Short-term effectiveness of structural bone graft and total hip arthroplasty through direct anterior approach in lateral decubitus position for Crowe type <b>Ⅲ</b> and <b>Ⅳ</b> developmental dysplasia of the hip_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PEI Lijia ¹ ,  ZHOU Xinshe ¹ , WU Yifan ² , LIU Yang ¹ , XUE Yadong ¹ , MENG Fanyu ¹ , LIU Ben ¹

1. Department of Orthopedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Osteoarthritis Diagnosis and Treatment Center, Anhui Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China;
2. Department of Orthopedics, Suzhou Affiliated Hospital of Anhui Medical University, Suzhou Anhui, 234099, P. R. China;

Corresponding author：

ZHOU Xinshe, Email: zhouxs1967@126.com

Keywords：

Developmental dysplasia of the hip; structural bone graft; direct anterior approach; total hip arthroplasty

DOI：

10.7507/1002-1892.202205117

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Objective To explore the feasibility and effectiveness of total hip arthroplasty (THA) with acetabulum structural bone grafting using autogenous femoral head through direct anterior approach (DAA) in lateral decubitus position in the treatment of Crowe type Ⅲ and Ⅳ developmental dysplasia of the hip (DDH). Methods Between June 2016 and July 2020, 12 patients with Crowe type Ⅲ and Ⅳ DDH were treated with THA with acetabulum structural bone grafting using autogenous femoral head through DAA in lateral decubitus position. There were 2 males and 10 females with an average age of 60.2 years (range, 50-79 years). Crowe classification was type Ⅲ in 10 hips and type Ⅳ in 2 hips. The preoperative Harris score of hip joint was 48.8±7.5, the difference in length of both lower extremities was (3.0±0.7) cm, and the visual analogue scale (VAS) score during activity was 7.2±0.9. The surgical incision length, operation time, intraoperative blood loss, and complications were recorded; the position and press-fitting of acetabulum and femoral prosthesis were observed after operation, and the difference in length of both lower extremities was measured; the horizontal coverage of acetabular cup and bone graft were measured, the healing with the host bone and the loosening of the prosthesis were evaluated; Harris score was used to evaluate hip joint function, and VAS score was used to evaluate patients’ pain during activity. Results The average surgical incision length was 9.3 cm, the average operation time was 117 minutes, and the average intraoperative blood loss was 283 mL. Two patients (16.7%) received blood transfusion during operation. There was no acetabular and femoral fractures during operation. All incisions healed by first intention, without dislocation, periprosthetic infection, sciatic nerve injury, deep venous thrombosis, and other complications. One patient had lateral femoral cutaneous nerve injury after operation. X-ray films at discharge showed a total acetabular cup level coverage of 93%-100%, with an average of 97.8%, and a bone graft level coverage of 25%-45%, with an average of 31.1%. All the 12 patients were followed up 22-71 months, with an average of 42.2 months. At last follow-up, the Harris score of hip joint was 89.7±3.9, the difference in length of both lower extremities was (0.9±0.4) cm, and the VAS score during activity was 1.1±0.6, which were significantly different from those before operation (P<0.05). During follow-up, there was no patient who needed hip revision surgery because of prosthesis loosening. At last follow-up, there was no translucent line between the graft and the host bone, the graft was fused, the position was good, and there was no obvious movement. One patient had one screw fracture and bone resorption at the outer edge of the graft, but the bone graft did not displace and healed well. Conclusion THA with acetabulum structural bone grafting using autogenous femoral head through DAA in lateral decubitus position in the treatment of Crowe type Ⅲ and Ⅳ DDH is safe and reliable, and has satisfactory short-term effectiveness.

Citation： PEI Lijia, ZHOU Xinshe, WU Yifan, LIU Yang, XUE Yadong, MENG Fanyu, LIU Ben. Short-term effectiveness of structural bone graft and total hip arthroplasty through direct anterior approach in lateral decubitus position for Crowe type Ⅲ and Ⅳ developmental dysplasia of the hip. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(9): 1084-1089. doi: 10.7507/1002-1892.202205117 Copy

