[Autograft of femoral head for acetabular reconstruction in total hip arthroplasty for developmental dysplasia of the hip with complicated deformity]

Yang Peng, Liu Yang, Guangxing Chen, Lingchuan Gu, Hao Chen
Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery] 2014, 52 (1): 25-9

OBJECTIVE: To observe autograft of femoral head for acetabular reconstruction in total hip arthroplasty(THA)without shortening femoral osteotomy for developmental dysplasia of the hip (DDH) with complicated deformity.

METHODS: A case series of 18 Crowe type-III-IV DDH patients (19 hips) with osteoarthritis between December 2004 and October 2010 was reported. There were 2 male and 16 female patients. Mean age was 34.3 years (19-44 years) and limb shortening 4.5 cm (3.0-6.2 cm), and preoperative Harris score was 40 ± 17. All cases were accomplished through posterolateral approach by the same surgeon and underwent the procedure of acetabular reconstruction using a bulk femoral head autograft and periarticular soft tissue releases(dissection of the entire articular capsule, scar tissues and osteophytes), but had no procedure of shortening by subtrochanteric transverse osteotomy. Design data through paired t-test compared the preoperative and postoperative Harris scores, also the radiographic observation, in order to asses the clinical efficacy of acetabular reconstruction, while observing the length of limb lengthening, complications and function.

RESULTS: Graft coverage of cases in the group were 16%-47% (mean, 26%), with 17 mm of the socket uncovered during operative evaluation. All patients were followed-up for 14-56 months (mean, 34.6 months). The lengthening of the affected limb was 2.9-4.6 cm (mean, (3.6 ± 0.7)cm). The limb-length discrepancy was 0-1.2 cm (mean, (0.6 ± 0.3)cm) after THA. The offset of the affected limbs was 26.4-34.3 cm(mean, (30.5 ± 1.6)cm). The postoperation radiography showed good position of the prosthetic components and coverage of the socket after bone graft was full. All patients had no static contraction abnormality of muscle in the affected limb. Three patients with numbness in lateral leg after the procedure recovered completely in one months. No other complication was observed except heterotopic ossification in 1 case. At the last follow-up examination, Harris hip score was 86 ± 11. There was statistical significance compared with the preoperative score (t = 5.86, P < 0.01) , and no revision was needed in all patients.

CONCLUSION: Autograft of femoral head for acetabular reconstruction in THA without shortening femoral osteotomy for developmental dysplasia of the hip (DDH) is an effective procedure to reconstruct acetabulum and improve the socket bone coverage.

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