Femoral Head Autograft to Manage Acetabular Bone Loss Defects in THA for Crowe III Hips by DAA: Retrospective Study and Surgical Technique

Abstract

The pathologic anatomy of Crowe III is characterized by the erosion of the superior rim of acetabulum, with a typical bone defect in its supero–lateral portion. The performance of a total hip arthroplasty requires the management of the acetabular bone defect, and femoral head autograft can be a valid option to optimize implant coverage. Material and Methods: In all, eight Crowe III patients (nine hips), seven of which having unilateral hip affected, and one with bilateral involvement by secondary osteoarthritis in DDH; maximum limb length discrepancy (LLD) of 3.5 cm in unilateral patients. All were operated on by direct anterior approach. Patients were evaluated in terms of clinical, surgical, and radiological (center-edge, horizontal coverage, cup inclination) parameters. Results: Cup placement was implanted with a mean of 39.5° ± 7.5°. Stem alignment showed average 1.5 ± 2.3° in valgus. LLD showed an overall average preoperative of −29.5 ± 10.5 mm at the affected side, with a significant improvement to −2.5 ± 6.4 mm (p = 0.023). The mean initial coverage evaluated like a percentage of the horizontal bone host was 52.1 ± 7.1%, while the mean final coverage at the last post-operative X-ray from femoral autograft bone was 97.0 ± 4.5% with an average improvement of 44.5%. Average CE improved from −9.5° ± 5.2° (CE I) to the immediate post-operative (CE II) of 40.6° ± 8.2°. At the final follow up, CE III showed a mean of 38.6 ± 6.2°, with an average decrease of 2.0°. Discussion: Acetabular bone defect in Crowe III DDH patients undergoing THA by DAA, can be efficiently managed by massive autograft femoral head, which allowed an adequate and long-lasting coverage of the implant, with cup positioning at the native acetabulum.

Direct Anterior Approach in Total Hip Arthroplasty for Severe Crowe IV Dysplasia: Retrospective Clinical and Radiological Study

“…At the last available follow-up, an average HHS improvement of 44.8 points was found, with preoperative values averaging 44.6 points (38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56), and a postoperative average of 89.4 points (82-96) (p < 0.001) (Table 1). Abductor muscle insufficiency with positive Trendelenburg gait and sign, which preoperatively was present in all the patients, was observed in 4 out of 19 patients (21%) at the last clinical evaluation.…”

“…Comparing the DAA approach to traditional THA approaches, including lateral, posterolateral, and posterior approaches, has shown excellent outcomes in DDH patients, both in terms of complications and long-term revision rates [38][39][40][41][42]. Traditional techniques are associated with some degree of muscle damage, with postoperative dislocation rates of up to 16.6% [2].…”

Integrated acetabular prosthesis versus bone grafting in total hip arthroplasty for Crowe type II and III hip dysplasia: a retrospective case–control study

“…Structural autograft with a bulk femoral head is a good choice for reconstructing the acetabulum in Crowe type II and III DDH. Metal screws are used to x bone graft, which not only ensure the stability of the acetabular cup, but also increase the bone reserve, so that the acetabular cup prosthesis bone ingrowth can achieve biological xation (20).…”

Observations on the Present and the Future of Hip Surgery

“…The implementation of minimally invasive surgery has allowed the support and extension of the indication of THA to younger patients for the first time, who require an early return to function and good aesthetic results [10], but it has also provided a unique opportunity to improve the quality of life in fragile elderly patients. In this sense, the direct anterior approach (DAA) has gained wide popularity in the last few years because of its intrinsic minimal operative trauma to the hip joint and because of the positive impact on implants' survival, which is achieved independently from body habitus, age [10] and bony anatomy [11][12][13]. However, since the DAA has gained popularity, many surgeons have experienced its effectiveness in the management of hip diseases, either performing a mini-open preservative procedure for slipped capital femoral epiphysis [14] or performing neck reshaping for femoral-acetabular impingement [15].…”