Abstract
Background
The primary aim of this study was to quantitatively analysis the acetabular morphological feature and 2D/3D coverage of the Crowe IV DDH hip, dividing into subgroups by the false acetabulum. The secondary aim was to propose a 3D bone mapping to determine acetabular bone defect analysis from the perspective of the implanted simulation.
Methods
A total of 53 Crowe IV hips (27 hips without the false acetabulum in IVa group and 26 hips in IVb group) and 40 normal hips met the inclusion criteria and were retrospectively evaluated. Firstly, the anatomical size and volume of the acetabulum were measured quantitatively. Secondly, through the simulated implantation, morphological assessments of the true acetabulum included Cup-CE, Cup-Sharp, acetabular anteversion angle, and thickness of the medial wall. Last, Acetabular sector angles (ASAs) and the component coverage ratio were measured to provide coverage indices. Further, 3D bone mapping visualization was applied to determine the uncovered component portion distribution.
Results
The anatomic shape and volume of the acetabular triangle were significantly smaller in Crowe IV hips. At the level of the acetabular component center, IVb acetabula were found to be more anteverted and abductive, with smaller Cup-CE and larger Cup-Sharp angles. The coverage sector angles in Crowe IVa hips were larger in the anterosuperior and superior direction, while smaller in the posterosuperior and posterior direction, with no subgroup difference in total component coverage. Both 3D bone mapping and correlation analysis reveal that posterosuperior and posterior bone stock is highly associated with the component coverage.
Conclusion
With the presence of the false acetabulum, there existed acetabular anteversion and segmental coverage distinctions between subgroups. During the acetabular reconstruction, management of posterosuperior and posterior bone stock was important for ideal component coverage.
Keywords: Morphological evaluation, Bone defect, Component coverage, Crowe type IV developmental dysplasia of the hip (DDH), 3D bone mapping
Introduction
High-riding Crowe type IV developmental dysplasia of the hip (DDH) is characterized by dysplastic hip morphology, insufficient bone stock and complete dislocation of the hip joint. Acetabular component malposition is recognized as a risk factor for dislocation and increased wear after total hip arthroplasty (THA). Considering the technical challenges of acetabular reconstruction, several orthopaedic surgeons have been focusing on improving the morphological evaluation and preoperative strategy to optimize hip arthroplasty [1–3]. The achievement of the acetabular reconstruction has been reported to be highly correlated with the risk of dislocation [4], initial stability [5, 6], and implant survival [7, 8] for DDH patients.
Presently, application of 3D simulation and bone mapping is proved to effectively achieve quantitative assessments for acetabular morphology and coverage metrics [2, 5, 9]. According to the descriptive studies, the severely dysplastic acetabulum is previously considered to be restricted volume, excessive anteversion and superior segmental bone defect [10, 11]. However, few studies have systematically addressed the morphological evaluation and coverage analysis of the true acetabulum quantitatively. Further, presence or absence of false acetabulum in high-dislocated hips also contribute to developmental diversity of the iliac shape [12] and femur medullary morphologic abnormalities [13, 14], which is considered to influence osteotomy pattern [15] and implant survival as well [7]. Comparatively, no study has conducted to explore the influence of false acetabulum on acetabular shape and morphology for type IV DDH.
The primary aim of the present study was to quantitatively evaluate the acetabular anatomy, morphological feature and 2D/3D coverage of the Crowe IV DDH acetabula, by dividing into IVa and IVb subgroups [13, 14, 16]. The secondary aim was to propose a 3D bone mapping to determine acetabular bone defect analysis from the perspective of the implanted simulation.
