Abstract
The high hip center technique (HHC) is considered to be feasible for acetabular reconstruction in patients with DDH, but there is little in-depth study of its specific impact on Crowe type II and III DDH. The purpose of this study was to simultaneously analyze the effect of HHC on bone coverage of the cup (CC) in the acetabular reconstruction of type II and III DDH patients and to propose a map of acetabular bone defects from the perspective of the cup. Forty-nine hip CT data of 39 patients with DDH (Crowe type II and III) were collected to simulate acetabular reconstruction by cup models of different sizes (diameter 38mm–50 mm, 2 mm increment) with the HHC technique. The frequency distribution was plotted by overlapping the portions of the 44 mm cups that were not covered by the host bone. The mean CC of cups with sizes of 38 mm, 40 mm, 42 mm, 44 mm, 46 mm, 48 mm, and 50 mm at the true acetabula were 77.85%, 76.71%, 75.73%, 74.56%, 73.68%, 72.51%, and 71.75%, respectively, and the maximum CC increments were 21.24%, 21.58%, 20.86%, 20.04%, 18.62%, 17.18%, and 15.42% (P < 0.001), respectively, after the cups were elevated from the true acetabula. The bone defect map shows that 95% of type II and III DDH acetabula had posterosuperior bone defects, and approximately 60% were located outside the force line of the hip joint. Acetabular cups can meet a CC of more than 70% at the true acetabulum, and approximately 60% of Crowe type II and III DDH patients can obtain satisfactory CC at the true acetabulum by using a 44-mm cup without additional operations.
Highlights
The best approach for placement of the acetabular component in total hip arthroplasty (THA) remains controversial for patients with developmental dysplasia of the hip (DDH), especially for those with Crowe type II and type III
The coverage of the cup (CC) of all cups with different sizes at the true acetabulum was greater than 70%, and as the acetabular cups elevated from the true acetabulum, the CC gradually increased until reaching the maximum and decreased gradually to below 70% (Fig. 2)
The CC values were positively correlated with elevated height for cups with sizes of 38 mm, 40 mm, 42 mm, 44 mm, 46 mm, 48 mm, and 50 mm, and the Pearson’s correlation coefficients were 0.9961, 0.9967, 0.9959, 0.9936, 0.9889, 0.9858, and 0.9821, respectively, indicating that the correlation between CC and elevated height was almost linear in all cups (Fig. 3)
Summary
The best approach for placement of the acetabular component in total hip arthroplasty (THA) remains controversial for patients with developmental dysplasia of the hip (DDH), especially for those with Crowe type II and type III. Characteristic Number of patients (hips) Gender (male/female) Age (Years)a Height (cm)a Weight (kg)a BMI (body mass index, kg/m2)a Unilateral(left/right) Bilateral Crowe type (number of hips) II III be required for in situ acetabular r econstruction[17] These studies did not conduct in-depth research on acetabular reconstruction evaluation of type II and type III DDH. To the best of the authors’ knowledge, no study has introduced the concept of fracture maps into the field of joint replacement and related research and investigated the distribution of acetabular bone defects in patients with type II and type III DDH from the perspective of uncovered acetabular cups. The map can be used to guide surgeons to reconstruct the acetabula in patients with Crowe type II and type III DDH in clinical work
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