BACKGROUNDDevelopmental dysplasia encompasses a wide spectrum of hip pathology ranging from a shallow acetabulum to a completely dislocated 'high-riding' hip. It is a common cause of secondary osteoarthritis in young adults and is the underlying diagnosis in up to 48% of patients requiring total hip arthroplasty (THA) for coxarthrosis. The aim of this study was to evaluate efficiency and safety of THA using Zweymüller hip implant in the treatment of severe osteoarthritis secondary to developmental dysplasia of the hip (DDH) in adults.

METHODSFrom January 2000 to February 2008, 35 patients (40 hips) with developmental dysplasia of the hip were included. Five were male and 30 were female, with ages ranging from 26 to 65 years and an average age of 45 years. According to Hartofilakidis classification, there were type I in 5 hips, type II in 20 hips, type III in 15 hips. All the patients were performed the THA using the Zweymüller hip implant. The preoperative average Harris score was 44. The bilateral arthroplasty was performed in 5 patients and the unilateral arthroplasty in 30 patients. The patients mainly suffered from pain and claudication. Clinical and radiological results were analyzed. The Harris score was used for outcome measurement.

RESULTSThirty five patients (40 hips) were followed and the mean follow-up period was 46 months (ranged from 24 months to 96 months). The latest follow-up average Harris score was 88.9 (97.1% of good rate). All the patients were pain-free and there was no sign of infection, aseptic loosening and subsidence.

CONCLUSIONSIn summary, THA using Zweymüller hip implant is a good treatment method for severe osteoarthritis secondary to DDH in adults. The key techniques for the total hip replacement are as follows: good preoperative plan, firmly placing the acetabular component in the true acetabulum, proper preparation of proximal femur, suitable femoral component choosing and improving the techniques of the bone graft.

Adult ; Aged ; Arthroplasty, Replacement, Hip ; methods ; Hip Prosthesis ; Humans ; Middle Aged ; Osteoarthritis, Hip ; surgery

Total hip arthroplasty in the young leads to difficult choices in implant selection. Until recently bone conserving options were not available for younger patients with deficient femoral head bone stock. The novel Birmingham Mid-Head Resection (BMHR) device offers the option of bone conserving arthroplasty in spite of deficient femoral head bone stock. Femoral neck fracture is a known complication of standard resurfacing arthroplasty and is the most common reason for revision. It is unknown whether this remains to be the case for the BMHR neck preserving implants. We report a case of a 57-year-old male, who sustained a periprosthetic fracture following surgery with a BMHR arthroplasty. This paper illustrates the first reported case of a BMHR periprosthetic fracture. The fracture pattern is spiral in nature and reaches to the subtrochanteric area. This fracture pattern is different from published cadaveric studies, and clinicians using this implant should be aware of this as revision is likely to require a distally fitting, rather than a metaphyseal fitting stem. We have illustrated the surgical technique to manage this rare complication.
Accidental Falls ; Arthroplasty, Replacement, Hip/*methods ; Humans ; Male ; Middle Aged ; Osteoarthritis, Hip/surgery ; *Periprosthetic Fractures

OBJECTIVEThe present study aimed to review the characteristics and influencing factors of squeaking after ceramic-on-ceramic (CoC) total hip arthroplasty (THA) and to analyze the possible mechanisms of the audible noise.

DATA SOURCESThe data analyzed in this review were based on articles from PubMed and Web of Science.

STUDY SELECTIONThe articles selected for review were original articles and reviews found based on the following search terms: "total hip arthroplasty", "ceramic-on-ceramic", "hip squeaking", and "hip noise."

RESULTSThe mechanism of the squeaking remains unknown. The possible explanations included stripe wear, edge loading, a third body, fracture of the ceramic liner, and resonance of the prosthesis components. Squeaking occurrence is influenced by patient, surgical, and implant factors.

CONCLUSIONSMost studies indicated that squeaking after CoC THA was the consequence of increasing wear or impingement, caused by prosthesis design, patient characteristics, or surgical factors. However, as conflicts exist among different articles, the major reasons for the squeaking remain to be identified.

Arthroplasty, Replacement, Hip ; adverse effects ; Ceramics ; therapeutic use ; Hip Prosthesis ; Humans ; Noise ; adverse effects ; Osteoarthritis, Hip ; surgery

OBJECTIVETo discuss the early clinical results and risk factors of modified Colonna capsular arthroplasty for young patients with unilateral hip dislocation.

