Advances in revision surgery after primary total hip arthroplasty for Crowe type <b>Ⅳ</b> developmental dysplasia of the hip_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Yi ,  LI Shuqiang , CHENG Qisheng , MU Jie

Department of Orthopedic Center, Bethune First Hospital of Jilin University, Changchun Jilin, 130012, P. R. China;

Corresponding author：

LI Shuqiang, Email: shuqiang@jlu.edu.cn

Keywords：

Developmental dysplasia of the hip; Crowe typing; total hip arthroplasty; revision surgery; bone defect

DOI：

10.7507/1002-1892.202309016

Video：

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Objective To review research advances of revision surgery after primary total hip arthroplasty (THA) for patients with Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods The recent literature on revision surgery after primary THA in patients with Crowe type Ⅳ DDH was reviewed. The reasons for revision surgery were analyzed and the difficulties of revision surgery, the management methods, and the related prosthesis choices were summarized. Results Patients with Crowe type Ⅳ DDH have small anteroposterior diameter of the acetabulum, large variation in acetabular and femoral anteversion angles, severe soft tissue contractures, which make both THA and revision surgery more difficult. There are many reasons for patients undergoing revision surgery after primary THA, mainly due to aseptic loosening of the prosthesis. Therefore, it is necessary to restore anatomical structures in primary THA, as much as possible and reduce the generation of wear particles to avoid postoperative loosening of the prosthesis. Due to the anatomical characteristics of Crowe type Ⅳ DDH, the patients have acetabular and femoral bone defects, and the repair and reconstruction of bone defects become the key to revision surgery. The acetabular side is usually reconstructed with the appropriate acetabular cup or combined metal block, Cage, or custom component depending on the extent of the bone defect, while the femoral side is preferred to the S-ROM prosthesis. In addition, the prosthetic interface should be ceramic-ceramic or ceramic-highly cross-linked polyethylene wherever possible. Conclusion The reasons leading to revision surgery after primary THA in patients with Crowe type Ⅳ DDH and the surgical difficulties have been clarified, and a large number of clinical studies have proposed corresponding revision modalities based on which good early- and mid-term outcomes have been obtained, but further follow-up is needed to clarify the long-term outcomes. With technological advances and the development of new materials, personalized prostheses for these patients are expected to become a reality.

Citation： LIU Yi, LI Shuqiang, CHENG Qisheng, MU Jie. Advances in revision surgery after primary total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of the hip. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(12): 1548-1555. doi: 10.7507/1002-1892.202309016 Copy

