Mehmet Faruk ÇATMA, Mehmet Atıf Erol AKSEKİLİ, Kasım KILINÇARSLAN, Bahar ANAFOROĞLU, İzzet KORKMAZ, Murat ALTAY

Crowe Tip 2 veya Tip 3 Gelişimsel Kalça Displazisi Nedeniyle Total Kalça Protezi Olan Hastalarda Otojen Femur Başı Greftiyle Asetabulum Rekonstrüksiyonu

GİRİŞ ve AMAÇ: Bu makalenin amacı gelişimsel kalça displazisinde uygulanan total kalça artroplastisinde femoral başın otogreft olarak kullanılarak asetabulumun yeniden yapılandırılmasındaki kısa-orta dönemdeki sonuçlarımızı değerlendirmektir.YÖNTEM ve GEREÇLER: 2010-2013 tarihleri arasında Crowe Tip 1 ve 2 gelişimsel kalça displazisi olan 16 hasta 15 erkek, 1 kadın ameliyat edildi. Ameliyat öncesi radyolojik bulguları ve ameliyat sırasındaki gözlemler değerlendirilerek asetabular komponentin %80 den az örtünmesi görüldüğünde greftleme uygulandı. Pelvis ve kalça anteroposterior grafileri ile takipleri yapıldı. Callaghan ve ark. tarafından tanımlanan kriterler dikkate alınarak asetabuler komponentin stabilitesi değerlendirildi. Kemik greftinin asetabular komponenti örtünmesi de DeLee ve Charnley zonlarına göre ölçüldü. Merkez kenar açısı ölçülerek asetabular örtünme değerlendirildi.BULGULAR: Cerrahi sırasındaki ortalama yaş 50.6±10.2 38-73 . Crowe sınıflamasına göre 8 tanesi tip 1, 8 tanesi tip 2 kalçaydı. Hastalar cerrahiden son kontrollerine kadar geçen takip süreleri ortalama 30,5±9.9 12-48 ay olarak bulundu. Tüm hastalarda greftlerde radyolojik kaynama görüldü. Hiçbir hastada nörovasküler bir komplikasyon, enfeksiyon veya çıkık görülmedi. DeLee ve Charnley zonları esas alarak yapılan ölçümlerde 10 kalçada %62,5 zone 1, 6 kalçada %37,5 zone 1 ve 2’de greftin asetabular cup örtünmesine destek olduğu saptandı. Merkez kenar açısı ölçümü ortalaması 47.75 35-80 , yatay olarak asetabuler komponentin örtünmesi oranıda % 66,6 50-78 olarak bulundu.TARTIŞMA ve SONUÇ: Gelişimsel kalça displazili hastalarda asetabulum rekonstrüksiyonunda femoral başın otogreft olarak kullanılması tercih edilelebilecek başarılı yöntemlerden biridir

Anahtar Kelimeler:

Displastik kalça, total kalça

Acetabular Reconstruction with Autogenous Femoral Head Graft in Patients with Total Hip Prosthesis Due to Crowe Type 2 or 3 Developmental Hip Dysplasia

INTRODUCTION: We aimed to evaluate our short- mid term results in acetabular reconstruction with autogenous femoral head graft in patients with total hip prosthesis due to developmental hip dysplasia.METHODS: Sixteen patients 15 male, 1 female with developmental hip dysplasia were operated between 2010 and 2013. Grafting was done when acetabular component was covered less than 80% based on pre operative radiological findings and intra operative observations. Pelvis and hip anterior- posterior x-rays were used in follow up. Stability of the acetabular component was evaluated based on criteria defined by Callaghan et al. coverage of acetabular component by bone graft was measured based on DeLee and Charnley zones. Center edge angle was measured to evaluate acetabular covering.RESULTS: Mean age of the patients at time of operation was 50.6 ±10.2 38-73 . According to Crowe classification; 8 of the hips were type 1 and 8 were type 2. Mean follow up period from operation to last control was 30,5±9.9 12-48 months. Radiological graft incorporation was detected in all patients. None of the patients showed any neurovascular complications, infection or dislocation. In measurements based on DeLee and Charnley zones; graft supported acetabular cup coverage in zone 1 in 10 hips 62,5% and in zone 1 and 2 in 6 hips 37,5% . Mean Center edge angle was 47.75 35-80 , horizontally coverage of acetabular component was 66,6 % 50-78 .DISCUSSION AND CONCLUSION: Acetabular reconstruction with autogenous femoral head graft in developmental hip dysplasia is one of the successfull methods.

