Effectiveness of structural bone graft in total hip arthroplasty for Hartofilakidis type <b>Ⅱ</b> developmental dysplasia of the hip_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

Maimaitimingjiang·Abulaiti , Wuhuzi·Wulamu , ZHANG Xiaogang , Nuerailijiang·Yushan , CAO Li ,  Asihaerjiang·Maimaitiyiming

Department of Joint Surgery, Orthopaedic Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830000, P. R. China;

Corresponding author：

Asihaerjiang·Maimaitiyiming, Email: askar660525@126.com

Keywords：

Developmental dysplasia of the hip; total hip arthroplasty; acetabular bone defect; structural bone graft

DOI：

10.7507/1002-1892.202109098

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Objective To summarize the effectiveness of acetabulum reconstruction with autologous femoral head structural bone graft in total hip arthroplasty (THA) for Hartofilakidis type Ⅱ developmental dysplasia of the hip (DDH). Methods A clinical data of 24 patients (27 hips) with Hartofilakidis type Ⅱ DDH, who underwent acetabulum reconstruction with autologous femoral head structural bone graft in primary THA between October 2012 and October 2020, was retrospectively analyzed. There were 3 males and 21 females, with an average age of 40 years (range, 20-58 years). The body mass index was 19.5-35.0 kg/m² with an average of 25.0 kg/m². There were 21 cases of unilateral hip and 3 cases of bilateral hips. The hip Harris score was 51.1±10.0. The leg length discrepancy of unilateral hip patients was (19.90±6.24) mm. The intraoperative blood loss, wound healing, and complications were recorded. The postoperative bone union, coverage rates of acetabular prosthesis and bone graft, and aseptic loosening of the prosthesis were evaluated based on X-ray films, and the improvement of hip function was observed by Harris score. Results The intraoperative blood loss was 50-1000 mL (median, 350 mL). All incisions healed by first intention, and no fracture, hematoma, infection, or other complications occurred. Sciatic nerve injury occurred in 1 case (1 hip) and deep venous thrombosis occurred in 1 case (1 hip). All patients were followed up 15-103 months (median, 40.5 months). At last follow-up, Harris score was 92.6±4.1 and the difference was significant when compared with preoperative value (t=−28.043, P=0.000). No hip prosthesis needed revision. X-ray films showed that the coverage rate of acetabular prosthesis was 91%-100% (mean, 97.8%), and the coverage rate of bone graft was 13%-46% (mean, 23.8%). The healing time of bone graft was 3-6 months (mean, 4.7 months). At last follow-up, all bone grafts completely healed without any signs of collapse. There was no graft resorption, ectopic ossification or osteolysis, or obvious aseptic loosening of the acetabular and femoral prostheses. The leg length discrepancy of unilateral hip patients was (2.86±2.18) mm, and the difference was significant when compared with preoperative value (t=17.028, P=0.000). Conclusion For Hartofilakidis type Ⅱ DDH patients, if the lateral acetabular prosthesis not covered by the host bone exceeds 5 mm in primary THA, autologous femoral head can be used for structural bone grafting, and the short- and mid-term effectiveness are favorable.

Citation： Maimaitimingjiang·Abulaiti, Wuhuzi·Wulamu, ZHANG Xiaogang, Nuerailijiang·Yushan, CAO Li, Asihaerjiang·Maimaitiyiming. Effectiveness of structural bone graft in total hip arthroplasty for Hartofilakidis type Ⅱ developmental dysplasia of the hip. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(2): 196-202. doi: 10.7507/1002-1892.202109098 Copy