1.	Schwartz BE, Piponov HI, Helder CW, et al. Revision total hip arthroplasty in the United States: national trends and in-hospital outcomes. Int Orthop, 2016, 40(9): 1793-1802.
2.	Badarudeen S, Shu AC, Ong KL, et al. Complications after revision total hip arthroplasty in the medicare population. J Arthroplasty, 2017, 32(6): 1954-1958.
3.	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.
4.	Bozic KJ, Kurtz SM, Lau E, et al. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg (Am), 2009, 91(1): 128-133.
5.	Bilgen ÖF, Salar N, Bilgen MS, et al. The effect of dislocation type (Crowe types Ⅰ-Ⅳ) on pelvic development in developmental dysplasia of the hip: a radiologic study of anatomy. J Arthroplasty, 2015, 30(5): 875-878.
6.	Yang Y, Liao W, Yi W, et al. Three-dimensional morphological study of the proximal femur in Crowe type Ⅳ developmental dysplasia of the hip. J Orthop Surg Res, 2021, 16(1): 621.
7.	Liu S, Zuo J, Li Z, et al. Study of three-dimensional morphology of the proximal femur in developmental adult dysplasia of the hip suggests that the on-shelf modular prosthesis may not be an ideal choice for patients with Crowe type Ⅳ hips. Int Orthop, 2017, 41(4): 707-713.
8.	Kilicarslan K, Yalcin N, Cicek H, et al. What happens at the adjacent knee joint after total hip arthroplasty of Crowe type Ⅲ and Ⅳ dysplastic hips? J Arthroplasty, 2012, 27(2): 266-270.
9.	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.
10.	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.
11.	Di Martino A, Castagnini F, Stefanini N, et al. Survival rates and reasons for revision of different stem designs in total hip arthroplasty for developmental dysplasia: a regional registry study. J Orthop Traumatol, 2021, 22(1): 29.
12.	沈俊民, 周勇刚, 孙菁阳, 等. Crowe Ⅳ 型髋关节发育不良人工全髋关节置换术后翻修原因及假体选择的研究. 中国修复重建外科杂志, 2020, 34(5): 557-562.
13.	Adami G, Saag KG. Glucocorticoid-induced osteoporosis update. Curr Opin Rheumatol, 2019, 31(4): 388-393.
14.	Walter SG, Randau TM, Gravius N, et al. Monoflanged custom-made acetabular components promote biomechanical restoration of severe acetabular bone defects by metallic defect reconstruction. J Arthroplasty, 2020, 35(3): 831-835.
15.	Zanasi S, Zmerly H. Customised three-dimensional printed revision acetabular implant for large defect after failed triflange revision cup. BMJ Case Rep, 2020, 13(5): e233965.
16.	Brown JM, Mistry JB, Cherian JJ, et al. Femoral component revision of total hip arthroplasty. Orthopedics, 2016, 39(6): e1129-e1139.
17.	Telleria JJ, Gee AO. Classifications in brief: Paprosky classification of acetabular bone loss. Clin Orthop Relat Res, 2013, 471(11): 3725-3730.
18.	McLaughlin JR, Lee KR. Acetabular revision arthroplasty using an uncemented deep profile jumbo component: a ten to sixteen year follow-up study. J Arthroplasty, 2018, 33(2): 496-499.
19.	Fan CY, Chen WM, Lee OK, et al. Acetabular revision arthroplasty using jumbo cups: an experience in Asia. Arch Orthop Trauma Surg, 2008, 128(8): 809-813.
20.	Moon JK, Ryu J, Kim Y, et al. Acetabular revision arthroplasty using press-fitted jumbo cups: an average 10-year follow-up study. Arch Orthop Trauma Surg, 2019, 139(8): 1149-1160.
21.	Chen HT, Wu CT, Huang TW, et al. Structural and morselized allografting combined with a cementless cup for acetabular defects in revision total hip arthroplasty: a 4- to 14-year follow-up. Biomed Res Int, 2018, 2018: 2364269.
22.	van der Donk S, Buma P, Slooff TJ, et al. Incorporation of morselized bone grafts: a study of 24 acetabular biopsy specimens. Clin Orthop Relat Res, 2002(396): 131-141.
23.	Stirling P, Viamont-Guerra MR, Strom L, et al. Does cup position at the high hip center or anatomic hip center in tha for developmental dysplasia of the hip result in better harris hip scores and revision incidence? A systematic review. Clin Orthop Relat Res, 2021, 479(5): 1119-1130.
24.	Yu R, Hofstaetter JG, Sullivan T, et al. Validity and reliability of the Paprosky acetabular defect classification. Clin Orthop Relat Res, 2013, 471(7): 2259-2265.
25.	Güneş Z, Bekmez Ş, Çağlar Ö, et al. Anatomic acetabular reconstruction with femoral head autograft for developmental dysplasia of the hip (DDH) with a minimum follow-up of 10 years. Hip Int, 2023, 33(4): 736-742.