METHODSFrom July 2011 to February 2013, 25 cases (25 hips) of modified Colonna capsular arthroplasty for unilateral hip dislocation in the 1st affiliated hospital of People's Liberation Army General hospital was collected, including 7 males, 18 females; aged 9.7-25.8 years, averaging 17.8 years; left 12 cases, right 13 cases; Body mass index ranged 15.6-29.6 kg/m², averaging 20.9 kg/m². Clinical indexes were collected, including: range of motion (ROM) of the hip, the Harris Hip Score (HHS), West Ontario and McMaster University Osteoarthritis Index (WOMAC), visual analogue scale (VAS) score before and after surgery, along with the satisfaction score of the surgery, Severin grades, and Tönnis osteoarthritis grades at last follow-up. Paired t-test was applied for the indexes before and after surgery, variances components analysis was applied for the satisfaction score and the function scores at last follow-up compared in 2 groups, aging at surgery <16 years (15 cases) and ≥ 16 years (10 cases).

RESULTSAll cases were followed up for 12-18 months, mean 13.4 months. The average hip ROM decreased from 380° in average pre-surgery to 200° in average at last follow-up. Indexes decreased comparing 9 months follow-up to pre-surgery, HHS(78 ± 9 vs. 84 ± 15, t = 2.107, P = 0.046), WOMAC function score(14.8 ± 8.4 vs. 8.6 ± 9.6, t = -2.657, P = 0.014) appeared statistically difference. Indexes increased at the last follow-up, showing no statistically difference. VAS and the satisfaction score were much better in patients <16 years group compared with ≥ 16 years group at last follow-up. VAS was 1.1 ± 0.8 compared with 2.8 ± 1.4 (F = 12.810, P = 0.002), whereas the satisfaction score was 89 ± 17 compared with 66 ± 22 (F = 7.535, P = 0.012). The last radiological follow-up resulted that, Severin grade I 21 cases, grade II 1 case, grade III 2 cases, grade IV 2 cases, and the Tönnis osteoarthritis grade 0 with 5 cases, grade 1 with 12 cases, grade 2 with 7 cases, grade 3 with 1 case.

CONCLUSIONSIn this early follow up, the majority of patients who underwent modified Colonna capsular arthroplasty for their unilateral hip dislocation would obtained satisfactory results, but with long term recovery, and the younger group (<16 years) with better clinical results than the elder group ( ≥ 16 years).With strict indications, exacted surgical techniques and optimized rehabilitation, the modified Colonna arthroplasty would have better clinical results.

Adolescent ; Adult ; Arthroplasty, Replacement, Hip ; Child ; Female ; Hip Dislocation ; surgery ; Hip Joint ; Hip Prosthesis ; Humans ; Male ; Osteoarthritis, Hip ; Range of Motion, Articular ; Treatment Outcome ; Young Adult

We report the surgical technique used to perform posterior-stabilized total knee arthroplasty (TKA) in two patients with a well positioned and functional hip arthrodesis. Intraoperatively, the operating table was placed in an increased Trendelenburg position. Episodically, we flexed the foot of the table by 90degrees to allow maximal knee flexion to facilitate exposure and bone cuts. We opted to resect the patella and tibia first to enable exposure, given the stiffness of the arthritic knee. One patient's medical condition prohibited complex conversion total hip arthroplasty (THA) prior to the TKA. The other patient's scarred soft tissues around the hip, due to chronic infection and multiple operations, made THA risky. The final outcome provided satisfactory results at a minimum of 2 years postoperatively. TKA can be successfully performed with adjustments of table position and modification of the sequence of surgical steps in patients with ipsilateral hip fusion.
Acetabulum/injuries/surgery ; Aged, 80 and over ; *Arthrodesis ; Arthroplasty, Replacement, Knee/*methods ; Fractures, Bone/surgery ; Hip Fractures/*surgery ; Hip Injuries/surgery ; Humans ; Male ; Middle Aged ; Osteoarthritis, Knee/*surgery ; War

OBJECTIVETo investigate the methods of restoring normal level of rotation center of the hip and limb length in patients with osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH) using total hip arthroplasty (THA).

METHODSFrom January 2000 to January 2003, total hip arthroplasties were performed for 21 patients (26 hips) with OA secondary to DDH. There were 19 females and 2 males with an average age of 51 years (range from 40 to 66 years). Based on radiographic classification of Crowe, there were 12 in type I, 5 in type II, 2 in type III and IV respectively. In addition to the standard procedure of THA, the methods of restoring normal level of rotating center of the hip included structural bone autografting and medialization of the cup. The methods of limb length restoration included carefully preoperative planning and intraoperative soft tissue release. During the follow-up period at 3, 6, 12 months postoperatively and then annually thereafter, rotation center of the hip and limb length were assessed radiographically. Harris score system (HSS) was used for clinical evaluation.

