Methods of acetabular defect visualization in dysplastic hip arthritis
Background. There is an opinion that according to the displacement of the femoral head, hip arthritis may be divided into central and superolateral forms; the latter is usually caused by the dysplastic changes of the hip joint. The extant classifications of the developmental dysplasia of the hip mostly describe either an acetabular contour or the cranial distance at which the femoral head becomes displaced. However, none of them takes into account dysplastic defects of the acetabulum or their influence on the results of the surgery. The purpose of the study was to evaluate the roentgen-anthropometric parameters of the dysplastic acetabulum and visualize the defects, affecting the outcomes of the total hip arthroplasty. Materials and methods. The roentgen-anthropometric analysis of 201 dysplastic hips and 70 normal hips acetabula was performed. We’ve studied the acetabular width, depth, thickness of the acetabular bottom, acetabular index and inclination and volume of the acetabular dysplastic defect. Statistical analysis included mean, relative values, median, quartiles, nonparametric Mann-Whitney and Kruskal-Wallis criterion with median-test, nonparametric Kendall correlation. The difference between values was considered significant if p < 0.05. Results. On performing statistical analysis, we found out that in types A-C by Eftekhar classification, the acetabular parameters were changing linearly. Some of them were combined in pairs. For example, the acetabular width increase was accompanied by an inclination increase; however, inclination increased more significantly. The bottom thickness and acetabular depth had an inverse correlation. The diagram for visualization of the changing parameters was drawn, and a pairing table was built. The latter allows creating a formula for any dysplastic acetabulum. A concept of the dysplastic defect was considered separately. Its prevalence rate and linear sizes represent the difference between the location of the rotation center of the femoral head in case of dysplastic hip arthritis and rotation center of the normal hip joint. Conclusions. Deformations of the acetabulum in the developmental dysplasia of the hip reflect the difficulties the surgeon faces during the preoperative planning and implantation. However, understanding of the pathomorphology of this process helps to solve some problems associated with implantation technique, e.g. bottom resection or required bone grafting of the dysplastic defect, and need for an additional preoperative examination in the patients.
Wittens C, Davies AH, Bækgaard N, et al. Editor's Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015 Jun;49(6):678-737. https://doi.org/10.1016/j.ejvs.2015.02.007.
Vestbo J, Hurd SS, Agustí AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstruc-tive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013 Feb 15;187(4):347-65. https://doi.org/10.1164/rccm.201204-0596PP.
Ledingham J, Dawson S, Preston B, Milligan G, Doherty M. Radiographic patterns and associations of osteoarthritis of the hip. Ann Rheum Dis. 1992 Oct;51(10):1111-6. https://doi.org/10.1136/ard.51.10.1111.
Anisimova EA, Yusupov KS, Anisimov DI. Morphology of bone structures of hip joint in normal state and in dysplastic coxarthrosis (review). Saratov Journal of Medical Scientific Research. 2014;10(3):373-377. (in Russian).
Postel M. Anatomical abnormalities of the hip. Rev Chir Orthop Reparatrice Appar Mot. 1976 Jul-Aug;62(5):515-8. (in French).
Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am. 1979 Jan;61(1):15-23.
Eftekhar NS. Total hip arthroplasty. 7th ed. St Louis: Mosby; 1993.
Hartofilakidis G, Karachalios T. Total hip arthroplasty for congenital hip disease. J Bone Joint Surg Am. 2004 Feb;86(2):242-50. https://doi.org/10.2106/00004623-200402000-00005.
Hartofilakidis G, Stamos K, Ioannidis TT. Low friction arthroplasty for old untreated congenital dislocation of the hip. J Bone and Joint Surg. 1988;70B(2):182-186. https://doi.org/10.1302/0301-620X.70B2.3346284.
Zub TO, Loskutov OYe, Loskutov OA. On the classification of dysplastic coxarthrosis in adults. Orthopaedics, Trauma-tology and Prosthetics. 2010;(2):83-87. https://doi.org/10.15674/0030-59872010283-87. (in Russian).
