Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
Department of Orthopaedic Surgery, Saiseikai Kagawa Hospital, Kagawa, Japan.
BMC Musculoskelet Disord. 2022 Jul 6;23(1):646. doi: 10.1186/s12891-022-05597-y.
Total hip arthroplasty after osteotomy is more technically challenging than primary total hip arthroplasty, especially concerning cup placement. This is attributed to bone morphological abnormalities caused by acetabular bone loss and osteophyte formation. This study aimed to investigate the clinical and radiological outcomes of total hip arthroplasty after rotational acetabular osteotomy compared with those of primary total hip arthroplasty, focusing mainly on acetabular deformity and cup position.
The study included 22 hips that had undergone rotational acetabular osteotomy and 22 hips in an age- and sex-matched control group of patients who underwent total hip arthroplasties between 2005 and 2020. We analyzed cup abduction and anteversion; lateral, anterior, and posterior cup center-edge angle; hip joint center position; femoral anteversion angle; and presence of acetabular defect using postoperative radiography and computed tomography. Operative results and clinical evaluations were also analyzed.
The clinical evaluation showed that the postoperative flexion range of motion was lower in total hip arthroplasty after rotational acetabular osteotomy than in primary total hip arthroplasty, although no significant difference was noted in the postoperative total Japanese Orthopedic Association hip score. The operative time was significantly longer in the rotational acetabular osteotomy group than in the control group, but there was no significant difference in blood loss. The lateral cup center-edge angle was significantly higher and the posterior cup center-edge angle was significantly lower in the total hip arthroplasty after rotational acetabular osteotomy, suggesting a posterior bone defect existed in the acetabulum. In total hip arthroplasty after rotational acetabular osteotomy, the hip joint center was located significantly superior and lateral to the primary total hip arthroplasty.
In total hip arthroplasty after rotational acetabular osteotomy, the cup tended to be placed in the superior and lateral positions, where there was more bone volume. The deformity of the acetabulum and the high hip center should be considered for treatment success because they may cause cup instability, limited range of motion, and impingement.
与初次全髋关节置换术相比，截骨术后的全髋关节置换术在技术上更具挑战性，尤其是在髋臼杯的放置方面。这归因于髋臼骨量丢失和骨赘形成导致的骨形态异常。本研究旨在比较旋转髋臼截骨术后全髋关节置换术与初次全髋关节置换术的临床和影像学结果，主要关注髋臼畸形和髋臼杯位置。
该研究纳入了 22 例接受旋转髋臼截骨术和 22 例年龄和性别匹配的初次全髋关节置换术对照组患者。我们分析了术后髋臼杯外展和前倾角；髋臼外侧、前侧和后侧中心边缘角；髋关节中心位置；股骨前倾角；以及髋臼缺损的存在情况。还分析了手术结果和临床评估。
临床评估显示，与初次全髋关节置换术相比，旋转髋臼截骨术后全髋关节置换术后的关节屈曲活动范围较低，但术后总日本矫形协会髋关节评分无显著差异。旋转髋臼截骨组的手术时间明显长于对照组，但失血量无显著差异。旋转髋臼截骨术后全髋关节置换术的髋臼外侧中心边缘角明显较高，后侧中心边缘角明显较低，提示髋臼存在后侧骨缺损。在旋转髋臼截骨术后全髋关节置换术中，髋关节中心位于明显高于初次全髋关节置换术的外侧位置。
在旋转髋臼截骨术后的全髋关节置换术中，髋臼杯倾向于放置在骨量较多的上外侧位置。髋臼畸形和高位髋关节中心应被视为治疗成功的关键因素，因为它们可能导致髋臼杯不稳定、活动范围受限和撞击。
