Revision Hip Arthroplasty with Initially High Position of the Acetabular Component: What’s Special?

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Abstract

Relevance. Total hip arthroplasty with a severe dysplasia refers to complex cases of joint replacement. One of the options for fixation of the acetabular component in this situation is to place the cup in the false acetabulum. Revisions in case of the acetabular component initial placement into the false acetabulum are highly complex. The purpose — to study the features of revision hip arthroplasty in the patients with dysplastic arthritis and loosening of the acetabular component initially placed in the false acetabulum. Materials and Methods. The clinical and functional results and complications were evaluated after 44 revisions performed by one surgical team from 2001 to 2019. How the position of vertical and horizontal centers of rotation of acetabular component after primary arthroplasty influenced the long-term survival of implants was analyzed. The degree of impact of the preoperative cranial displacement from the anatomical position of the femoral component center of rotation impact on surgical tactics was also investigated. Results. A combination of a highly porous cup with augment was used most frequently for acetabular component replacement (24 cases; 54.5%). Complications after the revision were detected in 6 (13.6%) patients. The values of the Oxford Hip Score, EQ-5D, VAS general health, and VAS pain depended on the postoperative position of the hip prosthesis center of rotation within 10 mm from the anatomical center. The odds ratio for the revision performed less than 10 years after the primary arthroplasty in the patients with a horizontal position of the center of rotation of 40 mm or more was equal to 14.571 (95% CI from 1.682 to 126.249; p = 0.011). The average value of the distal displacement of the center of rotation after the surgery was 32.0 mm (min-max 4.7 to 90.3 mm; Me 23.9 mm), the average residual displacement of the center of rotation after the surgery was 6.2 mm (min-max 10.8 to 32.1 mm; Me 4.75 mm). The standard approach was characterized by a lesser distal displacement of the center of rotation than various osteotomy options: 26.1 mm (min-max 4.7 to 77.2; Me 19.1 mm) vs 41.2 mm (min-max 10.8 to 90.3 mm; Me 36 mm), respectively (p = 0.021). A well-fixed stem preservation resulted in the mean distal displacement of the femur of 23.8 mm, the stem removed — of 35.0 mm. Conclusion. A horizontal center of rotation displacement of 40 mm or more affects the long-term survival of the implant. When the significant lowering of the femur is required (more than 30 mm) and a well-fixed femoral component is preserved, it is advisable to use the approach with extended trochanteric osteotomy or shortening femoral osteotomy. The acetabular component placement into the true acetabulum with weakened bone requires extended screw fixation. In this situation the use of individual 3D-printed implants has potential benefits.

About the authors

R. M. Tikhilov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: rtikhilov@gmail.com
ORCID iD: 0000-0003-0733-2414

Rashid M. Tikhilov — Dr. Sci. (Med.), Professor, Director

St. Petersburg

Россия

A. A. Dzhavadov

Vreden National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: alisagib.dzhavadov@mail.ru
ORCID iD: 0000-0002-6745-4707

Alisagib A. Dzhavadov — Research Assistant

St. Petersburg

Россия

A. S. Karpukhin

Vreden National Medical Research Center of Traumatology and Orthopedics; Federal Center of Traumatology, Orthopedics and Arthroplasty

Email: fake@neicon.ru
ORCID iD: 0000-0002-4525-2135

Aleksey S. Karpukhin — Orthopedic Surgeon, Vreden National Medical Research Center of Traumatology and Orthopedics; Head of Department, Federal Center of Traumatology, Orthopedics and Arthroplasty