Sharp IK. Acetabular dysplasia: the acetabular angle. J Bone Joint Surg. 1961;43B(2):268-272. https://doi.org/10.1302/0301-620X.43B2.268.
Oleynik OYe, Zub TO. An integral analysis of the acetabular parameters for the pathomorphological evaluation of dys-plastic hip arthritis. Morphologia. 2018;12(2):55-61. https://doi.org/10.26641/1997- 9665.2018.2.55-61. (in Russian).
Korzh AA, Tikhonenkov ES, Andrianov VL, et al. Displasticheskii koksartroz: khirurgicheskaia profilaktika i lechenie [Dysplastic coxarthrosis: surgical prevention and treatment]. Moscow: Meditsina; 1986. 208 p. (in Russian).
Loskutov OYe, Oleynik OYe, Zub TO. The features of deformation in dysplastic hip arthritis from the position of hip re-placement. Orthopaedics, Traumatology and Prosthetics. 2011;(2):23-28. (in Russian).
Inao S, Matsuno T. Cemented total hip arthroplasty with autogenous acetabular bone grafting for hips with develop-mental dysplasia in adults: the results at a minimum of ten years. J Bone Joint Surg Br. 2000 Apr;82(3):375-7.
Tikhilov RM, Shubnyakov II, Mazurenko AV, et al. Experimental substantiation of acetabular component impaction with uncoverage in arthroplasty of patients with severe hip dysplasia. Traumatology and Orthopedics of Russia. 2013;(4):42-51. https://doi.org/10.21823/2311-2905-2013--4-42-51. (in Russian).
Loskutov OYe, Oleynik OYe, Zub TO. The method of estimation of the acetabular dysplastic defect. Litopys of trauma-tology and orthopedics. 2012;(1-2):70-72. (in Ukrainian).
Zeng Y, Wang Y, Zhu Z, Tang T, Dai K, Qiu S. Differences in acetabular morphology related to side and sex in a Chinese population. J Anat. 2012 Mar;220(3):256-62. https://doi.org/10.1111/j.1469-7580.2011.01471.x.
Della Valle AG, Padgett DE, Salvati EA. Preoperative planning for primary total hip arthroplasty. J Am Acad Orthop Surg. 2005 Nov;13(7):455-62.
Hartofilakidis G, Stamos K, Karachalios T, Ioannidis TT, Zacharakis N. Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg Am. 1996 May;78(5):683-92. https://doi.org/10.2106/00004623-199605000-00007.
Dorr LD, Tawakkol S, Moorthy M, Long W, Wan Z. Medial protrusio technique for placement of a porous-coated, hemi-spherical acetabular component without cement in a total hip arthroplasty in patients who have acetabular dysplasia. J Bone Joint Surg Am. 1999 Jan;81(1):83-92. https://doi.org/10.2106/00004623-199901000-00012.
Daines BK, Dennis DA. The importance of acetabular component position in total hip arthroplasty. Orthop Clin North Am. 2012 Nov;43(5):e23-34. https://doi.org/10.1016/j.ocl.2012.08.002.
Bonnin MP, Archbold PH, Basiglini L, Fessy MH, Beverland DE. Do we medialise the hip centre of rotation in total hip arthroplasty? Influence of acetabular offset and surgical technique. Hip Int. 2012 Jul-Aug;22(4):371-8. https://doi:10.5301/HIP.2012.9350.
Schofer MD, Pressel T, Heyse TJ, Schmitt J, Boudriot U. Radiological determination of the anatomic hip centre from pelvic landmarks. Acta Orthop Belg. 2010 Aug;76(4):479-85.
Fukui K, Kaneuji A, Sugimori T, Ichiseki T, Matsumoto T. How far above the true anatomic position can the acetabular cup be placed in total hip arthroplasty? Hip Int. 2013 Mar-Apr;23(2):129-34. https://doi.org/10.5301/hipint.5000010.
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