26.	Philippe R, Gosselin O, Sedaghatian J, et al. Acetabular reconstruction using morselized allograft and a reinforcement ring for revision arthroplasty with Paprosky type Ⅱ and Ⅲ bone loss: survival analysis of 95 hips after 5 to 13 years. Orthop Traumatol Surg Res, 2012, 98(2): 129-137.
27.	Waddell BS, Boettner F, Gonzalez Della Valle A. Favorable early results of impaction bone grafting with reinforcement mesh for the treatment of Paprosky 3B acetabular defects. J Arthroplasty, 2017, 32(3): 919-923.
28.	Drampalos E, Fadulelmola A, Mohammed R, et al. Nine-year results of whole femoral head allograft with articular cartilage for acetabular impaction grafting in revision hip replacement. Ann R Coll Surg Engl, 2017, 99(3): 203-206.
29.	Ahmad AQ, Schwarzkopf R. Clinical evaluation and surgical options in acetabular reconstruction: A literature review. J Orthop, 2015, 12(Suppl 2): S238-S243.
30.	O'Neill CJ, Creedon SB, Brennan SA, et al. Acetabular revision using trabecular metal augments for Paprosky type 3 defects. J Arthroplasty, 2018, 33(3): 823-828.
31.	Löchel J, Janz V, Hipfl C, et al. Reconstruction of acetabular defects with porous tantalum shells and augments in revision total hip arthroplasty at ten-year follow-up. Bone Joint J, 2019, 101-B(3): 311-316.
32.	Zhou B, Zhou Y, Yang D, et al. The utilization of metal augments allows better biomechanical reconstruction of the hip in revision total hip arthroplasty with severe acetabular defects: A comparative study. J Arthroplasty, 2018, 33(12): 3724-3733.
33.	Li H, Wang L, Mao Y, et al. Revision of complex acetabular defects using cages with the aid of rapid prototyping. J Arthroplasty, 2013, 28(10): 1770-1775.
34.	Matar HE, Selvaratnam V, Shah N, et al. Custom triflange revision acetabular components for significant bone defects and pelvic discontinuity: Early UK experience. J Orthop, 2020, 21: 25-30.
35.	Hughes AJ, DeBuitleir C, Soden P, et al. 3D printing aids acetabular reconstruction in complex revision hip arthroplasty. Adv Orthop, 2017, 2017: 8925050.
36.	Durand-Hill M, Henckel J, Di Laura A, et al. Can custom 3D printed implants successfully reconstruct massive acetabular defects? A 3D-CT assessment. J Orthop Res, 2020, 38(12): 2640-2648.
37.	Sugano N, Noble PC, Kamaric E, et al. The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg (Br), 1998, 80(4): 711-719.
38.	Du Y, Li T, Sun J, et al. The effect of the false acetabulum on femoral proximal medullary canal in unilateral Crowe type Ⅳ developmental dislocation of the hip. Ther Clin Risk Manag, 2020, 16: 631-637.
39.	McCarthy JC, Lee JA. Complex revision total hip arthroplasty with modular stems at a mean of 14 years. Clin Orthop Relat Res, 2007, 465: 166-169.
40.	Sheth NP, Melnic CM, Rozell JC, et al. Management of severe femoral bone loss in revision total hip arthroplasty. Orthop Clin North (Am), 2015, 46(3): 329-342.
41.	Burstein G, Yoon P, Saleh KJ. Component removal in revision total hip arthroplasty. Clin Orthop Relat Res, 2004(420): 48-54.
42.	Noble PC, Kamaric E, Sugano N, et al. Three-dimensional shape of the dysplastic femur: implications for THR. Clin Orthop Relat Res, 2003, 417: 27-40.
43.	Park YS, Lim SJ. Long-term comparison of porous and hydroxyapatite sleeves in femoral revision using the S-ROM modular stem. Hip Int, 2010, 20(2): 179-186.
44.	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.
45.	Bellomo F, Bertignone L, Morino L, et al. MP-Link cementless distal fixation modular prosthesis for revision total hip arthroplasty. J Orthop Traumatol, 2002, 2(3): 121-124.
46.	Amanatullah DF, Howard JL, Siman H, et al. Revision total hip arthroplasty in patients with extensive proximal femoral bone loss using a fluted tapered modular femoral component. Bone Joint J, 2015, 97-B(3): 312-317.
47.	Smith AJ, Dieppe P, Vernon K, et al. Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales. Lancet, 2012, 379(9822): 1199-1204.
48.	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 Arthroplasty, 2019, 34(7S): S238-S241.
49.	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.

