Revision reasons and prosthesis selection of Crowe <b>Ⅳ</b> developmental dysplasia of hip after total hip arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHEN Junmin ^1,2 ,  ZHOU Yonggang ¹ , SUN Jingyang ¹ , MA Haiyang ¹ , DU Yinqiao ¹ , GAO Zhisen ¹ , PENG Yawen ¹ , CHEN Jiying ¹

1. Department of Orthopedics, the First Medical Center, General Hospital of Chinese PLA, Beijing, 100853, P.R.China;
2. School of Medicine, Nankai University, Tianjin, 300071, P.R.China;

Corresponding author：

ZHOU Yonggang, Email: zhouyg@263.net

Keywords：

Crowe Ⅳdevelopmental dysplasia of the hip; total hip arthroplasty; revision reason; prosthesis selection

DOI：

10.7507/1002-1892.201909015

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Objective To investigate revision reasons and prosthesis selection of Crowe Ⅳ developmental dysplasia of the hip (DDH) after total hip arthroplasty (THA). Methods A clinical data of 14 patients (15 hips) with Crowe Ⅳ DDH, who underwent a revision hip arthroplasty between January 2008 and May 2018, was retrospectively reviewed. There were 1 male (1 hip) and 13 females (14 hips). The age ranged from 27 to 63 years (mean, 45.0 years). There were 7 cases of left hip, 6 cases of right hip, and 1 case of bilateral hips. The prosthetic interfaces of primary THA were metal-on-polyethylene (MOP) in 9 hips, ceramic-on-ceramic (COC) in 4 hips, ceramic-on-polyethylene (COP) in 1 hip, and ceramic-on-metal in 1 hip. The time from primary THA to revision was 3-204 months (mean, 65.0 months). The causes of revision included aseptic loosening in 7 hips, dislocation in 3 hips, periprosthetic joint infection in 2 hips, osteolysis in 1 hip, nonunion of osteotomy in 1 hip, and a small-angle of femoral anteversion in 1 hip. Preoperative Harris score was 54.1±17.8 and the range of motion (ROM) of flexion was (92.7±20.2)°. Preoperative X-ray films showed the acetabular bone defect in 11 hips and osteolysis of femoral side in 4 hips. During the revision, the prostheses with COP and COC interfaces were used in 5 hips and 10 hips, respectively. Both acetabular and femoral revisions were performed in 11 hips and only femoral revision was performed in 4 hips.Results The mean operation time was 3.7 hours (range, 1.5-6.0 hours). The mean intraoperative blood loss was 940.0 mL (range, 200-2 000 mL). All patients were followed up 16-142 months (mean, 73.9 months). Postoperative X-ray films showed no difference in inclination and anteversion between primary THA and revision (P>0.05). The height of rotation center and offset after revision were higher than those after primary THA, and the difference in offset was significant (P<0.05). At last follow-up, the Harris score and ROM of flexion were 85.0±7.3 and (115.0±17.0)°, respectively, which were significantly higher when compared with those before revision (t=8.909, P=0.000; t=4.911, P=0.000). Three hips underwent a re-revision operation. All protheses were fixed well and no radiolucent line, loosening, or subsidence was observed at last follow-up.Conclusion The most common reason for revision in patients with Crowe Ⅳ DDH after THA was aseptic loosening. Due to high activity demand of this population, the prosthesis with MOP interface should be prevented and the prosthesis with COC interface could be alternative. Metal block, cup-cage, and reinforcement ring were reasonable solutions for reconstruction of acetabulum with severe bone defects and have satisfactory effectiveness. S-ROM prosthesis should be the preferred stem for neither primary THA or revision.

Citation： SHEN Junmin, ZHOU Yonggang, SUN Jingyang, MA Haiyang, DU Yinqiao, GAO Zhisen, PENG Yawen, CHEN Jiying. Revision reasons and prosthesis selection of Crowe Ⅳ developmental dysplasia of hip after total hip arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(5): 557-562. doi: 10.7507/1002-1892.201909015 Copy

