Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Arch Orthop Trauma Surg. 2022 Nov;142(11):3539-3547. doi: 10.1007/s00402-021-04253-9. Epub 2021 Nov 20.
Total hip arthroplasty (THA) after rotational acetabular osteotomy (RAO) is technically demanding because of the characteristic acetabular morphology after RAO. The present study aimed to investigate the differences in the three-dimensional cup position between THA after RAO and primary THA.
We analysed the pre-operative and post-operative computed tomography (CT) data of 120 patients (20 patients after RAO and 100 patients without a history of RAO) who underwent THA between January 2017 and June 2018. We evaluated radiographic parameters, including acetabular anteversion, antero-posterior distance at the level of the femoral head centre, the presence of anterior acetabular osteophyte and/or rotated fragment during RAO from the CT data. Additionally, operative data and clinical scores were also evaluated.
Although we found no significant differences in any clinical parameters, there were significant differences in radiographic parameters and operative data. The morphology of the acetabulum was significantly retroverted, and the antero-posterior distance was longer in patients after RAO, compared to the implanted cup. Additionally, longer operative time was necessary for such patients. These results reflect the atypical acetabular morphology after RAO, and emphasize that care should be taken to avoid anterior bony impingement and post-operative dislocation.
For cup implantation during THA after RAO, surgeons should acknowledge the atypical morphology of the acetabulum and not be misled by its visual shape.
由于旋转髋臼截骨术（RAO）后髋臼的特征性形态，全髋关节置换术（THA）后进行 RAO 技术要求较高。本研究旨在探讨 RAO 后 THA 与初次 THA 之间三维髋臼杯位置的差异。
我们分析了 2017 年 1 月至 2018 年 6 月期间接受 THA 的 120 名患者（RAO 后 20 名和无 RAO 史 100 名）的术前和术后 CT 数据。我们从 CT 数据评估了髋臼前倾角、股骨头中心水平的前后距离、RAO 过程中髋臼前赘生物和/或旋转碎片的存在等影像学参数。此外，还评估了手术数据和临床评分。
尽管我们在任何临床参数上均未发现显著差异，但在影像学参数和手术数据方面存在显著差异。与植入的髋臼杯相比，RAO 后患者的髋臼形态明显后倾，前后距离较长。此外，此类患者需要更长的手术时间。这些结果反映了 RAO 后髋臼的非典型形态，并强调应注意避免前骨撞击和术后脱位。
对于 RAO 后 THA 中的髋臼杯植入，外科医生应认识到髋臼的非典型形态，不要被其视觉形状所误导。