1.	Wang D, Li LL, Wang HY, et al. Long-term results of cementless total hip arthroplasty with subtrochanteric shortening osteotomy in Crowe type Ⅳ developmental dysplasia. J Arthroplasty, 2017, 32(4): 1211-1219.
2.	Ertilav D, Cavit A, Bilbaşar H, et al. Stepped osteotomy of femoral head autograft for acetabular reconstruction in total hip arthroplasty for dysplasia of the hip: 3 to 12 years’ results. Jt Dis Relat Surg, 2020, 31(2): 353-359.
3.	买买提明江·阿布来提, 吾湖孜·吾拉木, 张晓岗, 等. 结构性植骨在人工全髋关节置换术治疗HartofilakidisⅡ型发育性髋关节发育不良中的应用研究. 中国修复重建外科杂志, 2022, 36(2): 196-202.
4.	Free MD, Owen DH, Agius PA, et al. Direct anterior approach total hip arthroplasty: An adjunct to an enhanced recovery pathway: Outcomes and learning curve effects in surgeons transitioning from other surgical approaches. J Arthroplasty, 2018, 33(11): 3490-3495.
5.	Barrett WP, Turner SE, Murphy JA, et al. Prospective, randomized study of direct anterior approach vs posterolateral approach total hip arthroplasty: A concise 5-year follow-up evaluation. J Arthroplasty, 2019, 34(6): 1139-1142.
6.	Kaiser D, Ried E, Zingg PO, et al. Acetabular reconstruction with femoral head autograft in primary total hip arthroplasty through a direct anterior approach is a reliable option for patients with secondary osteoarthritis due to developmental dysplasia of the hip. Arch Orthop Trauma Surg, 2021. doi: 10.1007/s00402-021-04187-2.
7.	Vanlommel J, Sutter M, Leunig M. Total hip arthroplasty using the direct anterior approach and intraoperative neurophysiological monitoring for Crowe Ⅲ hip dysplasia: surgical technique and case series. Acta Orthop Belg, 2020, 86(1): 22-27.
8.	高建朋. 自体骨结构性植骨在治疗DDH髋臼骨缺损中的应用研究. 长春: 吉林大学, 2020.
9.	Gerber SD, Harris WH. Femoral head autografting to augment acetabular deficiency in patients requiring total hip replacement: A minimum five year and an average seven-year follow-up study. J Bone Joint Surg (Am), 1986, 68(8): 1241-1248.
10.	贾震宇, 刘永刚, 沈洪园, 等. 运用反锉装置行自体股骨头结构性植骨THA治疗CroweⅡ/Ⅲ型DDH的临床疗效. 中国骨与关节杂志, 2021, 10(8): 608-613.
11.	Tsukada S, Wakui M. Bulk femoral head autograft without decortication in uncemented total hip arthroplasty: seven- to ten-year results. J Arthroplasty, 2012, 27(3): 437-444.
12.	Kobayashi S, Saito N, Nawata M, et al. Total hip arthroplasty with bulk femoral head autograft for acetabular reconstruction in DDH. Surgical technique. J Bone Joint Surg (Am), 2004, 86-A Suppl 1: 11-17.
13.	Mulroy Jr RD, Harris WH. Failure of acetabular autogenous grafts in total hip arthroplasty. Increasing incidence:a follow-up note. J Bone Joint Surg (Am), 1990, 72(10): 1536-1540.
14.	Zahar A, Papik K, Lakatos J, et al. Total hip arthroplasty with acetabular reconstruction using a bulk autograft for patients with developmental dysplasia of the hip results in high loosening rates at mid-term follow-up. Int Orthop, 2014, 38(5): 947-951.
15.	Saito S, Ishii T, Mori S, et al. Long-term results of bulk femoral head autograft in cementless THA for developmental hip dysplasia. Orthopedics, 2011, 34(2): 88. doi: 10.3928/01477447-20101221-15.
16.	Maruyama M, Wakabayashi S, Ota H, et al. Reconstruction of the shallow acetabulum with a combination of autologous bulk and impaction bone grafting fixed by cement. Clin Orthop Relat Res, 2017, 475(2): 387-395.
17.	Viamont-Guerra MR, Chen AF, Stirling P, et al. The direct anterior approach for total hip arthroplasty for severe dysplasia (Crowe Ⅲ and Ⅳ) provides satisfactory medium to long-term outcomes. J Arthroplasty, 2020, 35(6): 1642-1650.
18.	Sako N, Kaku N, Kubota Y, et al. Iliac anatomy in women with developmental dysplasia of the hip: Measurements using three-dimensional computed tomography. J Orthop, 2021, 25: 1-5.
19.	Shen K, Feng E, Lin F, et al. Learning curve of total hip arthroplasty in direct anterior approach without requiring corrective osteotomy for hip dysplasia. Orthop Surg, 2022, 14(5): 840-850.
20.	冯尔宥, 肖莉莉, 沈凯魏, 等. 直接前方入路髋关节置换术的适应症和技术规范. 中华关节外科杂志 (电子版), 2021, 15(6): 773-780.
21.	周宏博, 罗正亮, 陈敏, 等. 全髋关节置换术直接前入路改良切口与股外侧皮神经损伤的解剖学研究. 中华解剖与临床杂志, 2021, 26(4): 387-390.

