Abstract
BackgroundThe purpose of this study was to investigate the relationship between the three dimensional (3D) femoral head displacement in patients with developmental dysplasia of the hip (DDH) and Crowe classification.MethodsRetrospectively, CT scans of 60 DDH patients and 55 healthy demography-matched healthy control subjects were analyzed. Using the anterior pelvic plane a pelvic anatomic coordinate system was established. The center coordinates of the femoral heads of both the DDH patients and control subjects were quantified relative to the pelvic coordinate system and were mapped proportionally to a representative normal pelvis for comparison.ResultsIn the anteroposterior (AP) direction, the center of the femoral head was significantly more anterior in the DDH patients (type I, II, and III, respectively45.0 ± 5.5, 42.9 ± 7.1, and 43.9 ± 4.6 mm) when compared to the controls (50.0 ± 5.2 mm) (p < 0.001 for all). In the medial-lateral (ML) direction, the center of the femoral head was significantly more lateral in the DDH patients (type I, II, and III =103.5 ± 8.6, 101.5 ± 6.6, 102.1 ± 11.2 mm) when compared to the controls (87.5 ± 5.1 mm) (p < 0.001 for all). In the superior-inferior (SI) direction, the center of the femoral head was significantly more proximal in the DDH patients (type I, II, and III =62.4 ± 7.3, 50.0 ± 6.3, and 43.2 ± 6.6 mm) when compared to the controls (66.0 ± 6.2 mm) (p < 0.001 for all).ConclusionsThe severity of DDH using the Crowe classification was related to the degree of the femoral head displacement in the SI direction, but not in the ML or AP directions. By assessing the 3D femoral head displacement in DDH patients, individualized component positioning might benefit surgical outcome.
Highlights
Total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH) is technically difficult and challenging due to severe deformity and anterolateral bone deficiency [1]
In the anterior-posterior (AP) direction, the center of the femoral heads of the DDH patients were significantly (p < 0.001) more anterior t when compared to the healthy controls (50.0 ± 5.2 mm, Table 2, Fig. 3a&d)
The severity of DDH using the Crowe classification was related to the degree of the femoral head displacement in the SI direction, but not in the ML or AP directions
Summary
Total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH) is technically difficult and challenging due to severe deformity and anterolateral bone deficiency [1]. The Crowe classification considers the distance from the femoral head center to the inferior margin of the acetabulum (i.e., the acetabular teardrop) on a plain anterior-posterior (AP) radiograph to categorize the value of femoral head displacement. The Crowe classification is a two-dimensional (2D) assessment and may, be unable to reflect 3dimensional (3D) morphological changes of the femoral head, especially deformities in the AP direction. The purpose of this study was to investigate the relationship between the three dimensional (3D) femoral head displacement in patients with developmental dysplasia of the hip (DDH) and Crowe classification
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