Table 3.
Evaluation and Follow-up
| Study | Outcome measure | Preop | Postop | Revisions | Complications | Radiological evaluation | Conclusion/remarks | Follow-up mentioned? |
|---|---|---|---|---|---|---|---|---|
| Zhen et al.3) (2018) | HHS | 55.3±9.5 | 92.5±12.7 | Nil | Nil | Distance from center of femoral head to Kohler’s line increased from 19.87±3.9 mm to 21.5±3.5 mm after the operation. | For patients with PA secondary to RA cementless, trabecular, metal modular cup allowing peripheral press fitting and restoration of bone stock by impacted bone graft - satisfactory short-term results | Yes |
| Baghdadi et al.8) (2015) | HHS | 55 | 82 | Revision, 15 hips; aseptic loosening, 12; polyethylene liner failure, 2; recurrent instability, 1 | Aseptic loosening, liner wear, recurrent instability | 5 unrevised acetabular components and 3 unrevised femoral components - non-progressive radiolucency | Satisfactory results for a median follow-up of 15 years for uncemented acetabular component in THR with PA | Yes |
| Dutka et al.10) (2011) | HHS | NA | Mean, 86.6; cemented, 84.2; uncemented, 92.6 | Revision in 10 hips Both component loosening, 6; acetabular component loosening, 4 | 10 hips, loosening; HO Brooker II in 15 cases, DVT in 6, and wear of the acetabular component in 4 | The radiographic outcomes: excellent in 47 hips (34.8%), good in 60 (44.5%), fair in 18 (13.3%), and poor in 10 (7.4%) | At 12-year follow-up, better outcomes seen with patients operated with autogenous bone grafting than mixed bone grafting. No significant difference in type of prosthesis, aetiology and severity of PA in final outcome. | Yes |
| Mullaji et al.20) (2007) | HHS | 52 | 85 | Nil | 1 postoperative hematoma 1 secondary suturing owing to necrosis of the superficial edges of the wound |
All bone grafts united by the 6th month. Several small radiolucencies seen around the screw in 3 cases. | Uncemented porous coated hemispheric cups with peripheral press fit fixation and restoration of bone stock with impacted autologous bone grafting appears to give satisfactory medium-term results. | Yes |
| Krushell et al.15) (2008) | HHS Hip centre to Kohler’s line distance |
41 24 mm |
84.6 30.9 mm |
1 case - secondary osteolysis due to polyethylene wear after 8 years | 1 peroneal nerve palsy and 1 case of recurrent dislocation. 1 case of late reoperation for polyethylene wear and secondary osteolysis. | At follow-up, mean protrusion medial to Kohler’s line was 1.0 mm, mean vertical distance 12.5 mm, mean horizontal distance 30.9 mm. | Excellent results obtained in 29 hips both clinically | Yes |
| Baghdadi et al.2) (2013) | HHS | 51±12 | 77±18 | 11 revised - 9 asepic loosening, 1 linear wear and liner exchange, 1 instability | 9 - asepic loosening 1 - linear wear and liner exchange 1 - instability |
Femoral offset decreased by 4±9 mm Hip COR improved by 11±6 mm |
10-year survival rate is 95% (95% CI). 15-year survival rate is 89% (95% CI) in uncemented. 10-year survival rate is 92% (95% CI). 15-year survival rate is 85% (95% CI) in cemented. |
Yes |
| Hansen and Ries12) (2006) | HHS | 32.3 | 71.7 | Revision - 1 due to recurrent dislocation | 5 - dislocation, 1 - developed a transient lateral femoral cutaneous neuropraxia, 1 - perioperative cardiac event | Mean protrusio position of the acetabular prostheses medial to Kohler’s line was 10.5 mm. | Uncontained medial acetabular defects can be successfully augmented with morselized bone graft , oversized rim fit acetabular component if good quality peripheral bone exists and integrity of acetabular rim is maintained. | Yes |
| Rosenberg et al.21) (2000) | Long-term survival rate for primary THA | NA | NA | 2 revisions due to aseptic loosening | Aseptic loosening - 2 | In all cases, radiographs - the impacted morsellized bone grafts had become incorporated with the surrounding bone. | Long-term survival rate for primary THA in RA patients having protrusio acetabuli and acetabular reconstruction with impacted morselized bone graft is 90% (95% CI) at an average 12-year follow-up. | Yes |
| Matsuno et al.18) (2000) | JOA score | 20.6 | 70.4 | Nil | One patient - transient sciatic nerve palsy | The COR of the hips was improved to within 4 mm of normal. | All grafts appeared to heal radiologically with no radiolucent line between graft and acetabulum. | Yes |
| Gates et al.11) (1989) | Central edge angle Protrusion medial to Kohler’s line |
80.3° +8.6 mm |
57.7° –10.5 mm |