RESULTSAll the patients were followed up for a mean time of 26.4 months (range from 12 to 48 months). All the patients had restoration of the normal level of rotation center of the hip. At the latest follow-up, Harris score was improved from preoperative 35 points (range from 12 to 68 points) to postoperative 94 points (range from 74 to 100 points).

CONCLUSIONIn addition to standard procedure, the restoration of normal level of rotation center of the hip could be achieved by structural bone autografting and medialization of the cup in THA for patients with DDH. Careful preoperative planning and intraoperative soft tissue release could restore limb length.

Adult ; Aged ; Arthroplasty, Replacement, Hip ; methods ; Female ; Follow-Up Studies ; Hip Dislocation, Congenital ; complications ; surgery ; Humans ; Male ; Middle Aged ; Osteoarthritis, Hip ; etiology ; surgery ; Treatment Outcome

Curved periacetabular osteotomy (CPO) was developed for the treatment of dysplastic hips in 1995. In CPO, the exposure of osteotomy sites and osteotomy of the ischium are made in the same manner as Bernese periacetabular osteotomy, and iliac and pubic osteotomies are performed in the same manner as rotational acetabular osteotomy. We studied the dynamic instabilities of 25 dysplastic hips before and after CPO using triaxial accelerometry. Overall magnitude of acceleration was significantly decreased from 2.30 +/- 0.57 m/sec2 preoperatively to 1.55 +/- 0.31 m/sec2 postoperatively. Pain relief and improvement of acetabular coverage resulting from acetabular reorientation seem to be related with reduction of dynamic instabilities of dysplastic hips. Isokinetic muscle strengths of 24 hips in 22 patients were measured preoperatively and after CPO. At 12 months postoperatively, the mean muscle strength exceeded the preoperative values. These results seem to be obtained due to no dissection of abductor muscles in CPO. The preoperative presence of acetabular cysts did not influence the results of CPO. An adequate rotation of the acetabular fragment induced cyst remodeling. Satisfactory results were obtained clinically and radiographically after CPO in patients aged 50 years or older. CPO alone for the treatment of severe dysplastic hips classified as subluxated hips of Severin group IV-b with preoperative CE angles of up to -20degrees could restore the acetabular coverage, weight-bearing area and medialization of the hip joint. CPO without any other combined procedure, as a treatment for 17 hips in 16 patients with Perthes-like deformities, produced good mid-term clinical and radiographic results. We have been performing CPO in conjunction with osteochondroplasty for the treatment of acatabular dysplasia associated with femoroacetabular impingement since 2006. The combined procedure has been providing effective correction of both acetabular dysplasia and associated femoral head-neck deformities without any increased complication rate. We have encountered an obturator artery injury in one case and two intraoperative comminuted fractures. Although serious complications such as motor nerve palsy, deep infection, necrosis of the femoral head or acetabulum, and delayed union or nonunion of the ilium were reported, such complications have never occurred in our 700 cases so far.
Acetabulum/physiopathology/*surgery ; Hip Dislocation, Congenital/complications/physiopathology/*surgery ; Humans ; Osteoarthritis, Hip/etiology/physiopathology/*surgery ; Osteotomy/adverse effects/*methods ; Recovery of Function

OBJECTIVETo study clinical efficacy of autologous bone graft for acetabular defect of Crowe III and IV hip dysplasia.

METHODSThe 22 patients with 25 hips of DDH (Crowe type III, IV) from March 2010 to May 2013 were retrospectively analyzed. Total hip arthroplasty (THA) combined autogenous bone grafting was performed for all these patients with osteoarthritis secondary to DDH. Among them, 19 patients were females (21 hips) and 3 patients were males (4 hips), ranging in age from 43 to 67 years old, averaged 55 years old. There were 6 hips with Crowe type III and 19 hips with Crowe type IV. Before surgery, all the patients had hip pain, limb shortening and hip limited function of hip joint. After 12 months, the degree of recovery about limb length, functional recovery, autogenous bone graft fusion were observed.

RESULTSAll the patients were followed up and no dislocation were occurred. At 12 months after operation, the average Harris hip joint llzncation score were 83.30±6.13, and 18 cases got an excellent result and 4 good. The length of lower limbs decreased from preoperative (3.20±0.81) cm to 12 months after operation (0.92±0.23) cm (t=14.864, P<0.05).

CONCLUSIONTHA combined with structural femoral head autograft for patients with osteoarthritis secondary to DDH can obtain favorable results, significantly improving the effect of operation treatment.

Acetabulum ; surgery ; Adult ; Aged ; Arthroplasty, Replacement, Hip ; Female ; Femur Head ; transplantation ; Hip Dislocation, Congenital ; surgery ; Humans ; Male ; Middle Aged ; Osteoarthritis ; surgery ; Transplantation, Autologous

OBJECTIVETo investigate the mothod and therapeutic efficacy of total hip anthroplasties (THA) for osteoarthritis secondary to Crowe type IV developmental dysplasia of hip in adults.

