Integrated Acetabular Prosthesis Versus Bone Grafting in Total Hip Arthroplasty for Crowe Type II and III Hip Dysplasia: A Retrospective Case-Control Study

Abstract

Objective: Many methods of acetabular reconstruction with total hip arthroplasty (THA) for Crowe type II and III adult developmental dysplasia of the hip (DDH) acetabular bone defect have been implemented clinically. However, there was no study comparing the results of integrated acetabular prosthesis (IAP) with bone grafting (BG). This study aims to investigate the efficacy of IAP and BG for acetabular reconstruction in Crowe type II and III DDH.

Methods: The clinical data of 45 patients with unilateral Crowe type II and III DDH who underwent THA from January 2020 to January 2023 were retrospectively analyzed. The patients were divided into two groups: 25 patients using 3D-printed IAP (IAP group) and 20 patients using BG (BG group). The operation time and intraoperative blood loss were recorded. The clinical outcomes were assessed by Harris Hip Score (HHS) and full weight-bearing time. The radiological outcomes were evaluated by the radiological examination. Accordingly, intraoperative and postoperative complications were observed as well. The data between the two groups were compared by independent sample t-tests and the Mann-Whitney U rank sum test.

Results: There were no significant differences between the two groups in Harris Hip Score (HHS) (preoperative, 6 months postoperative, and the last follow-up), leg length discrepancy (LLD), cup inclination, cup anteversion, vertical center of rotation (V-COR), horizontal center of rotation (H-COR) (p > 0.05). The mean HHS in the IAP group was higher than in the BG group at 1 and 3 months postoperative (p < 0.001). The mean surgical time and blood loss in the IAP group were less than in the BG group (p < 0.001). The mean full weight-bearing time in the IAP group was shorter than in the BG group (p < 0.01). No complications were observed in either group during the follow-up period.

Conclusion: IAP and BG have similar radiographic outcomes and long-term clinical efficacy in THA for Crowe type II and III DDH, but the IAP technique has higher surgical safety and facilitates the recovery of hip joint function, which is worthy of clinical promotion.

Keywords: 3D‐printed; Autologous Bone Grafting; Developmental Dysplasia of the Hip; Integrated Acetabular Prosthesis; Total Hip Arthroplasty.

FIGURE 1

Preoperative prosthesis design. (A) Three‐dimensional reconstruction of the patient pelvic model. (B) Appropriate placement of the hemispherical acetabular cup in the true acetabulum. (C) Construction of the IAP model with design screws placement direction. (D) Design of 3D printing guide plate. (E) The object of IAP. (F) Simulation of the compatibility between the IAP and the pelvis.

FIGURE 2

Radiographic assessments. (A) Preoperative V‐COR, H‐COR, and LLD measurements. (B) Postoperative V‐COR, H‐COR, and LLD measurements. (C) Cup inclination measurement. (D) Cup anteversion measurement.

FIGURE 3

Radiographs of a 55‐year‐old man with right Crowe type III DDH underwent THA with BG technique. (A) Preoperation. (B) Immediate radiograph after THA showed complete coverage of the acetabular prosthesis with bone graft. (C) The radiograph at 3 years postoperatively showed similar bone density between the bone graft and the acetabulum bone, proper prosthesis position, and no prosthesis of loosening or sinking.

FIGURE 4

Radiographs of a 51‐year‐old woman with right Crowe type III DDH underwent THA with IAP technique. (A) Preoperation. (B) Immediate radiograph after THA showed good compatibility between the prosthesis and the host bone. (C) The radiograph at 2 years postoperatively showed stable acetabular prosthesis, and the anterior and posterior walls of the acetabulum were firmly supported by the IAP.

FIGURE 5

Comparison of clinical data of the patients in both groups. (A) Comparison of operative time. (B) Comparison of intraoperative blood loss. (C) Comparison of time to full weight‐bearing. (D) Comparison of dynamic HHS.