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      The Effect of the False Acetabulum on Femoral Proximal Medullary Canal in Unilateral Crowe Type IV Developmental Dislocation of the Hip

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          Abstract

          Purpose

          To investigate the effect of the false acetabulum on femoral proximal medullary canal in unilateral Crowe type IV developmental dislocation of the hip (DDH) patients on anteroposterior radiographs.

          Patients and Methods

          We measured the following parameters of DDH and contralateral normal hip (CNH) of proximal morphology of femurs on 65 patients with unilateral Crowe type IV DDH (30 hips with no false acetabulum (type IVA) and 35 hips with a false acetabulum (type IVB)) in our hospital between September 2009 and July 2019 on anteroposterior radiographs: the widths of medullary canals at 20 mm above the center of lesser trochanter (CLT), 20 mm below the CLT and the isthmus. Canal flare index (CFI), metaphyseal canal flare index (MCFI), diaphyseal canal flare index (DCFI) were calculated.

          Results

          The values of CFI of DDH and CNH in unilateral type IVA patients were 2.8 and 4.4, respectively ( p < 0.001), and those in type IVB patients were 3.9 and 4.6, respectively ( p < 0.001). The MCFIs of DDH and CNH in type IVA group were 2.2 and 2.3, respectively ( p = 0.032), and those in type IVB group were 2.4 and 2.4, respectively ( p = 0.242). The DCFIs of DDH and CNH in type IVA group were 1.3 and 1.9, respectively ( p < 0.001), and those in type IVB group were 1.7 and 1.9, respectively ( p = 0.002).

          Conclusion

          The false acetabulum stimulated the development of the proximal femur in Crowe type IV DDH. The variation of the femoral proximal medullary canal in type IVA DDH mainly occurred at the metaphyseal and proximal diaphyseal levels, and that in type IVB DDH mainly occurred at the proximal diaphyseal level.

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          Most cited references 22

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          Total hip replacement in congenital dislocation and dysplasia of the hip.

          The results of thirty-one total hip replacements in twenty-four patients with either severe congenital dysplasia or dislocation, after an average follow-up of four years, were excellent in eleven, good in sixteen, fair in one, and poor in one. The operative technique included superolateral bone grafts to increase the acetabular coverage in six hips. Twenty-seven hips required smaller and straighter femoral components than normal. The incidence of major complications was 19 per cent.
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            The anatomic basis of femoral component design.

            The shape of the femoral canal is variable, much more variable, in fact, than most contemporary designs of femoral components would suggest or can accommodate. In the face of this variability, line-to-line or surface-to-surface contact is not expected between cementless implants and much of the endosteal surface. It also is apparent that changes in implant design are still needed if the normal biomechanics of the hip joint are to be restored in each patient and if component fixation is to be optimized. Most cementless components aim to achieve proximal load transfer to the femoral canal. However, increasing clinical evidence suggests that distal filling of the femur also is necessary to minimize the incidence of postoperative symptoms, particularly in revision procedures. If this is indeed the case, more accommodating designs of femoral components are needed that will enable proximal and distal fitting at the femoral canal so that stable fixation may be achieved regardless of variations in bone geometry.
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              Three-dimensional shape of the dysplastic femur: implications for THR.

              This study evaluates the three-dimensional anatomy of the femur with congenital dysplasia of the hip (CDH) in comparison with healthy controls. Computed tomographic scans were obtained from 207 women (154 with dysplasia; 54 healthy controls) with an average age of 51.6 years (range, 18-82 years). Most of the dysplastic joints were classified as Crowe I (43%), or Crowe II or III (48%), with 9% Crowe IV. Individualized three-dimensional computer models of the femur were generated by reconstruction of the CT scans. Dimensional and morphometric parameters were derived by computer analysis of each of the femoral reconstructions. The dysplastic femurs had shorter necks and smaller, straighter canals than the controls. The shape of the canal became more abnormal with increasing subluxation. Detailed analysis showed that the primary deformity of the dysplastic femur is rotational, with an increase in anteversion of 5 degrees to 16 degrees, depending on the degree of subluxation of the hip. The rotational deformity of the dysplastic femur arises within the diaphysis between the lesser trochanter and the isthmus and is not attributable to a torsional deformity of the metaphysis. This study shows that there is a significant difference in the geometry of the normal femurs and those with CDH, even in mild cases. In CDH cases, we recommend the use of modular or specially-designed components to accommodate the shape of the dysplastic canal.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                TCRM
                tcriskman
                Therapeutics and Clinical Risk Management
                Dove
                1176-6336
                1178-203X
                06 July 2020
                2020
                : 16
                : 631-637
                Affiliations
                [1 ]Department of Orthopedics, Chinese People’s Liberation Army General Hospital , Beijing 100853, People’s Republic of China
                Author notes
                Correspondence: Yonggang Zhou; Ming Ni Email ygzhou301@163.com; niming301@163.com
                [*]

                These authors contributed equally to this work

                Article
                255715
                10.2147/TCRM.S255715
                7352374
                © 2020 Du et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 1, Tables: 4, References: 25, Pages: 7
                Categories
                Original Research

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