Keywords:

Dysplastic hip, total hip arthroplasty,

PDF

___

1. Bilgen Ömer Faruk, Doğumsal kalça çıkığının total kalça protezi ile tedavisine yaklaşım, Klinik Araştırma (Clinical Research Vol.13No. 4, (202-214), 2002
2. Necdet SAĞLAM,Nadir ŞENER, Burak BEKSA., Ü. Remzi TÜZÜN, Yüksekte doğuştan kalça çıkığında total kalça protezi ve karşılaşılan sorunlar, Acta Orthop Traumatol Turc 2002;36:187-194
3. Abdel MP, Stryker LS, Trousdale RT, Berry DJ, Cabanela ME. Uncemented acetabular components with femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip: a concise follow-up report at a mean of twenty years. J Bone Joint Surg Am. 2014 Nov 19;96(22):1878- 82. doi: 10.2106/JBJS.N.00061.
4. Argenson JN, Ryembault E, Flecher X, Brassart N, Parratte S, Aubaniac JM. Threedimensional anatomy of the hip in osteoarthritis after developmental dysplasia. J Bone Joint Surg Br. 2005 Sep;87(9):1192-6.
5. Remzi TÖZÜN, Burak BEKSAÇ, Nadir ŞENER; Gelişimsel kalça displazisinde total kalça protezi, Acta Orthop Traumatol Turc 2007;41 Suppl 1:80-86
6. Schofer MD, Pressel T, Schmitt J, Heyse TJ, Boudriot U. Reconstruction of the acetabulum in THA using femoral head autografts in developmental dysplasia of the hip. J Orthop Surg Res. 2011 Jun 22;6:32. doi: 10.1186/1749-799X-6-32.
7. Ermiş MN, Dilaveroğlu B, Erçeltik O, Tuhanioğlu U, Karakaş ES, Durakbaşa MO.Intermediate-term results after uncemented total hip arthroplasty for the treatment of developmental dysplasia of the hip. Eklem Hastalik Cerrahisi. 2010 Apr;21(1):15-22.
8. Bobak P, Wroblewski BM, Siney PD, Fleming PA, Hall R. Charnley low-friction arthroplasty with an autograft of the femoral head for developmental dysplasia of the hip.J Bone Joint Surg 2000; 82-Br: 508-11.
9. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am. 1979 Jan;61(1):15-23.
10. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 1976;121:20-32.
11. Callaghan JJ, Dysart SH, Savory CG. The uncemented porous-coated anatomic total hip prosthesis. Two-year results of a prospective consecutive series. J Bone Joint Surg [Am] 1988;70:337-46.
12. Gerber SD, Harris WH (1986) Femoral head autografting to augment acetabular deficiency in patients requiring total hip replacement. A minimum five-year and an average seven-year follow-up study. J Bone Joint Surg Am 68:1241–1248
13. Markus D Schofer, Thomas Pressel, Jan Schmitt, Thomas J Heyse and Ulrich Boudriot, Reconstruction of the acetabulum in THA using femoral head autografts in developmental dysplasia of the hip, Schofer et al. Journal of Orthopaedic Surgery and Research 2011, 6:32
14. Lengsfeld M, Bassaly A, Boudriot U, Pressel T, Griss P. Size and direction of hip joint forces associated with various positions of the acetabulum. J Arthroplasty. 2000 Apr;15(3):314-20.
15. Kiyama T, Naito M, Shitama H, Maeyama A. Effect of superior placement of the hip center on abductor muscle strength in total hip arthroplasty. J Arthroplasty.2009 Feb;24(2):240-5. doi:10.1016/j.arth.2008.08.012.
16. Tanzer M. Role and results of the high hip center. Orthop Clin North Am 1998; 29: 241-47.
