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. 發育性髖關節發育不良病人的全髖關節置換術: 探索, 挑戰, 求精. 骨科, 2018, 9(5): 337-340.
5.	楊鑒, 梁燦, 張會忠. 嚴重髖臼缺損髖關節發育不良患者全髖置換中采用結構性植骨重建髖臼的有效性. 中國組織工程研究, 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.	萬安營, 唐淼, 劉忠堂, 等. 高位全髖關節置換治療Crowe Ⅱ和Ⅲ型成人髖臼發育不良. 中國矯形外科雜志, 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.	文興貴. 利用不同尺寸臼杯通過高髖中心技術為CroweⅡ、Ⅲ型發育性髖關節發育不良患者進行髖臼重建. 吉林: 吉林大學, 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.	陳俊文, 方洪松, 彭昊, 等. 內側突出技術在全髖關節置換術治療成人DDH中的應用療效評價. 生物骨科材料與臨床研究, 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, 陳云蘇, 張先龍, 等. 先天性髖關節發育不良Ⅳ型全髖關節置換術的肢體平衡. 中國矯形外科雜志, 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.	賈震宇, 劉永剛, 沈洪園, 等. 運用反銼裝置行自體股骨頭結構性植骨THA治療CroweⅡ/Ⅲ型DDH的臨床療效. 中國骨與關節雜志, 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.	段元濤, 王韶進, 劉文廣, 等. 植骨在髖臼骨缺損人工全髖關節置換中的應用. 山東大學學報 (醫學版), 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. 發育性髖關節發育不良病人的全髖關節置換術: 探索, 挑戰, 求精. 骨科, 2018, 9(5): 337-340.
5. 楊鑒, 梁燦, 張會忠. 嚴重髖臼缺損髖關節發育不良患者全髖置換中采用結構性植骨重建髖臼的有效性. 中國組織工程研究, 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. 萬安營, 唐淼, 劉忠堂, 等. 高位全髖關節置換治療Crowe Ⅱ和Ⅲ型成人髖臼發育不良. 中國矯形外科雜志, 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. 文興貴. 利用不同尺寸臼杯通過高髖中心技術為CroweⅡ、Ⅲ型發育性髖關節發育不良患者進行髖臼重建. 吉林: 吉林大學, 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. 陳俊文, 方洪松, 彭昊, 等. 內側突出技術在全髖關節置換術治療成人DDH中的應用療效評價. 生物骨科材料與臨床研究, 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, 陳云蘇, 張先龍, 等. 先天性髖關節發育不良Ⅳ型全髖關節置換術的肢體平衡. 中國矯形外科雜志, 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. 賈震宇, 劉永剛, 沈洪園, 等. 運用反銼裝置行自體股骨頭結構性植骨THA治療CroweⅡ/Ⅲ型DDH的臨床療效. 中國骨與關節雜志, 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. 段元濤, 王韶進, 劉文廣, 等. 植骨在髖臼骨缺損人工全髖關節置換中的應用. 山東大學學報 (醫學版), 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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