1. Schwartz BE, Piponov HI, Helder CW, et al. Revision total hip arthroplasty in the United States: national trends and in-hospital outcomes. Int Orthop, 2016, 40(9): 1793-1802.
2. Badarudeen S, Shu AC, Ong KL, et al. Complications after revision total hip arthroplasty in the medicare population. J Arthroplasty, 2017, 32(6): 1954-1958.
3. 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.
4. Bozic KJ, Kurtz SM, Lau E, et al. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg (Am), 2009, 91(1): 128-133.
5. Bilgen ÖF, Salar N, Bilgen MS, et al. The effect of dislocation type (Crowe types Ⅰ-Ⅳ) on pelvic development in developmental dysplasia of the hip: a radiologic study of anatomy. J Arthroplasty, 2015, 30(5): 875-878.
6. Yang Y, Liao W, Yi W, et al. Three-dimensional morphological study of the proximal femur in Crowe type Ⅳ developmental dysplasia of the hip. J Orthop Surg Res, 2021, 16(1): 621.
7. Liu S, Zuo J, Li Z, et al. Study of three-dimensional morphology of the proximal femur in developmental adult dysplasia of the hip suggests that the on-shelf modular prosthesis may not be an ideal choice for patients with Crowe type Ⅳ hips. Int Orthop, 2017, 41(4): 707-713.
8. Kilicarslan K, Yalcin N, Cicek H, et al. What happens at the adjacent knee joint after total hip arthroplasty of Crowe type Ⅲ and Ⅳ dysplastic hips? J Arthroplasty, 2012, 27(2): 266-270.
9. 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.
10. 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.
11. Di Martino A, Castagnini F, Stefanini N, et al. Survival rates and reasons for revision of different stem designs in total hip arthroplasty for developmental dysplasia: a regional registry study. J Orthop Traumatol, 2021, 22(1): 29.
12. 沈俊民, 周勇刚, 孙菁阳, 等. Crowe Ⅳ 型髋关节发育不良人工全髋关节置换术后翻修原因及假体选择的研究. 中国修复重建外科杂志, 2020, 34(5): 557-562.
13. Adami G, Saag KG. Glucocorticoid-induced osteoporosis update. Curr Opin Rheumatol, 2019, 31(4): 388-393.
14. Walter SG, Randau TM, Gravius N, et al. Monoflanged custom-made acetabular components promote biomechanical restoration of severe acetabular bone defects by metallic defect reconstruction. J Arthroplasty, 2020, 35(3): 831-835.
15. Zanasi S, Zmerly H. Customised three-dimensional printed revision acetabular implant for large defect after failed triflange revision cup. BMJ Case Rep, 2020, 13(5): e233965.
16. Brown JM, Mistry JB, Cherian JJ, et al. Femoral component revision of total hip arthroplasty. Orthopedics, 2016, 39(6): e1129-e1139.
17. Telleria JJ, Gee AO. Classifications in brief: Paprosky classification of acetabular bone loss. Clin Orthop Relat Res, 2013, 471(11): 3725-3730.
18. McLaughlin JR, Lee KR. Acetabular revision arthroplasty using an uncemented deep profile jumbo component: a ten to sixteen year follow-up study. J Arthroplasty, 2018, 33(2): 496-499.
19. Fan CY, Chen WM, Lee OK, et al. Acetabular revision arthroplasty using jumbo cups: an experience in Asia. Arch Orthop Trauma Surg, 2008, 128(8): 809-813.
20. Moon JK, Ryu J, Kim Y, et al. Acetabular revision arthroplasty using press-fitted jumbo cups: an average 10-year follow-up study. Arch Orthop Trauma Surg, 2019, 139(8): 1149-1160.
21. Chen HT, Wu CT, Huang TW, et al. Structural and morselized allografting combined with a cementless cup for acetabular defects in revision total hip arthroplasty: a 4- to 14-year follow-up. Biomed Res Int, 2018, 2018: 2364269.
22. van der Donk S, Buma P, Slooff TJ, et al. Incorporation of morselized bone grafts: a study of 24 acetabular biopsy specimens. Clin Orthop Relat Res, 2002(396): 131-141.
23. Stirling P, Viamont-Guerra MR, Strom L, et al. Does cup position at the high hip center or anatomic hip center in tha for developmental dysplasia of the hip result in better harris hip scores and revision incidence? A systematic review. Clin Orthop Relat Res, 2021, 479(5): 1119-1130.
24. Yu R, Hofstaetter JG, Sullivan T, et al. Validity and reliability of the Paprosky acetabular defect classification. Clin Orthop Relat Res, 2013, 471(7): 2259-2265.
25. Güneş Z, Bekmez Ş, Çağlar Ö, et al. Anatomic acetabular reconstruction with femoral head autograft for developmental dysplasia of the hip (DDH) with a minimum follow-up of 10 years. Hip Int, 2023, 33(4): 736-742.