St. Petersburg
Cheboksary 

Россия

A. G. Vahramyan

Shengavit Medical Center

Email: vagramian@mail.ru
ORCID iD: 0000-0002-1060-7506

Arsen G. Vahramyan — Head of Traumatology and Orthopedics Service

Yerevan

Армения

K. A. Demyanova

Kirov Military Medical Academy

Email: fake@neicon.ru
ORCID iD: 0000-0002-2239-2792

Kseniya A. Demyanova — Student

St. Petersburg

Россия

I. I. Shubnyakov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: shubnyakov@mail.ru
ORCID iD: 0000-0003-0218-3106

Igor I. Shubnyakov — Deputy Director

St. Petersburg

Россия

References

  1. Hartofilakidis G., Karachalios T. Total hip arthroplasty for congenital hip disease. J Bone Joint Surg Am. 2004;86(2):242250. doi: 10.2106/00004623-200402000-00005.
  2. Dapuzzo M.R., Sierra R.J. Acetabular considerations during total hip arthroplasty for hip dysplasia. Orthop Clin North Am. 2012;43(3):369-375. doi: 10.1016/j.ocl.2012.05.012.
  3. Greber E.M., Pelt C.E., Gililland J.M., Anderson M.B., Erickson J.A., Peters C.L. Challenges in Total Hip Arthroplasty in the Setting of Developmental Dysplasia of the Hip. J Arthroplasty. 2017;32(9S):38-44. doi: 10.1016/j.arth.2017.02.024.
  4. Gustke K. The dysplastic hip: not for the shallow surgeon. Bone Joint J. 2013;95-B(11 Suppl A):31-36. doi: 10.1302/0301-620X.95B11.32899
  5. Тихилов Р.М., Шубняков И.И., Денисов А.О., Плиев Д.г., Шубняков М.И., Ваграмян А.г., Авдеев А.И. Имеется ли клинический смысл в разделении врожденного вывиха бедра у взрослых на типы C1 и C2 по Hartofilakidis? Травматология и ортопедия России. 2019;25(3):9-24. doi: 10.21823/2311-2905-2019-25-3-9-24.
  6. Абельцев В.П. Диспластический коксартроз: спираль развития его лечения. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2015;(4):9-15.
  7. Schutzer S.F., Harris W.H. High placement of porouscoated acetabular components in complex total hip arthroplasty. J Arthroplasty. 1994;9(4):359-367. doi: 10.1016/0883-5403(94)90045-0.
  8. Tözün I.R., Beksaç B., Sener N. [Total hip arthroplasty in the treatment of developmental dysplasia of the hip]. Acta Orthop Traumatol Turc. 2007;41 Suppl 1:80-86. (In Turkish).
  9. Montalti M., Castagnini F., Giardina F., Tassinari E., Biondi F., Toni A. Cementless Total Hip Arthroplasty in Crowe III and IV Dysplasia: High Hip Center and Modular Necks. J Arthroplasty. 2018;33(6):1813-1819. doi: 10.1016/j.arth.2018.01.041.
  10. Chen M., Luo Z.L., Wu K.R., Zhang x.Q., Ling x.D., Shang x.F. Cementless Total Hip Arthroplasty With a High Hip Center for Hartofilakidis Type B Developmental Dysplasia of the Hip: Results of Midterm Follow-Up. J Arthroplasty. 2016;31(5):1027-1034. doi: 10.1016/j.arth.2015.11.009.
  11. Jerosch J., Steinbeck J., Stechmann J., Güth V. Influence of a high hip center on abductor muscle function. Arch Orthop Trauma Surg. 1997;116(6-7):385-389. doi: 10.1007/BF00433996.
  12. Johnston R.C., Brand R.A., Crowninshield R.D. Reconstruction of the hip. A mathematical approach to determine optimum geometric relationships. J Bone Joint Surg Am. 1979;61(5):639-652.
  13. Fukushi J.I., Kawano I., Motomura G., Hamai S., Kawaguchi K.I., Nakashima y. Does hip center location affect the recovery of abductor moment after total hip arthroplasty? Orthop Traumatol Surg Res. 2018;104(8):1149-1153. doi: 10.1016/j.otsr.2018.06.022.
  14. Pagnano W., Hanssen A.D., Lewallen D.G., Shaughnessy W.J. The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty. J Bone Joint Surg Am. 1996;78(7):10041014. doi: 10.2106/00004623-199607000-00004.
  15. Watts C.D., Abdel M.P., Hanssen A.D., Pagnano M.W. Anatomic Hip Center Decreases Aseptic Loosening Rates After Total Hip Arthroplasty with Cement in Patients with Crowe Type-II Dysplasia: A Concise Follow-up Report at a Mean of Thirty-six years. J Bone Joint Surg Am. 2016;98(11):910-915. doi: 10.2106/JBJS.15.00902.
  16. Dearborn J.T., Harris W.H. High placement of an acetabular component inserted without cement in a revision total hip arthroplasty. Results after a mean of ten years. J Bone Joint Surg Am. 1999;81(4):469-480. doi: 10.2106/00004623-199904000-00004.
  17. Tanzer M. Role and results of the high hip center. Orthop Clin North Am. 1998;29(2):241-247. doi: 10.1016/s0030-5898(05)70322-9.
  18. Nie y., Pei F., Li Z. Effect of high hip center on stress for dysplastic hip. Orthopedics. 2014;37(7):e637-e643. doi: 10.3928/01477447-20140626-55.
