Effects of femoral offset and mechanical axis of the lower extremity on hip after osteotomy for adult developmental dysplasia of the hip_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Yong , ZHANG Zhendong , REN Ningtao , CHENG Hui , LUO Dianzhong ,  ZHANG Hong

Department of Orthopedics, Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, 100037, P.R.China;

Corresponding author：

ZHANG Hong, Email: zhanghongmd@163.com

Keywords：

Developmental dysplasia of the hip; periacetabular osteotomy; proximal femoral osteotomy; femoral offset; mechanical axis of the lower extremity; adults

DOI：

10.7507/1002-1892.202108080

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Objective To investigate the effects of femoral offset and mechanical axis of the lower extremity on hip after osteotomy for adult developmental dysplasia of the hip (DDH). Methods A clinical data of 62 adult patients with DDH (62 hips), who underwent periacetabular osteotomy combined with femoral osteotomy between January 2016 and May 2019 and met selective criteria, was retrospectively analyzed. There were 6 males and 56 females. The age ranged from 18 to 38 years, with an average of 24.4 years. Body mass index ranged from 15.8 to 31.8 kg/m², with an average of 21.8 kg/m². There were 44 cases of Hartofilakidis typeⅠ and 18 cases of typeⅡ. According to the modified Tönnis osteoarthritis staging, 46 cases were stage 0 and 16 cases were stageⅠ. There were 13 cases with pelvic anteversion, 40 cases with normal pelvis, and 9 cases with pelvic retroversion. Intraoperative blood loss, length of hospital stay, and complications were recorded. Postoperative hip function was evaluated by Harris score and International Hip Outcome Tool (iHOT) score. The femoral offset, collo-diaphyseal angle, hip-knee-ankle angle (HKA), knee valus angle, CE (Wiberg central-edge angle), anterior CE angle, and acetabular index angle were measured and the osteotomy healing was observed on X-ray films. Patients were grouped according to postoperative femoral offset (≥48 mm or <48 mm) and HKA [varus group (HKA<177°), normal group (HKA 177°-183°), and valgus group (HKA>183°)]. Harris score and iHOT score were compared between groups. Results Intraoperative blood loss ranged from 200 to 1 550 mL, with an average of 476 mL. The length of hospital stay ranged from 8 to 21 days, with an average of 13.3 days. All incisions healed by first intention. All patients were followed up 2.0-4.5 years, with an average of 2.8 years. At 1 year after operation, the Harris score and iHOT score of the hip joint significantly increased when compared with those before operation (P<0.05); there were significant differences in the femoral offset, collo-diaphyseal angle, HKA, knee valus angle, CE angle, anterior CE angle, and acetabular index angle between pre- and post-operation (P>0.05). According to the modified Tönnis osteoarthritis staging, 38 cases were stage 0 and 24 cases were stageⅠ; and there was no significant difference between pre- and post-operation (χ²=2.362, P=0.124). There were 11 cases with pelvic anteversion, 38 cases with normal pelvis, and 13 cases with pelvic retroversion, showing no significant difference when compared with that before operation (χ²=0.954, P=0.623). The pubic branch osteotomy did not heal in 9 cases, proximal femur osteotomy did not heal in 2 cases, and inferior pubic ramus stress fracture occurred in 5 cases. There were significant differences (P<0.05) in the Harris score and iHOT score between femoral offset≥48 mm group (n=10) and femoral offset<48 mm group (n=52). There was no significant difference (P>0.05) in Harris score and iHOT score between varus group (n=13), normal group (n=40), and valgus group (n=9). Conclusion Periacetabular osteotomy combined with femoral osteotomy can improve the femoral offset and mechanical axis of the lower extremity of patients with DDH, and improve the functional score of the hip. However, excessive increase of femoral offset during femoral osteotomy is not desirable, resulting in low postoperative functional score.

Citation： LI Yong, ZHANG Zhendong, REN Ningtao, CHENG Hui, LUO Dianzhong, ZHANG Hong. Effects of femoral offset and mechanical axis of the lower extremity on hip after osteotomy for adult developmental dysplasia of the hip. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(12): 1549-1554. doi: 10.7507/1002-1892.202108080 Copy