1. Wang D, Li LL, Wang HY, et al. Long-term results of cementless total hip arthroplasty with subtrochanteric shortening osteotomy in Crowe type Ⅳ developmental dysplasia. J Arthroplasty, 2017, 32(4): 1211-1219.
2. Ertilav D, Cavit A, Bilbaşar H, et al. Stepped osteotomy of femoral head autograft for acetabular reconstruction in total hip arthroplasty for dysplasia of the hip: 3 to 12 years’ results. Jt Dis Relat Surg, 2020, 31(2): 353-359.
3. 买买提明江·阿布来提, 吾湖孜·吾拉木, 张晓岗, 等. 结构性植骨在人工全髋关节置换术治疗HartofilakidisⅡ型发育性髋关节发育不良中的应用研究. 中国修复重建外科杂志, 2022, 36(2): 196-202.
4. Free MD, Owen DH, Agius PA, et al. Direct anterior approach total hip arthroplasty: An adjunct to an enhanced recovery pathway: Outcomes and learning curve effects in surgeons transitioning from other surgical approaches. J Arthroplasty, 2018, 33(11): 3490-3495.
5. Barrett WP, Turner SE, Murphy JA, et al. Prospective, randomized study of direct anterior approach vs posterolateral approach total hip arthroplasty: A concise 5-year follow-up evaluation. J Arthroplasty, 2019, 34(6): 1139-1142.
6. Kaiser D, Ried E, Zingg PO, et al. Acetabular reconstruction with femoral head autograft in primary total hip arthroplasty through a direct anterior approach is a reliable option for patients with secondary osteoarthritis due to developmental dysplasia of the hip. Arch Orthop Trauma Surg, 2021. doi: 10.1007/s00402-021-04187-2.
7. Vanlommel J, Sutter M, Leunig M. Total hip arthroplasty using the direct anterior approach and intraoperative neurophysiological monitoring for Crowe Ⅲ hip dysplasia: surgical technique and case series. Acta Orthop Belg, 2020, 86(1): 22-27.
8. 高建朋. 自体骨结构性植骨在治疗DDH髋臼骨缺损中的应用研究. 长春: 吉林大学, 2020.
9. Gerber SD, Harris WH. Femoral head autografting to augment acetabular deficiency in patients requiring total hip replacement: A minimum five year and an average seven-year follow-up study. J Bone Joint Surg (Am), 1986, 68(8): 1241-1248.
10. 贾震宇, 刘永刚, 沈洪园, 等. 运用反锉装置行自体股骨头结构性植骨THA治疗CroweⅡ/Ⅲ型DDH的临床疗效. 中国骨与关节杂志, 2021, 10(8): 608-613.
11. Tsukada S, Wakui M. Bulk femoral head autograft without decortication in uncemented total hip arthroplasty: seven- to ten-year results. J Arthroplasty, 2012, 27(3): 437-444.
12. Kobayashi S, Saito N, Nawata M, et al. Total hip arthroplasty with bulk femoral head autograft for acetabular reconstruction in DDH. Surgical technique. J Bone Joint Surg (Am), 2004, 86-A Suppl 1: 11-17.
13. Mulroy Jr RD, Harris WH. Failure of acetabular autogenous grafts in total hip arthroplasty. Increasing incidence:a follow-up note. J Bone Joint Surg (Am), 1990, 72(10): 1536-1540.
14. Zahar A, Papik K, Lakatos J, et al. Total hip arthroplasty with acetabular reconstruction using a bulk autograft for patients with developmental dysplasia of the hip results in high loosening rates at mid-term follow-up. Int Orthop, 2014, 38(5): 947-951.
15. Saito S, Ishii T, Mori S, et al. Long-term results of bulk femoral head autograft in cementless THA for developmental hip dysplasia. Orthopedics, 2011, 34(2): 88. doi: 10.3928/01477447-20101221-15.
16. Maruyama M, Wakabayashi S, Ota H, et al. Reconstruction of the shallow acetabulum with a combination of autologous bulk and impaction bone grafting fixed by cement. Clin Orthop Relat Res, 2017, 475(2): 387-395.
17. Viamont-Guerra MR, Chen AF, Stirling P, et al. The direct anterior approach for total hip arthroplasty for severe dysplasia (Crowe Ⅲ and Ⅳ) provides satisfactory medium to long-term outcomes. J Arthroplasty, 2020, 35(6): 1642-1650.
18. Sako N, Kaku N, Kubota Y, et al. Iliac anatomy in women with developmental dysplasia of the hip: Measurements using three-dimensional computed tomography. J Orthop, 2021, 25: 1-5.
19. Shen K, Feng E, Lin F, et al. Learning curve of total hip arthroplasty in direct anterior approach without requiring corrective osteotomy for hip dysplasia. Orthop Surg, 2022, 14(5): 840-850.
20. 冯尔宥, 肖莉莉, 沈凯魏, 等. 直接前方入路髋关节置换术的适应症和技术规范. 中华关节外科杂志 (电子版), 2021, 15(6): 773-780.
21. 周宏博, 罗正亮, 陈敏, 等. 全髋关节置换术直接前入路改良切口与股外侧皮神经损伤的解剖学研究. 中华解剖与临床杂志, 2021, 26(4): 387-390.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of structural bone graft and total hip arthroplasty through direct anterior approach in lateral decubitus position for Crowe type Ⅲ and Ⅳ developmental dysplasia of the hip

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