routinely before operation. The principles of acetabular implants were that more than 70% of the bone-implant interface was covered, and the upward distance of acetabular implant was less than 15 mm. Results Acetabular implants were placed within 5 mm from the anatomical rotation center in 11 cases. The upward distance of acetabular implant was 5-10 mm in 8 cases and was 10-15 mm in 7 cases. No bone fracture or nerve injury was observed intraoperatively. All incisions healed by first intention, and no infection or lower limb deep venous thrombosis occurred. One case had dislocation at 3 days after operation, and was cured after reduction and conservative treatment. The follow-up time ranged from 15 to 71 months (mean, 34 months). The Harris score was 91.42±3.59, showing significant difference when compared with preoperative score (t=20.099, P=0.000). The Harris scores were 92.09±4.04 in patients having less than 5 mm upward distance, 91.25±2.82 in patients having 5-10 mm upward distance, and 90.57±3.95 in patients having 10-15 mm upward distance, showing no significant difference (F=0.377, P=0.690). No loosening or subsidence of the implant was observed by X-ray film during the follow-up. Conclusion The acetabular implants should be placed as close to anatomical rotation center as possible according to the principle. However, appropriate upward distance of the acetabular implants (≤15 mm) could be acceptable to meet 70% coverage of bone-implant interface and the implant stability. A satisfactory mid-term effectiveness can be obtained, but long-term effectiveness should be further investigated.

Citation： ZHANGZhiqi, LIAOWeiming, HOUChanghe, WUPeihui, KANGYan, ZHANGZiji, ZHAOXiaoyi. SELECTIVELY UPWARD PLACEMENT OF ACETABULAR IMPLANTS IN PATIENTS WITH ANATOMICALLY ABNORMAL ACETABULUM DURING TOTAL HIP ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(5): 566-570. doi: 10.7507/1002-1892.20140127 Copy

1.	Georgiades G, Babis GC, Kourlaba G, et al. Effect of cementless acetabular component orientation, position, and containment in total hip arthroplasty for congenital hip disease. J Arthroplasty, 2010, 25(7):1143-1150.
2.	Kobayashi S, Saito N, Nawata M, et al. Total hip arthroplasty with bulk femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip. J Bone Joint Surg (Am), 2003, 85-A(4):615-621.
3.	Karachalios T, Hartofilakidis G. Congenital hip disease in adults:terminology, classification, pre-operative planning and management. J Bone Joint Surg (Br), 2010, 92(7):914-921.
4.	de Jong PT, Haverkamp D, van der Vis HM, et al. Total hip replacement with a superolateral bone graft for osteoarthritis secondary to dysplasia:a long-term follow-up. J Bone Joint Surg (Br), 2006, 88(2):173-178.
5.	Hendrich C, Mehling I, Sauer U, et al. Cementless acetabular reconstruction and structural bone-grafting in dysplastic hips. J Bone Joint Surg (Am), 2006, 88(2):387-394.
6.	Chougle A, Hemmady MV, Hodgkinson JP. Severity of hip dysplasia and loosening of the socket in cemented total hip replacement. A long-term follow-up. J Bone Joint Surg (Br), 2005, 87(1):16-20.
7.	康焱, 邬培慧, 张紫机, 等. 初次全髋关节置换术后 5 年以上随访结果与分析. 中华关节外科杂志(电子版), 2011, 5(5):546-554.
8.	傅明, 廖威明, 何爱珊, 等. 全髋关节翻修术中髋臼假体的选择和髋臼骨缺损的处理. 中华关节外科杂志 (电子版), 2008, 2(5):497-504.
9.	Flecher X, Parratte S, Brassart N, et al. Evaluation of the hip center in total hip arthroplasty for old developmental dysplasia. J Arthroplasty, 2008, 23(8):1189-1196.
10.	Takao M, Ohzono K, Nishii T, et al. Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia. J Bone Joint Surg (Am), 2011, 93(6):548-555.
11.	Hartofilakidis G, Karachalios T. Total hip arthroplasty for congenital hip disease. J Bone Joint Surg (Am), 2004, 86-A(2):242-250.
12.	Russotti GM, Harris WH. Proximal placement of the acetabular component in total hip arthroplasty. A long-term follow-up study. J Bone Joint Surg (Am), 1991, 73(4):587-592.
13.	Hirakawa K, Mitsugi N, Koshino T, et al. Effect of acetabular cup position and orientation in cemented total hip arthroplasty. Clin Orthop Relat Res, 2001, (388):135-142.
14.	Murayama T, Ohnishi H, Okabe S, et al. 15-year comparison of cementless total hip arthroplasty with anatomical or high cup placement for Crowe I to Ⅲ hip dysplasia. Orthopedics, 2012, 35(3):e313-e318.
15.	Pagnano W, Hanssen AD, Lewallen DG, et al. The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty. J Bone Joint Surg (Am), 1996, 78(7):1004-1014.
16.	Bicanic G, Delimar D, Delimar M, et al. Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop, 2009, 33(2):397-402.
17.	Morag G, Zalzal P, Liberman B, et al. Outcome of revision hip arthroplasty in patients with a previous total hip replacement for developmental dysplasia of the hip. J Bone Joint Surg (Br), 2005, 87(8):1068-1072.
18.	Zhang Z, Fu M, Kang Y, et al. Upward and inward displacements of the acetabular component increase stress on femoral head in single endoprothesis models. Int Orthop, 2010, 34(4):479-483.
19.	Antoniades J, Pellegrini VJ Jr. Cross-sectional anatomy of the ilium:implications for acetabular component placement in total hip arthroplasty. Clin Orthop Relat Res, 2012, 470(12):3537-3541.
20.	沈彬, 裴福兴, 杨静. 髋关节发育不良的髋臼重建. 中华外科杂志, 2004, 42(16):1001-1005.
21.	张浩, 康焱, 张紫机, 等. 应用骨盆正位 X 线片测量全髋关节置换术后髋臼假体方位角的初步研究. 中国骨与关节外科, 2009, 2(4):290-295.
22.	Shaarani SR, McHugh G, Collins DA. Accuracy of digital preoperative templating in 100 consecutive uncemented total hip arthroplasties:a single surgeon series. J Arthroplasty, 2013, 28(2):331-337.
23.	邬培慧, 傅明, 毛玉瑢, 等. 重建股骨偏心距对人工全髋关节置换术后骨盆稳定性的影响. 中国修复重建外科杂志, 2011, 25(5):513-516.