1.	Vaquero-Picado A, González-Morán G, Garay EG, et al. Developmental dysplasia of the hip: update of management. EFORT Open Rev, 2019, 4(9): 548-556.
2.	陈博昌, 杨杰, 吴虹, 等. 新生儿发育性髋关节异常的超声筛查. 中华小儿外科杂志, 2007, 28(11): 590-593.
3.	Ganz R, Klaue K, Vinh TS, et al. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res, 1988, (232): 26-36.
4.	Zhu J, Chen X, Cui Y, et al. Mid-term results of Bernese periacetabular osteotomy for developmental dysplasia of hip in middle aged patients. Int Orthop, 2013, 37(4): 589-594.
5.	Ganz R, Klaue K, Vinh TS, et al. A new periacetabular osteotomy for the treatment of hip dysplasias: technique and preliminary results. 1988. Clin Orthop Relat Res, 2004, (418): 3-8.
6.	Wyles CC, Vargas JS, Heidenreich MJ, et al. Natural history of the dysplastic hip following modern periacetabular osteotomy. J Bone Joint Surg (Am), 2019, 101(10): 932-938.
7.	Keel MJ, Ecker TM, Siebenrock KA, et al. Rationales for the Bernese approaches in acetabular surgery. Eur J Trauma Emerg Surg, 2012, 38(5): 489-498.
8.	Cho YJ, Kim KI, Kwak SJ, et al. Long-term results of periacetabular rotational osteotomy concomitantly with arthroscopy in adult acetabular dysplasia. J Arthroplasty, 2020, 35(10): 2807-2812.
9.	Ziran N, Varcadipane J, Kadri O, et al. Ten- and 20-year survivorship of the hip after periacetabular osteotomy for acetabular dysplasia. J Am Acad Orthop Surg, 2019, 27(7): 247-255.
10.	Spiker AM, Fields KG, Nguyen JT, et al. Characterization of version in the dysplastic hip and the need for subsequent femoral derotational osteotomy after periacetabular osteotomy. J Hip Preserv Surg, 2020, 7(3): 575-582.
11.	Sakai T, Sugano N, Ohzono K, et al. Femoral anteversion, femoral offset, and abductor lever arm after total hip arthroplasty using a modular femoral neck system. J Orthop Sci, 2002, 7(1): 62-67.
12.	周丹. 成人发育性髋关节发育不良的诊断及治疗进展. 中外医学研究, 2013, 11(29): 153-155.
13.	徐永胜, 王岩. 成人髋关节发育不良的诊断与治疗研究进展. 内蒙古医学杂志 2012, 44(4): 458-461.
14.	Garras DN, Crowder TT, Olson SA. Medium-term results of the Bernese periacetabular osteotomy in the treatment of symptomatic developmental dysplasia of the hip. J Bone Joint Surg (Br), 2007, 89(6): 721-724.
15.	薛文东, 戴尅戎, 龙公. 中国人股骨上段几何特征研究. 北京生物医学工程, 2006, 25(1): 30-34.
16.	Hicks-Little CA, Peindl RD, Hubbard-Turner TJ, et al. The relationship between early-stage knee osteoarthritis and lower-extremity alignment, joint laxity, and subjective scores of pain, stiffness, and function. J Sport Rehabil, 2016, 25(3): 213-218.
17.	Maderbacher G, Baier C, Springorum HR, et al. Lower limb anatomy and alignment affect natural tibiofemoral knee kinematics: A cadaveric investigation. J Arthroplasty, 2016, 31(9): 2038-2042.
18.	Cibulka MT. Determination and significance of femoral neck anteversion. Phys Ther, 2004, 84(6): 550-558.
19.	McGrory BJ, Morrey BF, Cahalan TD, et al. Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty. J Bone Joint Surg (Br), 1995, 77(6): 865-869.
20.	Asayama I, Naito M, Fujisawa M, et al. Relationship between radiographic measurements of reconstructed hip joint position and the Trendelenburg sign. J Arthroplasty, 2002, 17(6): 747-751.
21.	Vendittoli PA, Ganapathi M, Nuño N, et al. Factors affecting hip range of motion in surface replacement arthroplasty. Clin Biomech (Bristol, Avon), 2007, 22(9): 1004-1012.
22.	Nassif NA, Schoenecker PL, Thorsness R, et al. Periacetabular osteotomy and combined femoral head-neck junction osteochondroplasty: a minimum two-year follow-up cohort study. J Bone Joint Surg (Am), 2012, 94(21): 1959-1966.
23.	Hu X, Zheng N, Chen Y, et al. Optimizing the femoral offset for restoring physiological hip muscle function in patients with total hip arthroplasty. Front Bioeng Biotechnol, 2021, 9: 645019. doi: 10.3389/fbioe.2021.645019.
24.	Moreland JR, Bassett LW, Hanker GJ. Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg (Am), 1987, 69(5): 745-749.
25.	吴伟, 郭万首. 下肢全长X线检查的临床应用及其精准性的研究进展. 中华骨与关节外科杂志, 2017, 10(1): 84-87.