1.	Jacobsen S, Sonne-Holm S, Søballe K, et al. Hip dysplasia and osteoarthrosis: a survey of 4151 subjects from the Osteoarthrosis Substudy of the Copenhagen City Heart Study. Acta Orthop, 2005, 76(2): 149-158.
2.	朱建辛, 王跃, 庞健, 等. 人工全髋关节置换术治疗重度成人髋关节发育不良疗效分析. 中国修复重建外科杂志, 2014, 28(3): 335-338.
3.	孙菁阳, 周勇刚, 高志森, 等. 人工全髋关节置换术治疗 Crowe Ⅳ 型髋关节发育不良术中应用粗隆下截骨的相关研究. 中国修复重建外科杂志, 2018, 32(2): 152-156.
4.	Argenson JN, Ryembault E, Flecher X, et al. Three-dimensional anatomy of the hip in osteoarthritis after developmental dysplasia. J Bone Joint Surg (Br), 2005, 87(9): 1192-1196.
5.	刘宏伟, 徐南伟, 张云坤, 等. Crowe Ⅳ 型成人发育性髋关节发育不良股骨近段形态研究及其临床意义. 中国修复重建外科杂志, 2015, 29(8): 931-935.
6.	Greber EM, Pelt CE, Gililland JM, et al. Challenges in total hip arthroplasty in the setting of developmental dysplasia of the hip. J Arthroplasty, 2017, 32(9S): S38-S44.
7.	Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
8.	Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty, 1994, 9(1): 33-44.
9.	Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res, 1979, (141): 17-27.
10.	DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 39-41.
11.	Ackland MK, Bourne WB, Uhthoff HK. Anteversion of the acetabular cup. Measurement of angle after total hip replacement. J Bone Joint Surg (Br), 1986, 68(3): 409-413.
12.	Gallo J, Goodman SB, Konttinen YT, et al. Particle disease: biologic mechanisms of periprosthetic osteolysis in total hip arthroplasty. Innate Immun, 2013, 19(2): 213-224.
13.	Vendittoli PA, Rivière C, Lavigne M, et al. Alumina on alumina versus metal on conventional polyethylene: a randomized clinical trial with 9 to 15 years follow-up. Acta Orthop Belg, 2013, 79(2): 181-190.
14.	Ryu KJ. What host factors affect aseptic loosening after THA and TKA? Clin Orthop Relat Res, 2015, 473(8): 2710-2711.
15.	Maloney WJ, Galante JO, Anderson M, et al. Fixation, polyethylene wear, and pelvic osteolysis in primary total hip replacement. Clin Orthop Relat Res, 1999, (369): 157-164.
16.	Kahlenberg CA, Swarup I, Krell EC, et al. Causes of revision in young patients undergoing total hip arthroplasty. J Arthroplasty, 2019, 34(7): 1435-1440.
17.	万国杨, 孙俊英, 查国春, 等. 第三代陶对陶人工全髋关节置换术治疗中青年髋关节疾病的中远期疗效. 中国修复重建外科杂志, 2015, 29(9): 1057-1061.
18.	Bryan AJ, Calkins TE, Karas V, et al. Primary total hip arthroplasty in patients less than 50 years of age at a mean of 16 years: highly crosslinked polyethylene significantly reduces the risk of revision. J Arthroplsty, 2019, 34(7S): S238-S241.
19.	贾金领, 侯文根, 张君, 等. 髋关节置换术后发生脱位的危险因素分析. 中国矫形外科杂志, 2016, 24(17): 1624-1627.
20.	Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
21.	Park DK, Della Valle CJ, Quigley L, et al. Revision of the acetabular component without cement. A concise follow-up, at twenty to twenty-four years, of a previous report. J Bone Joint Surg (Am), 2009, 91(2): 350-355.
22.	Whitehouse MR, Masri BA, Duncan CP, et al. Continued good results with modular trabecular metal augments for acetabular defects in hip arthroplasty at 7 to 11 years. Clin Orthop Relat Res, 2015, 473(2): 521-527.
23.	Park KS, Seon JK, Lee KB, et al. Revision total hip arthroplasty using an acetabular reinforcement ring with a hook: a precise follow-up, at average 11.4 years, of a previous report. J Arthroplasty, 2017, 32(2): 503-509.
24.	Symeonides PP, Petsatodes GE, Pournaras JD, et al. The effectiveness of the Burch-Schneider antiprotrusio cage for acetabular bone deficiency: five to twenty-one years’ follow-up. J Arthroplasty, 2009, 24(2): 168-174.
25.	Wang S, Zhou Y, Ma H, et al. Mid-term results of total hip replacement with subtrochanteric osteotomy, modular stem, and ceramic surface in Crowe Ⅳ hip dysplasia. Arthroplast Today, 2017, 4(3): 363-369.
26.	Moreta J, Uriarte I, Foruria X, et al. Medium-term outcomes of the S-ROM modular femoral stem in revision hip replacement. Eur J Orthop Surg Traumatol, 2018, 28(7): 1327-1334.

