Pre-Operative Planning of Total Hip Arthroplasty on Dysplastic Acetabuli. Issue 1 (January 2017)

• Record Type: Journal Article
• Authors: Lakstein, Dror; Tan, Zachary; Oren, Nugzar; Mäkinen, Tatu Johannes; Gross, Allan E.; Safir, Oleg
• Is Part Of: Hip international. Volume 27:Issue 1(2017)
• Page Start: 55
• Page End: 59
• Publication Date: 2017-01
• Subjects: Developmental hip dysplasia -- Pre-Operative planning -- Templating -- Total hip replacement; Hip joint -- Pathophysiology -- Periodicals; Hip joint -- Diseases -- Periodicals; Hip joint -- Surgery -- Periodicals; 617.581005
• DOI: 10.5301/hipint.5000419
• Languages: English
• ISSNs: 1120-7000

Abstract

Background: When performing total hip arthroplasty (THA) on a dysplastic hip, proper positioning of the acetabular component may not allow for more than 70% coverage. Structural support in the form of an autograft or a high porosity metal augment may be necessary. The purpose of the study was to investigate the value of pre-operative templating and deformity classification in predicting cup coverage and the need for structural support. Methods: 65 cases of THA for DDH were retrospectively analysed. 2 observers independently classified each dysplastic hip according to Hartofilakidis and determined the extent of cup coverage via templating software on pre-operative digital AP pelvic radiographs. Results: Weighted kappa interobserver agreement was 0.68 for cup coverage and 0.76 for Hartofilakidis type. Structural support was necessary in 10 hips. No structural support was necessary in Hartofilakidis type 1, dysplasia cases. However, 27-30% of cases with type 2 or type 3 dysplasia required structural support. All cases with templated cup coverage of 65% or less required structural support. Templated coverage within 65-75% and over 75% resulted in 20% and 10% of patients receiving structural augmentation, respectively. Conclusions: Pre-Operative planning for THA in the setting of hip dysplasia is crucial and can provide valuable insight to the need for column augmentation. However, the 3-D severity of the deformity may be underestimated in the 2-D radiographs.