Materials and methods
Study design and setting
Between January 2010 and September 2022, 76 patients (108 hips) who visited our hospital for a high-dislocated hip were included. All patients signed informed consent before X-ray and CT examination. According to the Crowe classification, 54 patients (68 hips) were graded as type IV DDH on standing anteroposterior pelvic radiographs. On standard AP plain radiographs, the height of the dislocation was defined as the vertical distance between the head-neck junction and the line connecting the lower edges of the bilateral teardrops. Dislocation rate was defined as the ratio between the height of the dislocation and the height of the entire pelvis. We retrospectively reviewed the preoperative computed tomography (CT) imaging data in our department. The inclusion criteria were as follows: (1) Crowe type IV DDH, as evaluated on standing anteroposterior pelvic radiographs and (2) standard anteroposterior pelvic radiographs and CT data before the operation. The exclusion criteria included (1) patients who underwent prior hip surgery; (2) patients with a dislocation attributed to infection or trauma. Of the 54 subjects, 7 (12 hips) with substandard scans and 2 (3 hips) who had undergone previous surgery (open or close reduction, acetabular osteotomy and femoral osteotomy) were excluded. Thus, 53 dysplastic hips in 45 patients met the inclusion criteria and were retrospectively evaluated. Due to the presence of a false acetabulum [13, 14, 16], the included patients were further divided as follows: group IVa, a dislocated femoral head located within the abductor muscle mass; and group IVb, evidence of the formation of a false acetabulum (Fig. 1AB). Herein, 27 hips were included in IVa group and 26 hips were included in IVb group. A total of 40 hips without acetabular fracture or deformities who had undergone computed tomography (CT) angiography to diagnose contralateral femoral fractures were selected as controls. The study was approved by the institutional review board of Guangdong Provincial People’s Hospital (IRB: S2023-1026-01). The demographic data are shown in Table 1.
Table 1.
Demographic data
| Control group | DDH group | |||
|---|---|---|---|---|
| IVa (n = 27) | IVb (n = 26) | P valure | ||
| Males/females (no.) | 6/40 | 3/24 | 3/23 | χ2 = 0.002, P = 0.961 |
| Age, years (SD; range) | 45.2 (13.96; 20 to 72) | 38.78 (14.78; 20 to 70) | 43.69 (12.24; 23 to 65) | t = 1.316; P = 0.194 |
| Height, cm (SD; range) | 162.85 (7.25; 155 to 185) | 157.74 (10.30; 141 to 175) | 156.08 (9.10; 143 to 175) | t=-0.622; P = 0.536 |
| BMI, kg/m2 (SD; range) | 24.02 (2.94; 18.00 to 35.42) | 23.78 (3.96; 18.73 to 30.08) | 22.68(5.05 13.33 to 35.42) | t=-0.891; P = 0.377 |
#p < 0.05, ##p < 0.01, compared with the control group; *p < 0.05, ** p < 0.01, for the comparison between the type IVa DDH and type IVb DDH
3D reconstructions and acetabular size analysis
CT scans of the entire pelvis were performed with a Toshiba Aquilion CT scanner (120 kVp, 320 mA, 512 × 512 matrix, and 0.5-mm slice thickness). The patients were placed in a supine position on the CT table with the patellae facing the ceiling, and the axis of the body coincided with the axis of the examination table. Scanning was performed from the iliac crest to the distal third of the femur. All standard CT slices were saved in Digital Imaging and Communications in Medicine (DICOM) format and imported into Mimics 19.0 software (Materialise, Leuven, Belgium) for 3D reconstruction. Before simulation and evaluation, the pelvic position and CT scans were standardized with reference to the anterior pelvic plane (APP) coordinate system [2, 17], determined by the anterior superior iliac spine and pubic tubercle bilaterally.
Based on the 3D reconstruction, morphology and bone stock distribution of the true acetabulum were compared qualitatively between Crowe IV subgroups. According to the true acetabulum, the distal part of the cotyloid notch (DPCN), the most superolateral point and the midpoint between them were digitized. According to the midpoint, the acetabular length, height, width and depth were measured to determine the acetabular size (Fig. 1CDE). Furthermore, the acetabular volume was also evaluated with reference to the acetabular opening plane.
