Total hip arthroplasty after rotational acetabular osteotomy for developmental dysplasia of the hip: a retrospective observational study

Abstract

Background: Total hip arthroplasty after osteotomy is more technically challenging than primary total hip arthroplasty, especially concerning cup placement. This is attributed to bone morphological abnormalities caused by acetabular bone loss and osteophyte formation. This study aimed to investigate the clinical and radiological outcomes of total hip arthroplasty after rotational acetabular osteotomy compared with those of primary total hip arthroplasty, focusing mainly on acetabular deformity and cup position.

Methods: The study included 22 hips that had undergone rotational acetabular osteotomy and 22 hips in an age- and sex-matched control group of patients who underwent total hip arthroplasties between 2005 and 2020. We analyzed cup abduction and anteversion; lateral, anterior, and posterior cup center-edge angle; hip joint center position; femoral anteversion angle; and presence of acetabular defect using postoperative radiography and computed tomography. Operative results and clinical evaluations were also analyzed.

Results: The clinical evaluation showed that the postoperative flexion range of motion was lower in total hip arthroplasty after rotational acetabular osteotomy than in primary total hip arthroplasty, although no significant difference was noted in the postoperative total Japanese Orthopedic Association hip score. The operative time was significantly longer in the rotational acetabular osteotomy group than in the control group, but there was no significant difference in blood loss. The lateral cup center-edge angle was significantly higher and the posterior cup center-edge angle was significantly lower in the total hip arthroplasty after rotational acetabular osteotomy, suggesting a posterior bone defect existed in the acetabulum. In total hip arthroplasty after rotational acetabular osteotomy, the hip joint center was located significantly superior and lateral to the primary total hip arthroplasty.

Conclusions: In total hip arthroplasty after rotational acetabular osteotomy, the cup tended to be placed in the superior and lateral positions, where there was more bone volume. The deformity of the acetabulum and the high hip center should be considered for treatment success because they may cause cup instability, limited range of motion, and impingement.

Keywords: Bone defect; Developmental dysplasia; Hip center; Rotational acetabular osteotomy; Total hip arthroplasty.

Fig. 1

Postoperative computed tomography of THA. The LCE angle (*) is defined as shown in the postoperative coronal computed tomography image of THA (a). The ACE (**) and PCE angles (***) are defined as shown in the postoperative sagittal computed tomography image (b) THA: total hip arthroplasty; LCE: lateral cup center-edge; ACE: anterior cup center-edge; PCE: posterior cup center-edge

Fig. 2

Postoperative anteroposterior X-ray radiogram of THA. The vertical distance (*) is defined as the distance from the lower edge of the bilateral the tear drops to the center of the hip joint. The horizontal distance (**) is defined as the distance of the horizontal direction from the lower edge of the tear drop to the hip joint center. THA: total hip arthroplasty

Fig. 3

Preoperative and postoperative X-ray and CT images of THA after RAO. Preoperative and postoperative anteroposterior radiographs of THA for a patient with hip osteoarthritis who underwent RAO 20 years ago (a, b). This is the axial section of CT image. Defects in the posterior wall of the acetabulum are observed (arrow) (c). This is the axial section of a CT image of a patient in the control group. There is no bone defect of acetabulum (arrow) (d). This is the sagittal section of a CT image. Bulk bone graft (arrow) was performed because of the fear of insufficient fixation of the cup due to bone defect in the posterior wall of the acetabulum (e). CT: computed tomography; RAO: rotational acetabular osteotomy; THA: total hip arthroplasty