Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
Orthop Surg. 2024 Nov;16(11):2793-2802. doi: 10.1111/os.14213. Epub 2024 Aug 28.
Due to the technical challenges associated with femoral reconstruction in total hip arthroplasty for patients with developmental dysplasia of the hip (DDH), the exact indications for using femoral modular stems, despite their satisfactory clinical outcomes, remain poorly investigated. This study sought to assess the morphology of the femur and acetabulum, and to investigate the discriminative ability of femoral anteversion (FA), acetabular anteversion (AA), and combined anteversion (CA) on the selection of femoral modular stem in dysplastic hips.
Retrospective data were collected from multiple centers on a total of 230 cases who underwent THA due to DDH from January 1, 2020, to March 1, 2023. There were 46 males and 184 females, with an average age of 51.57 ± 14.87. Patients were stratified according to Crowe and Eftekhar classifications. FA, AA, and CA were measured using computed tomography (CT). The distribution of these indices in different grades of dysplastic hips was compared, and the correlation between these indices and the selection of femoral modular stem was analyzed. Receiver operating characteristic (ROC) and likelihood statistics were performed to investigate the discriminating and predictive value of each index in selecting modular stem.
Two hundred and thirty hips were included in the study. FA increased as the subluxation percentage increased: type I, 21.5°; type II, 28.6°; type III, 34.9°; and type IV, 39.7°. AA was smaller in type I (16.9°) and higher in types II, III, and IV (18.9-22.6°). The area under the curve for the modular stem was 0.87 for FA, 0.86 for CA, and 0.65 for AA. The optimal cutoff values were FA > 32.6°, CA > 50.7°, and AA > 23.3°.
Excessive AA and femoral anteversion FA were observed in Crowe types II, III, and IV cases. FA and CA demonstrated strong discriminative ability and predictive value in the selection of a modular stem. The best cutoff values were ≥32.6° for FA and ≥50.7° for CA in discriminating the use of modular stem. Surgeons may contemplate the use of a modular stem when the preoperative evaluation approaches the cutoff value.
由于发育性髋关节发育不良（DDH）患者全髋关节置换术中股骨重建的技术挑战，尽管股骨模块化假体的临床效果令人满意，但确切的适应证仍研究不足。本研究旨在评估股骨和髋臼的形态，并探讨股骨前倾角（FA）、髋臼前倾角（AA）和联合前倾角（CA）对发育性髋关节中股骨模块化假体选择的区分能力。
回顾性收集了 2020 年 1 月 1 日至 2023 年 3 月 1 日因 DDH 接受 THA 的 230 例患者的多中心数据。其中男性 46 例，女性 184 例，平均年龄 51.57±14.87 岁。患者根据 Crowe 和 Eftekhar 分类进行分层。使用计算机断层扫描（CT）测量 FA、AA 和 CA。比较不同发育性髋关节畸形程度的这些指标的分布，并分析这些指标与股骨模块化假体选择的相关性。进行接收者操作特征（ROC）和似然统计分析，以研究每个指标在选择模块化假体中的区分和预测价值。
本研究共纳入 230 髋。随着脱位百分比的增加，FA 增加：I 型，21.5°；II 型，28.6°；III 型，34.9°；IV 型，39.7°。I 型 AA 较小（16.9°），II、III 和 IV 型较高（18.9-22.6°）。FA 的曲线下面积为 0.87，CA 为 0.86，AA 为 0.65。最佳截断值为 FA＞32.6°，CA＞50.7°，AA＞23.3°。
在 Crowe Ⅱ、Ⅲ和Ⅳ型病例中观察到过大的 AA 和股骨前倾角 FA。FA 和 CA 在模块化假体选择中具有较强的区分能力和预测价值。最佳截断值为 FA≥32.6°和 CA≥50.7°，以区分是否使用模块化假体。当术前评估接近截断值时，外科医生可能会考虑使用模块化假体。