Simulating implantation and acetabular morphological measurements
A set of standard-sized acetabular cup models with negligible thickness was created. The diameter of the cups ranged from 44 to 60 mm in 2-mm increments. These models were imported into the Mimics software in stereolithography (STL) format, and the total surface area (St) was available. The cups were implanted into the 3D acetabular reconstruction, the method of simulating acetabular cup implantation in THA was as described in our previous study [2]. The simulated acetabular replacement was performed by placing the component in the true acetabulum. The orientation of all the cups was set at 40° abduction and 20° anteversion. During the simulating implantation, the outer wall of the component was tangent to but did not penetrate the inner cortex of the medial acetabular wall to achieve the theoretical maximum coverage.
On the basis of the implantation simulation, the morphological assessments parameters included the following: (I) measurement of the Cup-CE angle and Cup-Sharp angle; (II) measurement of the acetabular anteversion angle and minimum thickness of medial acetabular wall. Further, the coverage assessments parameters included regional and total component coverage (CC). Basing on the contact boundary between native bone and the component, we measured the anterior and posterior ASAs in the axial plane. Further, the ASAs in the 45° anterosuperior direction, superior direction, and 45° posterosuperior direction were also measured on the corresponding planes [2, 17]. Acetabular sector angles were respectively named as A-ASA, P-ASA, AS-ASA, S-ASA and PS-ASA to determine regional component coverage (Fig. 1). Generally, the surface area of the uncovered portion (Su) was read by the Boolean operation function. The total component coverage was calculated by the following formula: CC = (St − Su)/St × 100%.
Fig. 1.
Morphological and coverage parameters analysis after simulated implantation. A Cup-Sharp angle (a) and Cup-CE angle (b), measured with the coronal plane passing through the component center; Point O is the component center, point E and F were superolateral and inferomedial borders between component and the true acetabulum; B Acetabular anteversion angle (a), anterior (A-ASA) and posterior (P-ASA) acetabular sector angles and thickness of medial acetabular wall (d), measured with the axial plane passing through the component center. Point O was the component center, points A and P = anterior and posterior borders of the true acetabulum, points Aʹ and Pʹ= anterior and posterior borders between the component and the true acetabulum. The direction of the medial wall thickness measurement is perpendicular to the acetabular opening (line AP). C Acetabular sector angles through the component center (point O) were measured in 5 directions: anterior (a), anterosuperior (b), superior (c), posterosuperior (d), and posterior (e). D The coverage ratio of the acetabular component was calculated according to the covered surface area and the total surface area. O was the component center, DPCN: distal part of the cotyloid notch
Acetabular component mapping and defect distribution
The uncovered portions of component cups were segmented and imported into Magics 22.03 (Materialise, Leuven, Belgium) in STL format. The uncovered portions were superimposed to create a compilation of uncovered portions on a complete 44-mm cup model. Based on the hotspot of the uncovered portions, an acetabular component map was determined and then the distribution frequency was calculated [9, 18]. According to the component opening plane, the component center and component rim were digitized to define a clock diagram to characterize the distribution and frequency of bone defect.
Statistical analysis
For assessing inter-observer reliability, two experienced surgeons (YYH and MYC) performed simulating implantation and corresponding measurements independently. For assessing intra-observer reliability, implantation, points selection and measurements were removed and repeated twice at monthly intervals by YYH. Intraclass correlation coefficient (ICC) was used to calculate inter-observer and intra-observer effects.
All statistical analyses were performed using SPSS version 21.0 (SPSS, Chicago, IL, USA). A post hoc power calculation was determined by the statistical power analyses G Power 3.1. Group comparisons for quantitative data were performed using unpaired Student’s t-tests, and categorical data were compared using the chi-squared test. Correlation between component coverage and morphological parameters was performed with Pearson’s coefficient. A P value less than 0.05 was statistically significant.
Results
Following the 3D reconstruction, the true acetabulum in Crowe IV hip tended to be markedly triangular and shallow (Fig. 2). As listed in Table 1, patients in IVa and IVb DDH groups had comparable age, height and body mass index (BMI). The ICC results of the intraobserver and interobserver reliabilities for all the measurement indices, as evaluated by the one-way random effects model, ranged from 0.90 to 0.97 and from 0.88 to 0.94, respectively. Post-hoc power analysis showed a power > 0.94 for detecting a significant difference.