1.	Karachalios T, Hartofilakidis G. Congenital hip disease in adults: terminology, classification, pre-operative planning and management. J Bone Joint Surg (Am), 2010, 92(7): 914-921.
2.	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.
3.	Sankar WN, Duncan ST, Baca GR, et al. Descriptive epidemiology of acetabular dysplasia: the academic network of conservational hip outcomes research (ANCHOR) periacetabular osteotomy. J Am Acad Orthop Surg, 2017, 25(2): 150-159.
4.	曹力. 发育性髋关节发育不良病人的全髋关节置换术: 探索, 挑战, 求精. 骨科, 2018, 9(5): 337-340.
5.	杨鉴, 梁灿, 张会忠. 严重髋臼缺损髋关节发育不良患者全髋置换中采用结构性植骨重建髋臼的有效性. 中国组织工程研究, 2019, 23(32): 5092-5096.
6.	Zhang Z, Wu P, Huang Z, et al. Cementless acetabular component with or without upward placement in dysplasia hip: Early results from a prospective, randomised study. J Orthop, 2017, 14(3): 370-376.
7.	Oe K, Iida H, Kawamura H, et al. Long-term results of acetabular reconstruction using three bulk bone graft techniques in cemented total hip arthroplasty for developmental dysplasia. Int Orthop, 2016, 40(9): 1949-1954.
8.	Maruyama M, Wakabayashi S, Ota H, et al. Reconstruction of the shallow acetabulum with a combination of autologous bulk and impaction bone grafting fixed by cement. Clin Orthop Relat Res, 2017, 475(2): 387-395.
9.	Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
10.	Gerber SD, Harris WH. Femoral head autografting to augment acetabular deficiency in patients requiring total hip replacement: A minimum five year and an average seven-year follow-up study. J Bone Joint Surg (Am), 1986, 68(8): 1241-1248.
11.	Brooker AF, Bowerman JW, Robinson RA, et al. Ecotopic ossification following total hip replacement: incidence and a method of classification. J Bone Joint Surg (Am), 1973, 55(8): 1629-1632.
12.	Hooten JP, Engh CA. Failure of structural acetabular allograft sincementles srevision hip arthroplasty. J Bone Joint Surg (Br), 1994, 76(3): 419-422.
13.	Mulroy RD, Harris WH. Failure of acetabular autogenous grafts in total hip arthroplasty. J Bone Joint Surg (Am), 1990, 72(10): 1536-1540.
14.	万安营, 唐淼, 刘忠堂, 等. 高位全髋关节置换治疗Crowe Ⅱ和Ⅲ型成人髋臼发育不良. 中国矫形外科杂志, 2020, 28(1): 36-40.
15.	Komiyama K, Fukushi JI, Motomura G, et al. Does high hip centre affect dislocation after total hip arthroplasty for developmental dysplasia of the hip? Int Orthop, 2019, 43(9): 2057-2063.
16.	文兴贵. 利用不同尺寸臼杯通过高髋中心技术为CroweⅡ、Ⅲ型发育性髋关节发育不良患者进行髋臼重建. 吉林: 吉林大学, 2020.
17.	Kobayashi S, Saito N, Nawata M, et al. Total hip arthroplasty with bulk femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip. J Bone Joint Surg (Am), 2003, 85(4): 615-621.
18.	Mou P, Liao K, Chen H, et al. Controlled fracture of the medial wall versus structural autograft with bulk femoral head to increase cup coverage by host bone for total hip arthroplasty in osteoarthritis secondary to developmental dysplasia of the hip: A retrospective cohort study. J Orthop Surg Res, 2020, 15(1): 1-12.
19.	Zha GC, Sun JY, Guo KJ, et al. Medial protrusio technique in cementless total hip arthroplasty for developmental dysplasiaof the hip: a prospective 6- to 9-year follow-up of 43 consecutive patients. J Arthroplasty, 2016, 31(8): 1761-1766.
20.	陈俊文, 方洪松, 彭昊, 等. 内侧突出技术在全髋关节置换术治疗成人DDH中的应用疗效评价. 生物骨科材料与临床研究, 2020, 17(4): 33-36.
21.	Iwase T, Morita D, Ito T, et al. Favorable results of primary total hip arthroplasty with acetabular impaction bone grafting for large segmental bone defects in dysplastic hips. J Arthroplasty, 2016, 31(10): 2221-2226.
22.	何文野, 陈云苏, 张先龙, 等. 先天性髋关节发育不良Ⅳ型全髋关节置换术的肢体平衡. 中国矫形外科杂志, 2014, 22(11): 965-970.
23.	Li H, Wang L, Dai K, et al. Autogenous impaction grafting intotal hip arthroplasty with developmental dysplasia of the hip. J Arthroplasty, 2013, 28(4): 637-643.
24.	贾震宇, 刘永刚, 沈洪园, 等. 运用反锉装置行自体股骨头结构性植骨THA治疗CroweⅡ/Ⅲ型DDH的临床疗效. 中国骨与关节杂志, 2021, 10(8): 608-613.
25.	Zahar A, Papik K, Lakatos J, et al. Total hip arthroplasty with acetabular reconstruction using a bulk autograft for patients with developmental dysplasia of the hip results in high loosening rates at mid-term follow-up. Orthopaedics, 2014, 38(5): 947-951.
26.	Inoue S, Horii M, Suehara H, et al. Minimum 10-year radiographic follow-up of a cementless acetabular component for primary total hip arthroplasty with a bulk autograft. J Orthop Sci, 2003, 8(5): 664-668.
27.	Barrack RL, Newland CC. Uncemented total hip arthroplasty with supe-rior acetabular deficiency-femoral head autograft technique and early clinical results. Arthroplasty, 1990, 5(2): 159-167.
28.	Abdel MP, Stryker LS, Trousdale RT, et al. Uncemented acetabular components with femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip: a concise follow-up report at a mean of twenty years. J Bone Joint Surg (Am), 2014, 96(22): 1878-1882.
29.	段元涛, 王韶进, 刘文广, 等. 植骨在髋臼骨缺损人工全髋关节置换中的应用. 山东大学学报 (医学版), 2008, 46(11): 1072-1074.