  19. Bozic K.J., Freiberg A.A., Harris W.H. The high hip center. Clin Orthop Relat Res. 2004;(420):101-105. doi: 10.1097/00003086-200403000-00014.
  20. Russotti G.M., Harris W.H. Proximal placement of the acetabular component in total hip arthroplasty. A long-term follow-up study. J Bone Joint Surg Am. 1991;73(4):587-592.
  21. Doehring T.C., Rubash H.E., Shelley F.J, Schwendeman L.J, Donaldson T.K., Navalgund y.A. Effect of superior and superolateral relocations of the hip center on hip joint forces. An experimental and analytical analysis. J Arthroplasty. 1996;11(6):693-703. doi: 10.1016/s0883-5403(96)80008-8.
  22. 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(2):187-194. doi: 10.1016/j.arth.2007.08.004.
  23. Christodoulou N.A., Dialetis K.P., Christodoulou A.N. High hip center technique using a biconical threaded Zweymüller cup in osteoarthritis secondary to congenital hip disease. Clin Orthop Relat Res. 2010;468(7):1912-1919. doi: 10.1007/s11999-009-1203-1.
  24. Nawabi D.H., Meftah M., Nam D., Ranawat A.S., Ranawat C.S. Durable fixation achieved with medialized, high hip center cementless THAs for Crowe II and III dysplasia. Clin Orthop Relat Res. 2014;472(2):630-636. doi: 10.1007/s11999-013-3187-0.
  25. Galea V.P., Laaksonen I., Donahue G.S., Fukui K., Kaneuji A., Malchau H., Bragdon C. Developmental Dysplasia Treated With Cementless Total Hip Arthroplasty Utilizing High Hip Center Reconstruction: A Minimum 13-year Followup Study. J Arthroplasty. 2018;33(9):2899-2905. doi: 10.1016/j.arth.2018.04.037.
  26. Liu B., Gao y.H., Ding L., Li S.Q., Liu J.G., Qi x. Computed Tomographic Evaluation of Bone Stock in Patients With Crowe Type III Developmental Dysplasia of the Hip: Implications for Guiding Acetabular Component Placement Using the High Hip Center Technique. J Arthroplasty. 2018;33(3):915-918. doi: 10.1016/j.arth.2017.10.021.
  27. Zheng L.L., Lin y.y., Zhang x.y., Ling Q.H., Liao W.M., Wu P.H. Best bone of acetabulum for cup component placement in Crowe types I to III dysplastic hips: a computer simulation study. Chin Med J (Engl). 2019;132(23):2820-2826. doi: 10.1097/CM9.0000000000000527.
  28. Karaismailoglu B., Kaynak G., Can A., Ozsahin M.K., Erdogan F. Bilateral High Hip Center Provides Gait Parameters Similar to Anatomical Reconstruction: A Gait Analysis Study in Hip Replacement Patients With Bilateral Developmental Dysplasia. J Arthroplasty. 2019;34(12):3099-3105. doi: 10.1016/j.arth.2019.06.063.
  29. Волокитина Е.А., Колотыгин Д.А. Особенности первичной и ревизионной имплантации бесцементного тазового компонента при диспластическом коксартрозе. Травматология и ортопедия России. 2009;(3):119-121.
  30. Ranawat C.S., Dorr L.D., Inglis A.E. Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. J Bone Joint Surg. Am. 1980;62(7):1059-1065.
  31. Артюх В.А., Базаров И.С., Карагодина М.П. Рентгенологическая оценка результатов эндопротезирования тазобедренного сустава. В кн.: Руководство по хирургии тазобедренного сустава. Под ред. Р.М. Тихилова, И.И. Шубнякова. СПб.: РНИИТО им. Р.Р. Вредена; 2014. Т. 2. С. 126.
  32. Rogers B. A., Garbedian S., Kuchinad R. A., Backstein D., Safir O., Gross A.E. Total Hip Arthroplasty for Adult Hip Dysplasia. J Bone Joint Surg. 2012;94(19):1809-1821. doi: 10.2106/jbjs.k.00779.
  33. Eskelinen A. Cementless Total Hip Arthroplasty in Patients with High Congenital Hip Dislocation. J Bone Joint Surg. 2006;88(1):80-91. doi: 10.2106/JBJS.E.00037.
  34. Erdemli B. yilmaz, C., Atalar, H., Güzel B., Cetin I. Total Hip Arthroplasty in Developmental High Dislocation of the Hip. J Arthroplasty. 2005;20(8):1021-1028.
  35. Туренков С.В., Ахтямов И.Ф. Анализ результатов хирургического лечения диспластического коксартроза различными вариантами тотального эндопротезирования тазобедренного сустава. Гений ортопедии. 2003;(2):19-23.
  36. Komiyama K., Nakashima y., Hirata M., Hara D., Kohno y., Iwamoto y. Does high hip center decrease range of motion in total hip arthroplasty? A computer simulation study. J Arthroplasty. 2016;31(10):234-2347. doi: 10.1016/j.arth.2016.03.014.
  37. Yoder S.A, Brand R.A., Pedersen D.R., O’Gorman T.W. Total hip acetabular component position affects component loosening rates. Clin Orthop Relat Res. 1988;(228):79-87.

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