Fig. 2.
DDH subgroups and acetabular size analysis. A A 22-year-old female patient in Crowe type IVa group (Left: IVa); B A 30-year-old female patient in Crowe type IVb group (Left: IVb); C The anatomical landmarks; DPCN: distal part of the cotyloid notch, T = most superolateral point of the acetabulum, O’= midpoint of T and DPCN; D Coronal image, H = acetabular height, L = acetabular length; E Axial image, W = acetabular width, D = acetabular depth
According to the standard AP plain radiographs, the dislocation rate was significantly higher in the IVa DDH group than in the IVb DDH group (30.04 ± 3.71% vs. 25.08 ± 5.17%). In consideration of the dysplastic acetabula, all aspects of the anatomic parameter in Crowe IV hips were significantly smaller, whose socket volume was only approximately one-fifth of the normal acetabulum. While, both acetabular and component size not only had no significant difference between subgroups, but were not correlated with individual height/BMI as well. At the level of the acetabular component center, IVb acetabula were found to be more anteverted and abductive, with smaller Cup-CE and larger Cup-Sharp angles. Medially, the acetabular wall was significantly thicker in Crowe IV hips than in normal hips, with no differences between subgroups either (Table 2).
Table 2.
Acetabular anatomy and morphological parameters for Crowe Iva, IVb DDH and control group
| Control group | DDH group | |||
|---|---|---|---|---|
| IVa (n = 27) | IVb (n = 26) | P valure | ||
|
Dislocation rate, % (SD; range) |
/ | 30.04 (3.71; 21.60 to 37.87) | 25.08 (5.17; 19.63 to 38.38) | t=-4.019; P < 0.001** |
| Acetabular Length, mm (SD; range) | 54.50 (2.02; 51.37 to 59.12) | 38.70 (4.57; 30.53 to 46.62) ## | 39.63 (3.97; 34.98 to 50.65) ## | t = 0.789; P = 0.434 |
| Acetabular Height, mm (SD; range) | 34.37 (3.08; 28.20 to 42.40) | 28.53 (4.22; 19.41 to 38.27) ## | 30.06 (4.15; 21.30 to 38.25) ## | t = 1.332; P = 0.189 |
|
Acetabular Width, mm (SD; range) |
50.09 (2.95; 42.27 to 55.41) | 27.27 (6.84; 18.02 to 41.62) ## | 28.12 (6.60; 15.38 to 45.39) ## | t = 0.463; P = 0.645 |
|
Acetabular Depth, mm (SD; range) |
27.27 (2.62; 23.89 to 33.30) | 13.35 (3.37; 7.52 to 21.72) ## | 14.44 (3.15; 7.51 to 21.90) ## | t = 1.212; P = 0.231 |
| Acetabular Volume, mm3 (SD; range) | 37234.31 (7395.23; 29995.27 to 48034.93) | 6934.87 (2148.18; 5002.00 to 12270.37) ## | 8221.78 (2106.68; 5066.66 to 13757.24) ## | t = 1.684; P = 0.103 |
| Cup Size, mm (SD; range) | 52.65 (2.41; 50 to 58) | 44.22 (0.85; 44 to 48) ## | 44.15 (0.54; 44 to 46) ## | t = 0.348; P = 0.729 |
| Cup-CE, deg (SD; range) | 45.74 (5.58; 31.74 to 55.69) | 24.74 (7.08; 12.93 to 40.13) ## | 20.70 (7.59; 8.20 to 38.71) ## | t=-2.007; P = 0.050* |
| Cup-Sharp, deg (SD; range) | 35.93 (4.16; 27.39 to 46.84) | 47.43 (4.00; 40.93 to 56.12) ## | 51.20 (6.05; 34.95 to 62.79) ## | t = 2.688; P = 0.010* |
| Anteversion Angle, deg (SD; range) | 20.07 (7.24; 7.13 to 37.68) | 30.17 (9.06; 11.41 to 50.14) ## | 36.49 (5.37; 27.74 to 49.48) ## | t = 3.075; P = 0.003** |
