Three-dimensional femoral morphology in Hartofilakidis type C developmental dysplastic hips and the implications for tot
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ORIGINAL PAPER
Three-dimensional femoral morphology in Hartofilakidis type C developmental dysplastic hips and the implications for total hip arthroplasty Zhaolun Wang 1 & Hua Li 1 & Yixin Zhou 1
&
Wang Deng 1
Received: 12 February 2020 / Accepted: 11 June 2020 # SICOT aisbl 2020
Abstract Purposes The aim of this study was to describe and compare the femoral morphologies of Hartofilakidis types C1 and C2 developmental dysplasia of the hip (DDH), and discuss the potential influence on subsequent total hip arthroplasty (THA). Methods We analyzed preoperative CT data from 81 patients (42 C1 and 39 C2 subtypes) who underwent THA for arthritis secondary to Hartofilakidis type C DDH. The CT data was three-dimensionally reconstructed and measured of following parameters: neck-shaft angle, femoral neck length, anteversion, medial inclination, femoral offset, height of the greater trochanter and femoral head, mediolateral (ML) and anteroposterior (AP) widths of the medullary canal. The canal flare indices and ML-toAP ratio were further calculated. We also reviewed surgical and follow-up records to compare the different implants utilized and the clinical results between C1 and C2 hips. Results The C2 femurs had a significantly lower neck-shaft angle (119.0° vs. 124.0°), shorter femoral neck (37.0 mm vs. 41.2 mm), larger medial cortical inclination (158.8° vs. 149.1°), and higher position of the greater trochanter. The C2 femurs were narrower and had a smaller canal flare index (2.88 ± 0.50) than C1 femurs (3.64 ± 0.69). The ML-to-AP ratio of the proximal femoral medullary canal was significantly smaller in the C2 group. Accordingly, C2 femurs required thinner stems, more non-sprouted sleeves, and had a higher rate and required a longer length of shortening osteotomies. At an average follow-up of 36.0 months, the C1 and C2 groups had a similar Harris Hip Score (83.5 ± 14.3 vs. 84.2 ± 9.8, P = 0.771) and no stem loosening occurred in either group. Conclusion C1 and C2 proximal femurs have substantial differences in the coronal, sagittal, and axial planes. In the setting of THA, C2 femurs may therefore require thinner stems, more non-sprouted sleeves, and have a higher rate and require a longer length of shortening osteotomies. Keywords Hip dysplasia . Hartofilakidis type C . Computed tomography . Femoral morphology
Introduction Developmental dysplasia of the hip (DDH) is one of the most common causes of secondary hip osteoarthritis in young adults [1] and represents a broad spectrum of abnormalities related to acetabular and femoral maldevelopment [2]. DDH Zhaolun Wang and Hua Li contributed equally to this manuscript. * Yixin Zhou [email protected] 1
Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, People’s Republic of China
in adults can be classified into three types using the Hartofilakidis classification system: types A (dysplasia), B (low dislocation), and C (high dislocation), according
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