1. Karachalios T, Hartofilakidis G. Congenital hip disease in adults: terminology, classification, pre-operative planning and management. J Bone Joint Surg (Am), 2010, 92(7): 914-921.
2. 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.
3. Sankar WN, Duncan ST, Baca GR, et al. Descriptive epidemiology of acetabular dysplasia: the academic network of conservational hip outcomes research (ANCHOR) periacetabular osteotomy. J Am Acad Orthop Surg, 2017, 25(2): 150-159.
4. 曹力. 发育性髋关节发育不良病人的全髋关节置换术: 探索, 挑战, 求精. 骨科, 2018, 9(5): 337-340.
5. 杨鉴, 梁灿, 张会忠. 严重髋臼缺损髋关节发育不良患者全髋置换中采用结构性植骨重建髋臼的有效性. 中国组织工程研究, 2019, 23(32): 5092-5096.
6. Zhang Z, Wu P, Huang Z, et al. Cementless acetabular component with or without upward placement in dysplasia hip: Early results from a prospective, randomised study. J Orthop, 2017, 14(3): 370-376.
7. Oe K, Iida H, Kawamura H, et al. Long-term results of acetabular reconstruction using three bulk bone graft techniques in cemented total hip arthroplasty for developmental dysplasia. Int Orthop, 2016, 40(9): 1949-1954.
8. Maruyama M, Wakabayashi S, Ota H, et al. Reconstruction of the shallow acetabulum with a combination of autologous bulk and impaction bone grafting fixed by cement. Clin Orthop Relat Res, 2017, 475(2): 387-395.
9. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
10. Gerber SD, Harris WH. Femoral head autografting to augment acetabular deficiency in patients requiring total hip replacement: A minimum five year and an average seven-year follow-up study. J Bone Joint Surg (Am), 1986, 68(8): 1241-1248.
11. Brooker AF, Bowerman JW, Robinson RA, et al. Ecotopic ossification following total hip replacement: incidence and a method of classification. J Bone Joint Surg (Am), 1973, 55(8): 1629-1632.
12. Hooten JP, Engh CA. Failure of structural acetabular allograft sincementles srevision hip arthroplasty. J Bone Joint Surg (Br), 1994, 76(3): 419-422.
13. Mulroy RD, Harris WH. Failure of acetabular autogenous grafts in total hip arthroplasty. J Bone Joint Surg (Am), 1990, 72(10): 1536-1540.
14. 万安营, 唐淼, 刘忠堂, 等. 高位全髋关节置换治疗Crowe Ⅱ和Ⅲ型成人髋臼发育不良. 中国矫形外科杂志, 2020, 28(1): 36-40.
15. Komiyama K, Fukushi JI, Motomura G, et al. Does high hip centre affect dislocation after total hip arthroplasty for developmental dysplasia of the hip? Int Orthop, 2019, 43(9): 2057-2063.
16. 文兴贵. 利用不同尺寸臼杯通过高髋中心技术为CroweⅡ、Ⅲ型发育性髋关节发育不良患者进行髋臼重建. 吉林: 吉林大学, 2020.
17. Kobayashi S, Saito N, Nawata M, et al. Total hip arthroplasty with bulk femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip. J Bone Joint Surg (Am), 2003, 85(4): 615-621.
