Postoperative radiographic evaluation and simulation study for optimal cup placement in high-hip centre total hip arthroplasty.

Abstract

Achieving favourable outcomes in high-hip centre reconstruction in hip dysplasia requires the optimal cup height and size, which can provide sufficient bone coverage for stable cup fixation that fits the anteroposterior acetabular rim without increasing the cup height more than necessary. We retrospectively reviewed 214 patients who underwent primary total hip arthroplasty (THA) and identified 30 hips with Crowe II (n = 15) or III (n = 15) developmental dysplasia of the hip (DDH). We measured the cup-centre-edge angle (cup-CE) and the vertical and horizontal distances from the teardrop. In a simulation study, we examined the cup-CE and optimal cup size by changing the cup height in 5-mm increments over a distance of 15-40 mm above the inter-teardrop line using a 3-dimensional template system. Postoperative radiographic evaluation revealed a mean cup-CE of 19.9° in Crowe II hips and 15.2° in Crowe III hips; the respective mean vertical distances were 26.6 mm and 27.6 mm (p = 0.511). There was no evidence of cup loosening or lateralisation at a minimum of 7 years (7-11 years) follow-up. Simulation showed that the hip centre needed to be elevated to 20 mm to acquire a cup-CE of more than 0°. More than 10° of cup-CE could be expected by elevating the hip centre to 25 mm in both Crowe II and III. Even in severe DDH, a high-hip centre positioned approximately 25 mm superior to the inter-teardrop line was sufficient to achieve optimal bone coverage, which could lead to more secure cup fixation.