J Korean Hip Soc.  2010 Mar;22(1):38-44. 10.5371/jkhs.2010.22.1.38.

Acetabular Medial Wall Displacement Osteotomy in Total Hip Arthroplasty for Dysplastic Hips

• Kweon SH
• Han HJ
• Yi Y

• KMID: 1461075
• DOI: http://doi.org/10.5371/jkhs.2010.22.1.38

Abstract

PURPOSE
This study evaluated the results of acetabular medial wall osteotomy to reconstruct the acetabulum in dysplastic hip during total hip arthroplasty.
MATERIALS AND METHODS
We clinically and radiologically evaluated 30 hips of 30 patients with secondary hip osteoarthritis caused by congenital hip dislocation or acetabular dysplasia who underwent total hip arthroplasty (THA) between March 1999 and October 2002. The average age of subjects was 46.5 years(17 to 73 years), and the mean follow-up period was 5 years(5.3 to 8.7 years). In 26 cases, a cementless hemispherical acetabular cup was inserted in the true acetabulum; in 4 cases a reinforced ring was inserted. Only 2 hips needed structural bone grafting.
RESULTS
The average Harris hip score improved from 56.3 points preoperatively to 93.2 points at the last follow up. Radiographic analysis revealed no aseptic loosening or radiolucent line, and showed stable bony fixation at the true acetabulum. The mean thickness of the medial acetabular wall postoperative was 20.5 mm(10 to 36 mm). Bone union of the medial wall was observed at a mean of four months postoperatively.
CONCLUSION
Acetabular medial wall osteotomy can maintain the integrity of the acetabular medial wall while achieving enhanced acetabular coverage and more normal hip biomechanics.

Keyword

Acetabular dysplasia; Acetabular medial wall osteotomy; Total hip arthroplasty

MeSH Terms

Acetabulum
Arthroplasty
Biomechanics
Bone Transplantation
Displacement (Psychology)
Follow-Up Studies
Hip
Hip Dislocation, Congenital
Humans
Osteoarthritis, Hip
Osteotomy

Figure

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  Fig. 1 (A) Preoperative radiograph of a 28-year-old man shows Craw type III dysplasia. (B) 11 month postoperative radiograph shows the medialized the rotating hip center with acetabular reinforcement ring with hook.

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  Fig. 2 The radiographic measurements included (A) pelvic height, (B) height of the true acetabulum, (C) proximal migration of the lesser trochanter, (D) Ranawat triangle, (E) thickness of the medial wall, (F) theta angle, (G) medial femoral-neck junction, (H) position of the cup medial to the Ranawat triangle, (I) relationship of the cup to the superior border of the Ranawat triangle, and (J) position of the cup medial to the kohler line.

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  Fig. 3 (A) Preoperative radiograph of a 21-year-old woman shows Crowe type IV dysplasia. (B) 12 month postoperative radiograph shows that the acetabular medial wall bone stock was well preserved. (C) 15 month postoperative radiograph shows well union of distal femoral osteotomy site.

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