1. Vaquero-Picado A, González-Morán G, Garay EG, et al. Developmental dysplasia of the hip: update of management. EFORT Open Rev, 2019, 4(9): 548-556.
2. 陈博昌, 杨杰, 吴虹, 等. 新生儿发育性髋关节异常的超声筛查. 中华小儿外科杂志, 2007, 28(11): 590-593.
3. Ganz R, Klaue K, Vinh TS, et al. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res, 1988, (232): 26-36.
4. Zhu J, Chen X, Cui Y, et al. Mid-term results of Bernese periacetabular osteotomy for developmental dysplasia of hip in middle aged patients. Int Orthop, 2013, 37(4): 589-594.
5. Ganz R, Klaue K, Vinh TS, et al. A new periacetabular osteotomy for the treatment of hip dysplasias: technique and preliminary results. 1988. Clin Orthop Relat Res, 2004, (418): 3-8.
6. Wyles CC, Vargas JS, Heidenreich MJ, et al. Natural history of the dysplastic hip following modern periacetabular osteotomy. J Bone Joint Surg (Am), 2019, 101(10): 932-938.
7. Keel MJ, Ecker TM, Siebenrock KA, et al. Rationales for the Bernese approaches in acetabular surgery. Eur J Trauma Emerg Surg, 2012, 38(5): 489-498.
8. Cho YJ, Kim KI, Kwak SJ, et al. Long-term results of periacetabular rotational osteotomy concomitantly with arthroscopy in adult acetabular dysplasia. J Arthroplasty, 2020, 35(10): 2807-2812.
9. Ziran N, Varcadipane J, Kadri O, et al. Ten- and 20-year survivorship of the hip after periacetabular osteotomy for acetabular dysplasia. J Am Acad Orthop Surg, 2019, 27(7): 247-255.
10. Spiker AM, Fields KG, Nguyen JT, et al. Characterization of version in the dysplastic hip and the need for subsequent femoral derotational osteotomy after periacetabular osteotomy. J Hip Preserv Surg, 2020, 7(3): 575-582.
11. Sakai T, Sugano N, Ohzono K, et al. Femoral anteversion, femoral offset, and abductor lever arm after total hip arthroplasty using a modular femoral neck system. J Orthop Sci, 2002, 7(1): 62-67.
12. 周丹. 成人发育性髋关节发育不良的诊断及治疗进展. 中外医学研究, 2013, 11(29): 153-155.
13. 徐永胜, 王岩. 成人髋关节发育不良的诊断与治疗研究进展. 内蒙古医学杂志 2012, 44(4): 458-461.
14. Garras DN, Crowder TT, Olson SA. Medium-term results of the Bernese periacetabular osteotomy in the treatment of symptomatic developmental dysplasia of the hip. J Bone Joint Surg (Br), 2007, 89(6): 721-724.
15. 薛文东, 戴尅戎, 龙公. 中国人股骨上段几何特征研究. 北京生物医学工程, 2006, 25(1): 30-34.
16. Hicks-Little CA, Peindl RD, Hubbard-Turner TJ, et al. The relationship between early-stage knee osteoarthritis and lower-extremity alignment, joint laxity, and subjective scores of pain, stiffness, and function. J Sport Rehabil, 2016, 25(3): 213-218.
17. Maderbacher G, Baier C, Springorum HR, et al. Lower limb anatomy and alignment affect natural tibiofemoral knee kinematics: A cadaveric investigation. J Arthroplasty, 2016, 31(9): 2038-2042.
18. Cibulka MT. Determination and significance of femoral neck anteversion. Phys Ther, 2004, 84(6): 550-558.
19. McGrory BJ, Morrey BF, Cahalan TD, et al. Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty. J Bone Joint Surg (Br), 1995, 77(6): 865-869.
20. Asayama I, Naito M, Fujisawa M, et al. Relationship between radiographic measurements of reconstructed hip joint position and the Trendelenburg sign. J Arthroplasty, 2002, 17(6): 747-751.
21. Vendittoli PA, Ganapathi M, Nuño N, et al. Factors affecting hip range of motion in surface replacement arthroplasty. Clin Biomech (Bristol, Avon), 2007, 22(9): 1004-1012.
22. Nassif NA, Schoenecker PL, Thorsness R, et al. Periacetabular osteotomy and combined femoral head-neck junction osteochondroplasty: a minimum two-year follow-up cohort study. J Bone Joint Surg (Am), 2012, 94(21): 1959-1966.
23. Hu X, Zheng N, Chen Y, et al. Optimizing the femoral offset for restoring physiological hip muscle function in patients with total hip arthroplasty. Front Bioeng Biotechnol, 2021, 9: 645019. doi: 10.3389/fbioe.2021.645019.
24. Moreland JR, Bassett LW, Hanker GJ. Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg (Am), 1987, 69(5): 745-749.
25. 吴伟, 郭万首. 下肢全长X线检查的临床应用及其精准性的研究进展. 中华骨与关节外科杂志, 2017, 10(1): 84-87.

Chinese Journal of Reparative and Reconstructive Surgery

Effects of femoral offset and mechanical axis of the lower extremity on hip after osteotomy for adult developmental dysplasia of the hip

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