Soft tissue balancing in total hip arthroplasty for patients with adult dysplasia of the hip

Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
Orthopaedic Surgery 08/2009; 1(3):212-5. DOI: 10.1111/j.1757-7861.2009.00034.x
Source: PubMed
To summarize our surgical experience of release and balance of soft tissues around the hip in total hip arthroplasty (THA) for patients with adult dysplasia of the hip (ADH).
From January 2001 to January 2006, 29 adult patients with dysplastic hips (31 hips) were included in this study. Among them, there were 19 women and 10 men, aged from 38 to 65 years. According to the Crowe classification system, there were 8 type I, 12 type II, 6 type III and 5 type IV. THA was performed via a lateral approach. All acetabular cups were reconstructed at the original anatomic location through soft tissue releasing around the hip to restore limb length, and techniques of balance of soft tissue were applied to extend the strength of the hip abductor and improve its function.
All patients had restoration of limb length (range, 1.5-4.5 cm). One postoperative dislocation occurred due to slight enlargement of the angle of abduction of the acetabulum. At 1.5-year follow-up (mean, 3.2 years) in 29 patients, the Harris score had increased from 42.6 preoperatively to 85.4. All hips were pain free with good function.
In order to restore the anatomic structure and physiologic function of the affected hip, the technique of release and balance of soft tissues around the hip should be applied cautiously in arthroplasty of ADH.

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    • "With the femur displaced proximally, the gluteus medius muscle and other soft tissues around the affected hip contracts in patients with DDH and leads to leg length discrepancy and hip instability [7]. It has been suggested that the gluteus medius muscle as well as other soft tissues be released to obtain femoral reduction [8,9] and optimal biomechanics in patients with DDH during total hip arthroplasty. Previous studies [10,11] compared length changes of the gluteus medius muscle between the pelvic support osteotomy preoperative and posteroperative in the congenital dislocation of the hip. "
    [Show abstract] [Hide abstract] ABSTRACT: The gluteus medius muscle is essential for gait and hip stability. Changes that occur in the gluteus medius muscles in patients with developmental dysplasia of the hip (DDH) are not well understood. A better understanding of DDH related changes will have positive repercussions toward hip soft tissue reconstruction. 19 adult patients with unilateral DDH scheduled for total hip arthroplasty were assessed for: cross-sectional area (CSA), radiological density (RD) and the length of gluteus medius using computed tomograhpy(CT) (scanned before THA). Hip abductor moment arm and gluteus medius activation angle were also measured via hip anteroposterior radiographs. Both CSA and RD of gluteus medius muscle were significantly reduced (p < 0.05) in the affected hip compared to the control. In the affected hip, the length of the gluteus medius muscle was reduced by 8-11% (p < 0.05) while the gluteus medius activation angle was significantly increased (p < 0.05) and the hip abductor moment arm was decreased (p < 0.05). The gluteus medius showed substantial loss of CSA, RD as well as decreased length in patients with DDH in the affected hip. These changes should be considered in both hip reconstruction and postoperative rehabilitation training in patients with DDH.
    Full-text · Article · Jun 2012 · BMC Musculoskeletal Disorders
  • [Show abstract] [Hide abstract] ABSTRACT: Background: It is crucial to determine the location of the rotation center of the hip joint using X-ray. Ranawat’s triangle is commonly used to define the hip rotational center in bilateral developmental dysplasia of the hip and revision hip surgery especially in cases with bone stock deficiency, but there are rare articles about its value in normal hip. Objective: To compare the difference between Ranawat’s triangle method and Mose circle method in determining the healthy hip joint rotational center. Methods:We selected 30 patients with normal traumatic femoral neck fracture, who underwent unilateral total hip arthroplasty. Ranawat’s triangle method and Mose circle method were applied to measure the anteroposterior radiographs of the pelvis after arthroplasty and to compare the distance between the hip rotational center and the reference lines (X-axis: teardrop line; Y-axis: a line perpendicular to the X-axis, drawn from the intersection of the Kohler line and the teardrop line. The distance from the hip joint rotational center to X-axis isdx1, dx2 and the distance to Y-axis is dy1, dy2 in Ranawat’s triangle and Mose circle respectively.). We also compared the ratios (dx1/H, dy1/W; dx2/H, dy2/W) in the pelvic height (H: the distance between the highest point on the iliac wing and the lowest point on the ischial tuberosity) and width (W: the distance between the most lateral points on the iliac crests). Results and Conclusion: When the values were compared with both methods, highly significantdifferences were observed for both X and Y, Ranawat’s triangle method dx1=(19.52±3.03) mm, dy1=(24.43±2.26) mm; and Mose circle method dx2=(11.90±3.55) mm, dy2=(34.29±3.79) mm (P< 0.001) and these ratios (dx1/H=0.099 2±0.013 3, dy1/W=0.085 5±0.006 9; dx2/H=0.061 1±0.019 4, dy2/W=0.120 1±0.017 8) in pelvic height and width (P< 0.001). Scatterplot results demonstrated that the hip rotational centeridentified by Ranawat’s triangle method is near to the proximal end and medial end, which may affect mechanical environment surrounding the joint. For cases of bilateral hip dysplasia and joint revision, because of the changes in structure surrounding the acetabulum, Ranawat’s triangle method can be a feasible method to identify the hip rotational center. For cases of unilateral lesion, Mose circle method can exactly identify the hip rotational center taking healthy side as a control. © 2015 Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved.
    No preview · Article · Apr 2015