ObjectiveTo explore the effectiveness of total hip arthroplasty (THA) for non-functional bony ankylosed hip in young and middle-aged patients. MethodsBetween January 2010 and March 2013, 14 cases (19 hips) of non-functional bony ankylosed hip were treated by THA. There were 9 males and 5 females, aged 37.5 years on average (range, 23-58 years). The left hip was involved in 6 cases, the right hip in 3 cases, and bilateral hips in 5 cases. The causes were tuberculosis in 2 patients, ankylosing spondylitis in 5 patients, traumatic arthritis in 5 patients, osteoarthritis in 1 patient, and suppurative infection in 1 patient. The disease duration was 7-18 years with an average of 8.9 years. Flexion stiffness was observed in 10 hips, flexion abduction stiffness in 6 hips, and flexion adduction shortening stiffness in 3 hips. Only 5 patients could walk with a crutch before operation. Harris hip score was 24.368±7.625. ResultsThe average operation time was 63.4 minutes (range, 50-90 minutes). The average intraoperative blood loss was 196.8 mL (range, 100-400 mL). Patients obtained primary healing of incision; no complication of neurovascular injury, fracture, joint dislocation, or infection occurred. All patients were followed up 2.2 years on average (range, 1 year to 4 years and 3 months). The Harris score was 86.837±7.742 at last follow-up, showing significant difference when compared with preoperative score (t=-41.956, P=0.000). The results were excellent in 5 hips, good in 11 hips, fair in 2 hips, and poor in 1 hip, with an excellent and good rate of 84.2%. All patients could basically take care of themselves; 2 patients could walk with crutch, and the other patients could walk without crutch. X-ray films showed that prosthesis was in good position; no shifting, loosening, or sinking was found. Heterotopic ossification occurred in 2 hips. ConclusionTHA is an effective surgical approach to treat non-functional bony ankylosed hip in young and middle-aged patients.
ObjectiveTo explore the method of acetabular orientation determination in total hip arthroplasty (THA) for bony ankylosed hip and the accuracy of the postoperative evaluation. MethodsBetween January 2009 and March 2013, 33 consecutive patients (49 hips) underwent THA. There were 25 males and 8 females with a mean age of 35.8 years (range, 18-69 years). The left hip was involved in 10 cases, the right hip in 7 cases, and bilateral hips in 16 cases. The causes were ankylosing spondylitis in 18 patients, tuberculosis in 6 patients, traumatic arthritis in 6 patients, osteoarthritis in 2 patients, and suppurative infection in 1 patient. The disease duration was 7-15 years with an average of 10.8 years. The acetabular orientation was determined with periacetabular bone marks (the upper margin of the obturator foramen, acetabular notch etc.) and soft tissue signs (acetabulum transverse ligament etc.). The hip or pelvic radiograph was taken to measure the acetabular prosthesis anteversion and abduction angle, and upward or downward, inward or outward acetabular migration degree. The acetabular anteversion angle of 15 degrees, the abduction angle of 45 degrees, and upward or downward, inward or outward acetabular migration degree of 0 served as a reference value to evaluate the accuracy of acetabular position. ResultsThere was no complications of neurovascular injury, fracture, joint dislocation, and infection. All of patients were followed up 13-63 months (mean, 30.3 months). The anteversion angle and abduction angle were (13.904±4.034)° and (42.898±7.474)° at last follow-up, showing no significant difference when compared with reference value (t=1.386, P=0.178; t=1.969, P=0.055). The inward or outward and upward or downward acetabulum migration degree were (2.530±2.261) mm and (3.886±3.334) mm respectively, showing significant differences when compared with reference value (t=7.830, P=0.000; t=8.159, P=0.000); it was less than 5 mm in 29 hips, 5-10 mm in 18 hips, and more than 10 mm in 2 hips; the acetabulum center coincidence rate was 59.2%. ConclusionFor bony ankylosed hip having loss of normal anatomy structure, intraoperative residues and permanent anatomical structure should be used for acetabular positioning.
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.