26. Philippe R, Gosselin O, Sedaghatian J, et al. Acetabular reconstruction using morselized allograft and a reinforcement ring for revision arthroplasty with Paprosky type Ⅱ and Ⅲ bone loss: survival analysis of 95 hips after 5 to 13 years. Orthop Traumatol Surg Res, 2012, 98(2): 129-137.
27. Waddell BS, Boettner F, Gonzalez Della Valle A. Favorable early results of impaction bone grafting with reinforcement mesh for the treatment of Paprosky 3B acetabular defects. J Arthroplasty, 2017, 32(3): 919-923.
28. Drampalos E, Fadulelmola A, Mohammed R, et al. Nine-year results of whole femoral head allograft with articular cartilage for acetabular impaction grafting in revision hip replacement. Ann R Coll Surg Engl, 2017, 99(3): 203-206.
29. Ahmad AQ, Schwarzkopf R. Clinical evaluation and surgical options in acetabular reconstruction: A literature review. J Orthop, 2015, 12(Suppl 2): S238-S243.
30. O'Neill CJ, Creedon SB, Brennan SA, et al. Acetabular revision using trabecular metal augments for Paprosky type 3 defects. J Arthroplasty, 2018, 33(3): 823-828.
31. Löchel J, Janz V, Hipfl C, et al. Reconstruction of acetabular defects with porous tantalum shells and augments in revision total hip arthroplasty at ten-year follow-up. Bone Joint J, 2019, 101-B(3): 311-316.
32. Zhou B, Zhou Y, Yang D, et al. The utilization of metal augments allows better biomechanical reconstruction of the hip in revision total hip arthroplasty with severe acetabular defects: A comparative study. J Arthroplasty, 2018, 33(12): 3724-3733.
33. Li H, Wang L, Mao Y, et al. Revision of complex acetabular defects using cages with the aid of rapid prototyping. J Arthroplasty, 2013, 28(10): 1770-1775.
34. Matar HE, Selvaratnam V, Shah N, et al. Custom triflange revision acetabular components for significant bone defects and pelvic discontinuity: Early UK experience. J Orthop, 2020, 21: 25-30.
35. Hughes AJ, DeBuitleir C, Soden P, et al. 3D printing aids acetabular reconstruction in complex revision hip arthroplasty. Adv Orthop, 2017, 2017: 8925050.
36. Durand-Hill M, Henckel J, Di Laura A, et al. Can custom 3D printed implants successfully reconstruct massive acetabular defects? A 3D-CT assessment. J Orthop Res, 2020, 38(12): 2640-2648.
37. Sugano N, Noble PC, Kamaric E, et al. The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg (Br), 1998, 80(4): 711-719.
38. Du Y, Li T, Sun J, et al. The effect of the false acetabulum on femoral proximal medullary canal in unilateral Crowe type Ⅳ developmental dislocation of the hip. Ther Clin Risk Manag, 2020, 16: 631-637.
39. McCarthy JC, Lee JA. Complex revision total hip arthroplasty with modular stems at a mean of 14 years. Clin Orthop Relat Res, 2007, 465: 166-169.
40. Sheth NP, Melnic CM, Rozell JC, et al. Management of severe femoral bone loss in revision total hip arthroplasty. Orthop Clin North (Am), 2015, 46(3): 329-342.
41. Burstein G, Yoon P, Saleh KJ. Component removal in revision total hip arthroplasty. Clin Orthop Relat Res, 2004(420): 48-54.
42. Noble PC, Kamaric E, Sugano N, et al. Three-dimensional shape of the dysplastic femur: implications for THR. Clin Orthop Relat Res, 2003, 417: 27-40.
43. Park YS, Lim SJ. Long-term comparison of porous and hydroxyapatite sleeves in femoral revision using the S-ROM modular stem. Hip Int, 2010, 20(2): 179-186.
44. 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.
45. Bellomo F, Bertignone L, Morino L, et al. MP-Link cementless distal fixation modular prosthesis for revision total hip arthroplasty. J Orthop Traumatol, 2002, 2(3): 121-124.
46. Amanatullah DF, Howard JL, Siman H, et al. Revision total hip arthroplasty in patients with extensive proximal femoral bone loss using a fluted tapered modular femoral component. Bone Joint J, 2015, 97-B(3): 312-317.
47. Smith AJ, Dieppe P, Vernon K, et al. Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales. Lancet, 2012, 379(9822): 1199-1204.
48. 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 Arthroplasty, 2019, 34(7S): S238-S241.
49. 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.

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Advances in revision surgery after primary total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of the hip

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