Is the Any Clinical Importance for Separation Congenitally Dislocated Hip in Adults into Types C1 and C2 by Hartofilakidis?

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Abstract

The main questions of the study: 1) is there any difference in anatomical features between subtypes C1 and C2 of high hip dislocation by Hartofolakidis classification; 2) are the conditions for performing the THA different and what are the surgical decisions; 3) what are the THA results in different groups? Materials and Methods. In a single center study the authors retrospectively evaluated the outcomes of 561 THAs performed in 349 patients with a high hip dislocation including 32 men (9.2%) and 317 women (90.8%) with the follow up from 12 to 188 months (average 69,4 months). In 326 cases (58.1%) the dislocation was assessed as type C1, and in 235 cases (41.9%) — as type C2. The average age of the patients at the time of surgery was 47.6 (19 to 74) years, for men — 39.1 years and 48.1 years for women. Results. Paavilainen shortening osteotomy was performed in 100% of patients with type C2 and only in 50.6% of patients with type C1, p<0.001. The cup was implanted into the true acetabulum cavity in 99.1% of cases with type C2, and for type C1 only in 69.0% of cases, p<0.001. Lateral under-coverage of the cup in patients with type C2 required supplementing by femoral head autograft only in three cases, and for type C1 — in 18 patients, p = 0.009. In the group of C2, the mean length of the osteotomized fragment of the proximal femur was 78.6 mm compared to 62.5 mm in patients with type C1. This provided a better contact area between the greater trochanter and the femur and in 92.8% of cases fixation was done by cerclage wires and two screws. In the group of patients with type C1, this option was feasible only in 60.0% of cases. Odds ratio (OR) for fixation of the greater trochanter by a special plate for primary indications in patients with type C1 were 10 367, p = 0.008. Harris Hip score improved averaged from 39.5 points to 83.6, without statistically significant differences between groups of C1 and C2. Early complications included 9 dislocations (1.6%), 8 cases of femoral nerve neuropathy (1.4%) and 3 early infections (0.5%). No cases of sciatic nerve paresis were observed. Non-union of the greater trochanter was observed with almost equal frequency in patients with C1 and C2 types, and revision fixation was needed in 27 patients (6.8%). Revision arthroplasty was performed in 22 cases (3.9%) due to 4 infections, 2 aseptic loosening of the stem, 11 aseptic loosening of the acetabular component and 5 recurrent dislocations. Conclusion. The group of patients with high hip dislocation is very heterogenic in terms of severity of anatomical changes and demands different surgical tactics. Hartofolakidis classification helps the surgeon to select the best type of the surgical procedure, minimize the mistakes and predict treatment outcomes.

About the authors

R. M. Tikhilov

Vreden Russian Research Institute of Traumatology and Orthopedics;
Mechnikov North-Western State Medical University

Email: fake@neicon.ru

Dr. Sci. (Med.), Professor, Director,
professor, Traumatology and Orthopedics Department

St. Petersburg

Russian Federation

I. I. Shubnyakov

Vreden Russian Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: shubnyakov@mail.ru

Dr. Sci. (Med.), Chief Researcher

St. Petersburg

Russian Federation

A. O. Denisov

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Cand. Sci. (Med.), Academic Secretary

St. Petersburg

Russian Federation

D. G. Pliev

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Cand. Sci. (Med.), Head of the Hip Pathology Department

St. Petersburg

Russian Federation

M. I. Shubnyakov

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Researcher, Hip Pathology Department

St. Petersburg

Russian Federation

A. G. Vahramyan

Shengavit Medical Center

Email: fake@neicon.ru

Head of Traumatology and Orthopedics Service

Yerevan

Armenia

A. I. Avdeev

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

PhD Student

St. Petersburg

Russian Federation

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CrossRef: 4

  1. Mazurenko AV, Shubnyakov II. Comment to the Article “Comparative Assessment of Subtrochanteric Shortening Osteotomy and Paavilainen’s Proximal Osteotomy in Total Hip Arthroplasty for Crowe III–IV Dysplasia”. Traumatology and Orthopedics of Russia. 2020;26(1):36. doi: 10.21823/2311-2905-2020-26-1-36-39
  2. Tikhilov RM, Dzhavadov AA, Karpukhin AS, Vahramyan AG, Demyanova KA, Shubnyakov II. Revision Hip Arthroplasty with Initially High Position of the Acetabular Component: What’s Special?. Traumatology and Orthopedics of Russia. 2020;26(3):9. doi: 10.21823/2311-2905-2020-26-3-9-20
  3. Shubnyakov II, Tikhilov RM, Denisov AO, Akhmedilov MA, Cherny AZ, Totoev ZA, et al. What Has Changed in the Structure of Revision Hip Arthroplasty?. Traumatology and Orthopedics of Russia. 2019;25(4):9. doi: 10.21823/2311-2905-2019-25-4-9-27
  4. Shubnyakov II, Riahi A, Shubnyakov MI, Denisov AO, Khujanazarov IE, Tikhilov RM. Cementless Hip Implants: History and Current Status of the Issue. Traumatology and Orthopedics of Russia. 2020;26(2):160. doi: 10.21823/2311-2905-2020-26-2-160-179

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