17. T Yamaguchi, M Naito, I Asayama, K Shiramizu, Cementless total hip arthroplasty using an autograft of the femoral head for marked acetabular dysplasia: case series; Journal of Orthopaedic Surgery 2004;12(1):14–18
18. Paavilainen T, Hoikka V, Solonen KA. Cementless total replacement for severely dysplastic or dislocated hips. JBone Joint Surg 1990;72-B: 205-11.
19. Delp SL, Maloney W. Effects of hip center location on the moment-generating capacity of the muscles. J Biomech1993;26:485-99.
20. Doehring TC, Rubash HE, Shelley FJ, Schwendeman LJ,Donaldson TK, Navalgund YA. Effect of superior and superolateral relocations of the hip center on hip joint forces. An experimental and analytical analysis. J.Arthroplasty 1996;11:693-703.
21. Pagnano W, Hanssen AD, Lewallen DG, Shaughnessy WJ. The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty. J Bone Joint Surg Am. 1996 Jul;78(7):1004-14.
22. Hartofilakidis G, Stamos K, Karachalios T, Ioannidis TT, Zachorokis N. Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg 1996; 78- A:683-92.
23. Wu LD, Jin LB, Yan SG, Yang QS, Dai XS, Wang XH. Total hip arthroplasty with cementless cups and femoral head autografts for patients with hip dysplasia and osteoarthritis. Chin J Traumatol. 2004 Oct;7(5):280-5.
24. Hasegawa Y, Iwata H, Iwase T, Kawamota K, Iwosada S. Cementless total hip arthroplasty with autologous bone grafting for hip dysplasia. Clin Orthop 1996; 324: 179-86.
25. Mulroy RD Jr, Harris WH: Failure of acetabular autogenous grafts in total hip arthroplasty. Increasing incidence: a follow-up note. J Bone Joint Surg Am 1990, 72(10):1536- 1540.
26. Hintermann B, Morscher EW. Total hip replacement with solid autologous femoral head graft for hip dysplasia. Arch Orthop Trauma Surg 1995;114:137- 44.
27. Stans AA, Pagnano MW, Shaughnessy WJ, Hanssen AD: Results of total hip arthroplasty for Crowe Type III developmental hip dysplasia. Clin Orthop Relat Res 1998, , 348: 149-157.
28. MacKenzie JR, Kelley SS, Johnston RC. Total hip replacement for coxarthrosis secondary to congenital dysplasia and dislocation of the hip. Long-term results. J Bone Joint Surg Am. 1996 Jan;78(1):55-61.
29. Morand F, Clarac JP, Gayet LE, Pries P: [Acetabular reconstruction using bone allograft in the revision of total hip prosthesis]. Rev Chir Orthop Reparatrice Appar Mot 1998, 84(2):154-161.
30. Imbuldeniya AM, Walter WL, Zicat BA, Walter WK. Cementless total hip replacement without femoral osteotomy in patients with severe developmental dysplasia of the hip: minimum 15-year clinical and radiological results. Bone Joint J. 2014 Nov;96-B(11):1449- 54. doi: 10.1302/0301-620X.96B11.33698.
31. Zhu J, Wang Y, Pang J, Lü B, Huang C, Hao P, Tan B. [Effectiveness of total hip arthroplasty for severe developmental dysplasia of hip in adults]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014 Mar;28(3):335- 8.
32. Iida H, Matsusue Y, Kawanabe K, Okumura H, Yamamura T, Nakamura T. Cemented total hip arthroplasy with asetabular bone graft for developmental dysplasia. J Bone Joint Surg 2000; 82-Br: 176- 184.
33. Gross A, Catre MG. The use of femoral head autograft shelf reconstructýon and cemented acetabular components in the dysplastic hip. Clin Orthop 1994; 298: 60-8.