METHODSFrom May 2006 to December 2013, THA was performed on 15 adult patients (17 hips) with Growe type IV acetabular dysplasia, including 13 females and 2 males, with a mean age of 30.9 years old (22 to 58 years old) and an average preoperative Harris score of (34.0 ± 6.5) points. Traction of the affected limb was not performed before surgery. After extensive release and lengthening of soft tissues, sub-trochanteric osteotomy of the femur was performed, hip joint center was rebuilt and the abduction function was restored.

RESULTSThe patients were followed up with a mean period of 33 months (ranged from 6 months to 5 years). The postoperative Harris score was 85.0 ± 7.3,higher than the preoperative score. The extended length of limb ranged from 1.6 to 5.4 cm, with a mean of (3.42 ± 0.65) cm. The shortening and malformation of the affected limb were corrected in the most patients,with the difference in length of the two legs less than 1.5 cm. After surgery, 1 patient experienced partial sciatic nerve injury, which was largely recovered after 3 months of conservative treatment. One patient experienced complete sciatic nerve injury, which was partially recovered after 6 months of conservative treatment; a foot-drop varus deformity was formed in the distal end of the affected limb, which was improved after tendon transposition and transplantation. Joint pain was relieved, and the joint function was restored significantly. Over the follow-up period, no severe complications such as dislocation, infection, prosthesis loosening, or subsiding occurred.

CONCLUSIONSatisfactory efficacy can be achieved for adult Growe type IV acetabular dysplasia associated with osteoarthritis by THA, with proper soft tissue release and lengthening, sub-trochanteric osteotomy of femur, joint functional restoration, appropriate choice of prosthesis, and careful protection of nerves and vessels.

Adult ; Arthroplasty, Replacement, Hip ; methods ; Female ; Hip Dislocation, Congenital ; complications ; Humans ; Leg Length Inequality ; therapy ; Male ; Middle Aged ; Osteoarthritis, Hip ; surgery

OBJECTIVE: Severe hip osteoarthritis, caused by bone or joint maldevelopment, biomechanical transformation and previous surgical intervention, is inclusively existed in spondyloepiphyseal dysplasia (SED). To investigate and discuss the short-term efficacy and possible effects of total hip arthroplasty in the treatment of Tönnis grade 3 hip osteoarthritis in patients with SED. METHODS: From January 2017 to June 2019, 374 patients with hip osteoarthritis were involved for total hip arthroplasty conducted by senior professional surgeons, of whom 9 patients (6 males and 3 females) with 12 hip osteoarthritis secondary to the SED met the inclusive and exclusive criteria and received the above-mentioned hip operation. The short-term outcomes were observed. RESULTS: All the patients were implanted with Johnson & Johnson ceramic on ceramic cementless hip prostheses within the arthroplasty. They were followed up for an average period of 20 months. Except for one muscular calf vein thrombosis case, no complications, such as aseptic loosening, joint dislocation, fracture, neurovascular injury, deep vein thrombosis and infection were observed in all the 9 patients. Before the surgery, the average Harris hip score was 35.55, while the average of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) was 56.56. The level of quality of life indicated by SF-12 score was 41.56 on average. The mean pre-operation visual analogue scale (VAS) was 7.44. At the last follow-up, the average Harris hip score increased to 89.56, whereas the average WOMAC declined to 41.11. Compared with the baseline point, the average SF-12 score went up to 56.33. Dramatic drop of the mean VAS value to 2.67 was also observed at the last follow-up. In addition, post-operative increase of several pelvic-related parameters including pelvic incidence, pelvic tilt and sacral slope could be observed in the SED patients. The average measured pelvic incidence, pelvic tilt and sacral slope were 68.95°±4.60°, 52.75°±1.06° and 17.45°±1.77° before operation, respectively; whilst the mean value of these specific parameters increased to 76.98°±5.12°, 60.51°±4.35° and 18.10°±2.02°, respectively. The even leg lengths of the lower extremities were obtained after total hip arthroplasty. CONCLUSION Total hip arthroplasty is satisfactory in the short-term pain relieve and function recovery for the management of Tönnis grade 3 hip osteoarthritis secondary to the SED.
Arthroplasty, Replacement, Hip ; Female ; Follow-Up Studies ; Hip Prosthesis ; Humans ; Male ; Osteoarthritis, Hip/surgery* ; Osteochondrodysplasias ; Quality of Life ; Retrospective Studies ; Treatment Outcome