Effectiveness of autologous femoral head bone graft in total hip arthroplasty for Crowe type <b>Ⅲ</b> developmental dysplasia of hip with acetabular bone defect _Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YIN Shijiu , ZHONG Hang , LI Ruibo , MOU Ping ,  YANG Jing

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

YANG Jing, Email: cd-yangjing@163.com

Keywords：

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

DOI：

10.7507/1002-1892.201708005

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Objective To explore the surgical technique and effectiveness of autologous femoral head bone graft in total hip arthroplasty (THA) for Crowe type Ⅲ developmental dysplasia of the hip (DDH) with acetabular bone defect. Methods Between July 2012 and September 2015, 12 cases (12 hips) of Crowe type Ⅲ DDH with acetabular bone defect were included. Of the 12 patients, 2 were male and 10 were female, with an average age of 54.3 years (range, 37-75 years). The Harris score before operation was 41.08±7.90. The preoperative leg length discrepancy was 0.53-4.28 cm, with an average of 2.47 cm. Autologous femoral head bone graft and cancellous screw fixation were used in all cases to reconstruct acetabula in THA. Four cases were performed with subtrochanteric shortening osteotomy at the same time. Results All incisions healed by first intention. Twelve cases were followed up 1 year and 10 months to 5 years, with an average of 3.0 years. X-ray films showed that bone healing was observed in all cases at 6 months to 1 year after operation. There was no bone graft osteolysis, absorption, bone graft collapse, and acetabular prosthesis loosening. At last follow-up, the Harris score was 89.50±2.78, showing significant difference when compared with preoperative value (t=–25.743, P=0.003). The length discrepancy was 0-1.81 cm at last follow-up with an average of 0.76 cm. Conclusion Autologous femoral head bone graft is effective for Crowe type Ⅲ DDH with acetabular bone defect, which has advantages of restoring pelvic bone stock, obtaining satisfied prosthetic stability and mid-term effectiveness.

Citation： YIN Shijiu, ZHONG Hang, LI Ruibo, MOU Ping, YANG Jing. Effectiveness of autologous femoral head bone graft in total hip arthroplasty for Crowe type Ⅲ developmental dysplasia of hip with acetabular bone defect . Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(1): 20-24. doi: 10.7507/1002-1892.201708005 Copy

1.	Haddad FS, Rayan F. The role of impaction grafting: the when and how. Orthopedics, 2009, 32(9). DOI: 10.3928/01477447-20090728-19.
2.	Kim M, Kadowaki T. High long-term survival of bulk femoral head autograft for acetabular reconstruction in cementless THA for developmental hip dysplasia. Clin Orthop Relat Res, 2010, 468(6): 1611-1620.
3.	Akiyama H, Kawanabe K, Iida H, et al. Long-term results of cemented total hip arthroplasty in developmental dysplasia with acetabular bulk bone grafts after improving operative techniques. J Arthroplasty, 2010, 25(5): 716-720.
4.	彭阳, 杨柳, 陈光兴, 等. Crowe Ⅲ及Ⅳ型髋关节发育不良全髋关节置换术中髋臼骨缺损的重建. 中华外科杂志, 2014, 52(1): 25-29.
5.	Farrell CM, Berry DJ, Cabanela ME. Autogenous femoral head bone grafts for acetabular deficiency in total-hip arthroplasty for developmental dysplasia of the hip: long-term effect on pelvic bone stock. J Arthroplasty, 2005, 20(6): 698-702.
6.	Murayama T, Ohnishi H, Okabe S, et al. 15-year comparison of cementless total hip arthroplasty with anatomical or high cup placement for Crowe Ⅰ to Ⅲ hip dysplasia. Orthopedics, 2012, 35(3): e313-318.
7.	Nawabi DH, Meftah M, Nam D, et al. Durable fixation achieved with medialized, high hip center cementless THAs for Crowe Ⅱ and Ⅲ dysplasia. Clin Orthop Relat Res, 2014, 472(2): 630-636.
8.	Al-Amiry B, Mahmood S, Krupic F, et al. Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem-stem or cup positioning? Acta Radiol, 2017, 58(9): 1125-1131.
9.	Abolghasemian M, Samiezadeh S, Jafari D, et al. Displacement of the hip center of rotation after arthroplasty of Crowe Ⅲ and Ⅳ dysplasia: a radiological and biomechanical study. J Arthroplasty, 2013, 28(6): 1031-1035.
10.	Komiyam K, Nakashima Y, Hirata M, et al. Does High Hip Center Decrease Range of Motion in Total Hip Arthroplasty? A Computer Simulation Study. J Arthroplasty, 2016, 31(10): 2342-2347.
11.	Kilicasrlan K, Yalcin N, Bicic V, et al. Determination of structural femoral head allograft viability and integrity with a novel diagnostic tool: SPECT/CT. A preliminary study. Hip international: the journal of clinical and experimental research on hip pathology and therapy, 2017, 27(6): 558-563.
12.	Muscolo DL, Ayerza MA, Aponte-Tinao LA. Survivorship and radiographic analysis of knee osteoarticular allografts. Clin Orthop Relat Res, 2000, (373): 73-79.
13.	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. International Orthopaedics, 2014, 38(5): 947-951.
14.	Schofer MD, Pressel T, Schmitt J, et al. Reconstruction of the acetabulum in THA using femoral head autografts in developmental dysplasia of the hip. J Orthop Surg Res, 2011, (6): 32.
15.	Willett K, Hearm TC, Cuncins AV. Biomechanical testing of a new design for Schanz pedicle screws. J Orthop Trauma, 1993, 7(4): 375-380.
16.	Yao JF, Shen JZ, Li DK, et al. Rap system of stress stimulation can promote bone union after lower tibial bone fracture: a clinical research. International Journal of Medical Sciences, 2012, 9(6): 462-466.