1. Jacobsen S, Sonne-Holm S, Søballe K, et al. Hip dysplasia and osteoarthrosis: a survey of 4151 subjects from the Osteoarthrosis Substudy of the Copenhagen City Heart Study. Acta Orthop, 2005, 76(2): 149-158.
2. 朱建辛, 王跃, 庞健, 等. 人工全髋关节置换术治疗重度成人髋关节发育不良疗效分析. 中国修复重建外科杂志, 2014, 28(3): 335-338.
3. 孙菁阳, 周勇刚, 高志森, 等. 人工全髋关节置换术治疗 Crowe Ⅳ 型髋关节发育不良术中应用粗隆下截骨的相关研究. 中国修复重建外科杂志, 2018, 32(2): 152-156.
4. Argenson JN, Ryembault E, Flecher X, et al. Three-dimensional anatomy of the hip in osteoarthritis after developmental dysplasia. J Bone Joint Surg (Br), 2005, 87(9): 1192-1196.
5. 刘宏伟, 徐南伟, 张云坤, 等. Crowe Ⅳ 型成人发育性髋关节发育不良股骨近段形态研究及其临床意义. 中国修复重建外科杂志, 2015, 29(8): 931-935.
6. Greber EM, Pelt CE, Gililland JM, et al. Challenges in total hip arthroplasty in the setting of developmental dysplasia of the hip. J Arthroplasty, 2017, 32(9S): S38-S44.
7. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
8. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty, 1994, 9(1): 33-44.
9. Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res, 1979, (141): 17-27.
10. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 39-41.
11. Ackland MK, Bourne WB, Uhthoff HK. Anteversion of the acetabular cup. Measurement of angle after total hip replacement. J Bone Joint Surg (Br), 1986, 68(3): 409-413.
12. Gallo J, Goodman SB, Konttinen YT, et al. Particle disease: biologic mechanisms of periprosthetic osteolysis in total hip arthroplasty. Innate Immun, 2013, 19(2): 213-224.
13. Vendittoli PA, Rivière C, Lavigne M, et al. Alumina on alumina versus metal on conventional polyethylene: a randomized clinical trial with 9 to 15 years follow-up. Acta Orthop Belg, 2013, 79(2): 181-190.
14. Ryu KJ. What host factors affect aseptic loosening after THA and TKA? Clin Orthop Relat Res, 2015, 473(8): 2710-2711.
15. Maloney WJ, Galante JO, Anderson M, et al. Fixation, polyethylene wear, and pelvic osteolysis in primary total hip replacement. Clin Orthop Relat Res, 1999, (369): 157-164.
16. Kahlenberg CA, Swarup I, Krell EC, et al. Causes of revision in young patients undergoing total hip arthroplasty. J Arthroplasty, 2019, 34(7): 1435-1440.
17. 万国杨, 孙俊英, 查国春, 等. 第三代陶对陶人工全髋关节置换术治疗中青年髋关节疾病的中远期疗效. 中国修复重建外科杂志, 2015, 29(9): 1057-1061.
18. Bryan AJ, Calkins TE, Karas V, et al. Primary total hip arthroplasty in patients less than 50 years of age at a mean of 16 years: highly crosslinked polyethylene significantly reduces the risk of revision. J Arthroplsty, 2019, 34(7S): S238-S241.
19. 贾金领, 侯文根, 张君, 等. 髋关节置换术后发生脱位的危险因素分析. 中国矫形外科杂志, 2016, 24(17): 1624-1627.
20. Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
21. Park DK, Della Valle CJ, Quigley L, et al. Revision of the acetabular component without cement. A concise follow-up, at twenty to twenty-four years, of a previous report. J Bone Joint Surg (Am), 2009, 91(2): 350-355.
22. Whitehouse MR, Masri BA, Duncan CP, et al. Continued good results with modular trabecular metal augments for acetabular defects in hip arthroplasty at 7 to 11 years. Clin Orthop Relat Res, 2015, 473(2): 521-527.
23. Park KS, Seon JK, Lee KB, et al. Revision total hip arthroplasty using an acetabular reinforcement ring with a hook: a precise follow-up, at average 11.4 years, of a previous report. J Arthroplasty, 2017, 32(2): 503-509.
24. Symeonides PP, Petsatodes GE, Pournaras JD, et al. The effectiveness of the Burch-Schneider antiprotrusio cage for acetabular bone deficiency: five to twenty-one years’ follow-up. J Arthroplasty, 2009, 24(2): 168-174.
25. Wang S, Zhou Y, Ma H, et al. Mid-term results of total hip replacement with subtrochanteric osteotomy, modular stem, and ceramic surface in Crowe Ⅳ hip dysplasia. Arthroplast Today, 2017, 4(3): 363-369.
26. Moreta J, Uriarte I, Foruria X, et al. Medium-term outcomes of the S-ROM modular femoral stem in revision hip replacement. Eur J Orthop Surg Traumatol, 2018, 28(7): 1327-1334.

Chinese Journal of Reparative and Reconstructive Surgery

Revision reasons and prosthesis selection of Crowe Ⅳ developmental dysplasia of hip after total hip arthroplasty

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