1. Georgiades G, Babis GC, Kourlaba G, et al. Effect of cementless acetabular component orientation, position, and containment in total hip arthroplasty for congenital hip disease. J Arthroplasty, 2010, 25(7):1143-1150.
2. Kobayashi S, Saito N, Nawata M, et al. Total hip arthroplasty with bulk femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip. J Bone Joint Surg (Am), 2003, 85-A(4):615-621.
3. Karachalios T, Hartofilakidis G. Congenital hip disease in adults:terminology, classification, pre-operative planning and management. J Bone Joint Surg (Br), 2010, 92(7):914-921.
4. de Jong PT, Haverkamp D, van der Vis HM, et al. Total hip replacement with a superolateral bone graft for osteoarthritis secondary to dysplasia:a long-term follow-up. J Bone Joint Surg (Br), 2006, 88(2):173-178.
5. Hendrich C, Mehling I, Sauer U, et al. Cementless acetabular reconstruction and structural bone-grafting in dysplastic hips. J Bone Joint Surg (Am), 2006, 88(2):387-394.
6. Chougle A, Hemmady MV, Hodgkinson JP. Severity of hip dysplasia and loosening of the socket in cemented total hip replacement. A long-term follow-up. J Bone Joint Surg (Br), 2005, 87(1):16-20.
7. 康焱, 邬培慧, 张紫机, 等. 初次全髋关节置换术后 5 年以上随访结果与分析. 中华关节外科杂志(电子版), 2011, 5(5):546-554.
8. 傅明, 廖威明, 何爱珊, 等. 全髋关节翻修术中髋臼假体的选择和髋臼骨缺损的处理. 中华关节外科杂志 (电子版), 2008, 2(5):497-504.
9. Flecher X, Parratte S, Brassart N, et al. Evaluation of the hip center in total hip arthroplasty for old developmental dysplasia. J Arthroplasty, 2008, 23(8):1189-1196.
10. Takao M, Ohzono K, Nishii T, et al. Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia. J Bone Joint Surg (Am), 2011, 93(6):548-555.
11. Hartofilakidis G, Karachalios T. Total hip arthroplasty for congenital hip disease. J Bone Joint Surg (Am), 2004, 86-A(2):242-250.
12. Russotti GM, Harris WH. Proximal placement of the acetabular component in total hip arthroplasty. A long-term follow-up study. J Bone Joint Surg (Am), 1991, 73(4):587-592.
13. Hirakawa K, Mitsugi N, Koshino T, et al. Effect of acetabular cup position and orientation in cemented total hip arthroplasty. Clin Orthop Relat Res, 2001, (388):135-142.
14. Murayama T, Ohnishi H, Okabe S, et al. 15-year comparison of cementless total hip arthroplasty with anatomical or high cup placement for Crowe I to Ⅲ hip dysplasia. Orthopedics, 2012, 35(3):e313-e318.
15. Pagnano W, Hanssen AD, Lewallen DG, et al. The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty. J Bone Joint Surg (Am), 1996, 78(7):1004-1014.
16. Bicanic G, Delimar D, Delimar M, et al. Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop, 2009, 33(2):397-402.
17. Morag G, Zalzal P, Liberman B, et al. Outcome of revision hip arthroplasty in patients with a previous total hip replacement for developmental dysplasia of the hip. J Bone Joint Surg (Br), 2005, 87(8):1068-1072.
18. Zhang Z, Fu M, Kang Y, et al. Upward and inward displacements of the acetabular component increase stress on femoral head in single endoprothesis models. Int Orthop, 2010, 34(4):479-483.
19. Antoniades J, Pellegrini VJ Jr. Cross-sectional anatomy of the ilium:implications for acetabular component placement in total hip arthroplasty. Clin Orthop Relat Res, 2012, 470(12):3537-3541.
20. 沈彬, 裴福兴, 杨静. 髋关节发育不良的髋臼重建. 中华外科杂志, 2004, 42(16):1001-1005.
21. 张浩, 康焱, 张紫机, 等. 应用骨盆正位 X 线片测量全髋关节置换术后髋臼假体方位角的初步研究. 中国骨与关节外科, 2009, 2(4):290-295.
22. Shaarani SR, McHugh G, Collins DA. Accuracy of digital preoperative templating in 100 consecutive uncemented total hip arthroplasties:a single surgeon series. J Arthroplasty, 2013, 28(2):331-337.
23. 邬培慧, 傅明, 毛玉瑢, 等. 重建股骨偏心距对人工全髋关节置换术后骨盆稳定性的影响. 中国修复重建外科杂志, 2011, 25(5):513-516.

Chinese Journal of Reparative and Reconstructive Surgery

SELECTIVELY UPWARD PLACEMENT OF ACETABULAR IMPLANTS IN PATIENTS WITH ANATOMICALLY ABNORMAL ACETABULUM DURING TOTAL HIP ARTHROPLASTY

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