1. Haddad FS, Rayan F. The role of impaction grafting: the when and how. Orthopedics, 2009, 32(9). DOI: 10.3928/01477447-20090728-19.
2. Kim M, Kadowaki T. High long-term survival of bulk femoral head autograft for acetabular reconstruction in cementless THA for developmental hip dysplasia. Clin Orthop Relat Res, 2010, 468(6): 1611-1620.
3. Akiyama H, Kawanabe K, Iida H, et al. Long-term results of cemented total hip arthroplasty in developmental dysplasia with acetabular bulk bone grafts after improving operative techniques. J Arthroplasty, 2010, 25(5): 716-720.
4. 彭阳, 杨柳, 陈光兴, 等. Crowe Ⅲ及Ⅳ型髋关节发育不良全髋关节置换术中髋臼骨缺损的重建. 中华外科杂志, 2014, 52(1): 25-29.
5. Farrell CM, Berry DJ, Cabanela ME. Autogenous femoral head bone grafts for acetabular deficiency in total-hip arthroplasty for developmental dysplasia of the hip: long-term effect on pelvic bone stock. J Arthroplasty, 2005, 20(6): 698-702.
6. Murayama T, Ohnishi H, Okabe S, et al. 15-year comparison of cementless total hip arthroplasty with anatomical or high cup placement for Crowe Ⅰ to Ⅲ hip dysplasia. Orthopedics, 2012, 35(3): e313-318.
7. Nawabi DH, Meftah M, Nam D, et al. Durable fixation achieved with medialized, high hip center cementless THAs for Crowe Ⅱ and Ⅲ dysplasia. Clin Orthop Relat Res, 2014, 472(2): 630-636.
8. Al-Amiry B, Mahmood S, Krupic F, et al. Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem-stem or cup positioning? Acta Radiol, 2017, 58(9): 1125-1131.
9. Abolghasemian M, Samiezadeh S, Jafari D, et al. Displacement of the hip center of rotation after arthroplasty of Crowe Ⅲ and Ⅳ dysplasia: a radiological and biomechanical study. J Arthroplasty, 2013, 28(6): 1031-1035.
10. Komiyam K, Nakashima Y, Hirata M, et al. Does High Hip Center Decrease Range of Motion in Total Hip Arthroplasty? A Computer Simulation Study. J Arthroplasty, 2016, 31(10): 2342-2347.
11. Kilicasrlan K, Yalcin N, Bicic V, et al. Determination of structural femoral head allograft viability and integrity with a novel diagnostic tool: SPECT/CT. A preliminary study. Hip international: the journal of clinical and experimental research on hip pathology and therapy, 2017, 27(6): 558-563.
12. Muscolo DL, Ayerza MA, Aponte-Tinao LA. Survivorship and radiographic analysis of knee osteoarticular allografts. Clin Orthop Relat Res, 2000, (373): 73-79.
13. 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. International Orthopaedics, 2014, 38(5): 947-951.
14. Schofer MD, Pressel T, Schmitt J, et al. Reconstruction of the acetabulum in THA using femoral head autografts in developmental dysplasia of the hip. J Orthop Surg Res, 2011, (6): 32.
15. Willett K, Hearm TC, Cuncins AV. Biomechanical testing of a new design for Schanz pedicle screws. J Orthop Trauma, 1993, 7(4): 375-380.
16. Yao JF, Shen JZ, Li DK, et al. Rap system of stress stimulation can promote bone union after lower tibial bone fracture: a clinical research. International Journal of Medical Sciences, 2012, 9(6): 462-466.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of autologous femoral head bone graft in total hip arthroplasty for Crowe type Ⅲ developmental dysplasia of hip with acetabular bone defect

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