5 revisions -progressive protrusion | Loosening, 8; trochanteric non-union, 2 | Postoperatively-average distance of migration of the femoral head medial to Kohler’s line 10.5 mm, vertical migration average 5.3 mm. | Vertical migration and horizontal distance, two measurements utilizing a x-y coordinate system based on the tear drop-most useful radiographic measurements for determining the presence of PA and in following postoperative progression | Yes |
| Kondo et al.14) (2002) | JOA score | 19.6 | 35.2 | Nil | 6 acetabular component loosening | Acetabular component loosening | The rate of loosening of THA without bone grafting was higher than that of THA with bone grafting. | Yes |
| Liu et al.17) (2023) | 1. Range of flexion motion of the hip joint 2. Range of abduction motion 3. HHS |
39.48°±8.36° 10.86°±4.34° 37.84±4.74 |
103.07°±7.64° 36.75°±3.99° 89.55±4.05 |
Nil | Reduction of the hip joint was extremely difficult in three patients (4 hips) | The horizontal distance of the hip rotation center increased from preoperative 10.40±2.50 mm to postoperative 24.03±1.77 mm, and the vertical distance increased from preoperative 72.36±3.10 mm to postoperative 92.48±5.31 mm. | Uncemented THA combined with impacted grafting granule bone of the autogenous femoral head and biological acetabular cup-reconstruct the acetabulum, restore the COR of hip joint, and achieve good medium-term outcomes in the treatment of moderate to severe PA secondary to RA. | Yes |
| Zuh et al.23) (2015) | HHS | 42.3±3.9 | 85.2±3.0 | Nil | HO, 6 cases | Hip COR was restored close to the ideal values on the vertical axis, while on the horizontal axis the COR obtained was lateral to the ideal point. | Impaction bone grafting for acetabuloplasty, associated with the implantation of an uncemented cup, yields good midterm clinical and radiological results in patients with PA or primary hip arthrosis with a thinned medial acetabular wall. | Yes |
| Yun et al.22) (2021) | Hip disability and osteoarthritis outcome score | Not done | 91±10.4 | 1 revision - stem subsidence | 1 case - Meckel’s diverticulum required 20 days of inpatient care for small bowel obstruction and acute pyelonephritis | Preoperative AK distance (mm): 8±4.5; range, 1-16 Postoperative AK distance (mm): 0±2.2; range, -4 to 3 |
Anterior approach may decrease the significant risks of dislocation by avoiding posterior dissection. | Yes |
| Mibe et al.19) (2005) | JOA score | 25.2±8.6 | 55.6±8.7 | 2 revisions owing to loosening of the Ganz ring | Loosening of the Ganz ring - 2 patients | The mean depth of the protrusio acetabuli was 3.6 mm before operation, and 3.1 mm just after the operation. | With THA for protrusio acetabuli in RA - no loosening, and bone stock maintained by a bone graft using a support ring. It suppresses progression of the PA in the short-term. | Yes |
| Lee et al.16) (2022) | Modified HHS | NA | Restored group: 83.6±12.1, Medialized group: 83.8±10.4 | One patient - periprosthetic femoral fracture | No other complications | The mean abduction and anteversion angles (in degrees) of the acetabular component were 37.4 and 23.7 in the medialized group and 43.8 and 24.9 in the restored group, respectively. | Implant stability and favorable results were obtained by press-fitted cups, irrespective of hip center restoration. THA in PA patients-promising clinical and radiological results. | Yes |
| Figueras Coll et al.9) (2008) | HHS | 42.3 | 90.6 | Nil | 4 DVT, 3 posterior hip dislocations, 3 wound infection | One had radiolucent lines >2 mm - zone 2, which did not progress. | Bone-grafting and acetabular wiremesh - effective and simple method to arrest the progresion of PA | Yes |
| Johnsson et al.13) (1984) | NA | NA | NA | One hip revised - deep infection Recurrent dislocations occurred in one - re-operation planned |
Recurrent dislocations, 1 hip; deep infection, 1 | Progressive radiolucent zone of 4-5 mm at the bone- cement interface - 2 hips Calcar resorption of 4-10 mm - 2 hips with 10 mm distal migration of the femoral component in the latter case |
THA with the use of autogenous spongious bone graft reinforcement to the medial acetabular wall-successful surgical procedure in patients with RA and PA | Yes |
Values are presented as mean±standard deviation.
Preop: preoperative, Postop: postoperative, HHS: Harris hip score, Nil: nothing, PA: protrusio acetabuli, RA: rheumatoid arthritis, THR: total hip replacement, NA: not available, HO: heterotopic ossification, DVT: deep vein thrombosis, COR: centre of rotation, CI: confidence interval, THA: total hip arthroplasty, JOA: Japanese Orthopaedic Association, AK distance: medial acetabular border to kohler line distance.