A Report on Three Consecutive Cases using Computer Tomography 3D Preoperative Planning for Conversion of Arthrodesed Hips to Total Hip Replacements

Abstract

CT-based preoperative 3D planning could be a powerful guidance tool for conversion of arthrodesed hips to THAs.

Total Hip Arthroplasty for Femoral Neck Fracture after Postoperative Intertrochanteric Fracture in a Patient with Spontaneous Fused Hip

“…Another study by Richards and Duncan reported significantly worse clinical outcomes and patient satisfaction as well as higher complication rates compared to common primary and revision THA [23]. Regardless of the higher complication rate, patient satisfaction and postoperative outcomes were generally good [6,8,22]. Regarding surgical techniques, it was difficult to secure adequate visualization of the surgical field due to the contracture of the soft tissue and a lack of hip movement [7,21].…”

“…Regarding surgical techniques, it was difficult to secure adequate visualization of the surgical field due to the contracture of the soft tissue and a lack of hip movement [7,21]. Additionally, the level of the neck cut and the original acetabulum were difficult to identify due to the deformity of the pelvis and fused proximal femur [6][7][8]. Malpositioning of the femur, which included a high femoral neck-shaft angle, unusual anteversion, and flexion-abduction contracture, made the preparation of the femur difficult [6,8,12].…”

“…Additionally, the level of the neck cut and the original acetabulum were difficult to identify due to the deformity of the pelvis and fused proximal femur [6][7][8]. Malpositioning of the femur, which included a high femoral neck-shaft angle, unusual anteversion, and flexion-abduction contracture, made the preparation of the femur difficult [6,8,12]. Furthermore, poor visualization, insufficient bone stock, and loss of the surgical landmark made it difficult to set the acetabular cup at the original acetabulum.…”

“…This challenging procedure often provides significant improvement to the patient's quality of life. However, higher complication rates have been reported [4][5][6][7][8]. On the other hand, a proximal femoral fracture in a patient with a fused hip rarely develops [9].…”

Total hip arthroplasty planning

“…Our opinion is that advantages of 3D can be shown clearly when treating more complicated cases, as Kuroda et al demonstrated in their study about three consecutive cases for conversion of arthrodesis hips to total hip replacements. 15…”