A PROSPECTIVE STUDY ON THE EARLY FINDINGS CEMENTLESS ACETABULAR COMPONENT WITH OR WITH OUT UPWARD IMPLANTATION IN HIP DYSPLASIA
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Abstract
The defective acetabulum makes total hip arthroplasty (THA) challenging in cases of developmental dysplasia of the hip (DDH). This study aimed to assess the anatomical and upward positioning differences of the acetabular component in the early stages. Forty DDH patients (Crowe I to III, 42 hips) were prospectively allocated to either the upward or anatomic group between April 2006 and June 2009 . From the time before surgery until a year following it, WOMAC and Harris scores were recorded. Age and body mass index (BMI), among other patient characteristics, did not differ significantly (P > 0.05). Surgery time, intraoperative blood loss, haemoglobin (Hb), blood transfusion, albumin decrease, and length of stay did not differ statistically significantly between the two groups; however, the anatomic group experienced significantly longer surgery times and blood losses among patients who received structural bone grafts. Although there was no difference in the postoperative limb-length discrepancy (LLD), the anatomic group's limb lengthening was superior (P = 0.042). Although there were no appreciable changes, the anatomic group's overall hospital expenses were greater. A suitable upward placement (less than 20 mm) that can achieve at least 70% native bone coverage of the acetabular implant is a useful technique for an early, quicker recovery. Acetabular reconstruction for DDH subluxation should be reconstructed as close to the actual acetabular location as possible.
References
2. Hendrich C, Mehling I, Sauer U, Kirschner S, Martell JM. Cementless acetabular reconstruction and structural bone-grafting in dysplastic hips. J Bone Jt Surg Am. 2006;88(February (2)):387-394.
3. Kaneuji A, Sugimori T, Ichiseki T, Yamada K, Fukui K, Matsumoto T. Minimum ten-year results of a porous acetabular component for Crowe I to III hip dysplasia using an elevated hip center. J Arthroplasty. 2009;24(February (2)):187-194.
4. Flecher X, Parratte S, Brassart N, Aubaniac J-M, Argenson J-N. Evaluation of the hip center in total hip arthroplasty for old developmental dysplasia. J Arthroplasty. 2008;23(December (8)):1189-1196.
5. Hirakawa K, Mitsugi N, Koshino T, Saito T, Hirasawa Y, Kubo T. Effect of acetabular cup position and orientation in cemented total hip arthroplasty. Clin Orthop Relat Res. 2001;388(July):135-142.
6. Takao M, Ohzono K, Nishii T, Miki H, Nakamura N, Sugano N. Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia. J Bone JtSurgAm. 2011;93(March (6)):548- 555.
7. 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(March (3)):e313-e318
8. Russotti GM, Harris WH. Proximal placement of the acetabular component in total hip arthroplasty: a long-term follow-up study. J Bone Jt Surg Am. 1991 Apr;73(4):587-592.
9. Zhang Z, Fu M, Kang Y, Chen Y, Liao W. Upward and inward displacements of the acetabular component increase stress on femoral head in single endoprothesis models. Int Orthop. 2010;34(April (4)):479-483.
10. Johnston RC, Brand RA, Crowninshield RD. Reconstruction of the hip: a mathematical approach to determine optimum geometric relationships. J Bone Joint SurgAm. 1979;61(July (5)):639-652.
11. Pagnano W, Hanssen AD, Lewallen DG, Shaughnessy WJ. The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty. J Bone Jt SurgAm. 1996;78(July (7)):1004-1014.
12. Koh KH, Moon YW, Lim SJ, Lee HI, Shim JW, Park YS. Complete acetabular cup revision versus isolated liner exchange for polyethylene wear and osteolysis without loosening in cementless total hip arthroplasty. Arch Orthop Trauma Surg. 2011 Nov;131(11):1591-600. Epub 2011 Jun 19.
13. Bonner KF, Delanois RE, Harbach G, Bushelow M, Mont MA. Cementation of a polyethylene liner into a metal shell. Factors related to mechanical stability. J Bone Joint Surg Am. 2002 Sep;84(9):1587-93.
14. Hofmann AA, Prince EJ, Drake FT, Hunt KJ. Cementation ofa polyethylene liner into a metal acetabular shell: a biomechanical study. J Arthroplasty. 2009 Aug;24(5):775-82. Epub 2008 Aug 12.
15. Wang JP, Chen WM, Chen CF, Chiang CC, Huang CK, Chen TH. Cementation of cross-linked polyethylene liner into well-fixed acetabular shells: mean 6-year follow¬up study. J Arthroplasty. 2010 Apr;25(3):420-4.
16. Yoon TR, Seon JK, Song EK, Chung JY, Seo HY, Park YB. Cementation ofa metal¬inlay polyethylene liner into a stable metal shell in revision total hip arthroplasty. J Arthroplasty. 2005 Aug;20(5):652-7.
17. O’Brien JJ, Burnett RS, McCalden RW, MacDonald SJ, Bourne RB, Rorabeck CH. Isolated liner exchange in revision total hip arthroplasty: clinical results using the direct lateral surgical approach. J Arthroplasty. 2004 Jun;19(4):414-23.
18. Lawless BM, Healy WL, Sharma S, Iorio R. Outcomes of isolated acetabular revision. Clin Orthop Relat Res. 2010 Feb;468(2):472-9.
19. Hallstrom BR, Golladay GJ, Vittetoe DA, Harris WH. Cementless acetabular revision with the Harris-Galante porous prosthesis. Results after a minimum of ten years of follow-up. J Bone Joint Surg Am. 2004 May;86(5):1007-11.
20. Lian YY, Yoo MC, Pei FX, Kim KI, Chun SW, Cheng JQ. Cementless hemispheric acetabular component for acetabular revision arthroplasty: a 5- to 19-year follow-up study. J Arthroplasty. 2008 Apr;23(3):376-82. Epub 2007 Oct 24.
21. Sun C, Lian YY, Jin YH, Zhao CB, Pan SQ, Liu XF. Clinical and radiographic assessment of cementless acetabular revision with morsellised allografts. Int Orthop. 2009 Dec;33(6):1525-30. Epub 2009 Feb 26.
22. Lubbeke A, Katz JN, Perneger TV, Hoffmeyer P. Primary and revision hip ar¬throplasty: 5-year outcomes and influence of age and comorbidity. J Rheumatol. 2007 Feb;34(2):394-400. Epub 2006 Nov 15.
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Singh Manvendra Pratap
Associate Professor, Department of Orthopaedics, ERA'S Lucknow Medical College and Hospital, Sarfarazganj Hardoi Raod, Lucknow