18. Mou P, Liao K, Chen H, et al. Controlled fracture of the medial wall versus structural autograft with bulk femoral head to increase cup coverage by host bone for total hip arthroplasty in osteoarthritis secondary to developmental dysplasia of the hip: A retrospective cohort study. J Orthop Surg Res, 2020, 15(1): 1-12.
19. Zha GC, Sun JY, Guo KJ, et al. Medial protrusio technique in cementless total hip arthroplasty for developmental dysplasiaof the hip: a prospective 6- to 9-year follow-up of 43 consecutive patients. J Arthroplasty, 2016, 31(8): 1761-1766.
20. 陈俊文, 方洪松, 彭昊, 等. 内侧突出技术在全髋关节置换术治疗成人DDH中的应用疗效评价. 生物骨科材料与临床研究, 2020, 17(4): 33-36.
21. Iwase T, Morita D, Ito T, et al. Favorable results of primary total hip arthroplasty with acetabular impaction bone grafting for large segmental bone defects in dysplastic hips. J Arthroplasty, 2016, 31(10): 2221-2226.
22. 何文野, 陈云苏, 张先龙, 等. 先天性髋关节发育不良Ⅳ型全髋关节置换术的肢体平衡. 中国矫形外科杂志, 2014, 22(11): 965-970.
23. Li H, Wang L, Dai K, et al. Autogenous impaction grafting intotal hip arthroplasty with developmental dysplasia of the hip. J Arthroplasty, 2013, 28(4): 637-643.
24. 贾震宇, 刘永刚, 沈洪园, 等. 运用反锉装置行自体股骨头结构性植骨THA治疗CroweⅡ/Ⅲ型DDH的临床疗效. 中国骨与关节杂志, 2021, 10(8): 608-613.
25. Zahar A, Papik K, Lakatos J, et al. Total hip arthroplasty with acetabular reconstruction using a bulk autograft for patients with developmental dysplasia of the hip results in high loosening rates at mid-term follow-up. Orthopaedics, 2014, 38(5): 947-951.
26. Inoue S, Horii M, Suehara H, et al. Minimum 10-year radiographic follow-up of a cementless acetabular component for primary total hip arthroplasty with a bulk autograft. J Orthop Sci, 2003, 8(5): 664-668.
27. Barrack RL, Newland CC. Uncemented total hip arthroplasty with supe-rior acetabular deficiency-femoral head autograft technique and early clinical results. Arthroplasty, 1990, 5(2): 159-167.
28. Abdel MP, Stryker LS, Trousdale RT, et al. Uncemented acetabular components with femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip: a concise follow-up report at a mean of twenty years. J Bone Joint Surg (Am), 2014, 96(22): 1878-1882.
29. 段元涛, 王韶进, 刘文广, 等. 植骨在髋臼骨缺损人工全髋关节置换中的应用. 山东大学学报 (医学版), 2008, 46(11): 1072-1074.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of structural bone graft in total hip arthroplasty for Hartofilakidis type Ⅱ developmental dysplasia of the hip

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