|
Medial Thickness, mm (SD; range) |
3.63 (1.24; 2.21 to 6.66) | 7.21 (3.21; 2.57 to 14.31) ## | 6.13 (2.40; 2.53 to 10.93) ## | t=-1.382; P = 0.173 |
IVa: without false acetabulum; IVb: with false acetabulum;
#p < 0.05, ##p < 0.01, compared with the control group; *p < 0.05, ** p < 0.01, for the comparison between the type IVa DDH and type IVb DDH
Regarding the coverage assessments, the coverage angles in Crowe IV hips were significantly smaller in the other 4 directions, except the posterior direction in IVb hips. Further, the abnormally distributed bone stock was found to be different between two DDH subgroups. The coverage sector angles in Crowe IVa hips were larger in the anterosuperior and superior direction, while smaller in the posterosuperior and posterior direction, with no difference in the anterior direction. In general, the total component coverage ratio was significantly lower in the dysplastic hips, with no subgroup difference (Table 3). In addition, the correlation indices regarding component coverage are summarized in Table 4. In terms of acetabular anatomy, the acetabular length, depth and volume were significantly positive correlated with CC. Based on implanted simulation, the Cup-CE and sector coverage angles except A-ASA were significantly positive correlated with CC. It is worth emphasizing that the high correlation indices of the PS-ASA and P-ASA were 0.724 and 0.618, respectively.
Table 3.
2D/3D coverage parameters for Crowe IVa, IVb DDH and control group
| Control group | DDH group | |||
|---|---|---|---|---|
| IVa (n = 27) | IVb (n = 26) | P valure | ||
| A-ASA, deg (SD; range) | 73.36 (7.89; 56.24 to 100.23) | 57.83 (8.00; 43.87 to 72.05) ## | 52.91 (10.19; 20.63 to 68.20) ## | t=-1.959; P = 0.056 |
| AS-ASA, deg (SD; range) | 118.95 (6.18; 107.35 to 132.24) | 90.47 (14.36; 70.42 to 118.84) ## | 80.91 (9.89; 64.82 to 107.35) ## | t=-2.831; P = 0.007* |
| S-ASA, deg (SD; range) | 135.50 (5.43; 121.26 to 144.69) | 114.83 (7.05; 103.13 to 130.13) ## | 110.55 (7.54; 98.20 to 127.77) ## | t=-2.133; P = 0.038* |
| PS-ASA, deg (SD; range) | 132.76 (6.86; 115.85 to 144.58) | 110.41 (7.13; 95.55 to 125.02) ## | 116.74 (12.46; 94.49 to 143.77) ## | t = 2.262; P = 0.029* |
| P-ASA, deg (SD; range) | 108.97 (9.20; 72.50 to 126.66) | 100.85 (11.22; 78.73 to 120.09) ## | 109.73 (14.16; 84.70 to 134.83) | t = 2.533; P = 0.014* |
| CC, % (SD; range) | 94.89 (1.87; 91.42 to 98.60) | 78.21 (5.65; 63.40 to 87.58) ## | 80.62 (6.16; 64.79 to 89.84) ## | t = 1.487; P = 0.143 |
IVa: without false acetabulum; IVb: with false acetabulum; CC: component coverage
#p < 0.05, ##p < 0.01, compared with the control group; *p < 0.05, ** p < 0.01, for the comparison between the type IVa DDH and type IVb DDH
Table 4.
Correlation analysis
| Pearson’s coefficient | P value | |
|---|---|---|
| Acetabular Length | 0.345 | 0.011* |
| Acetabular Depth | 0.284 | 0.039* |
| Acetabular Volume | 0.370 | 0.037* |
| Cup-CE | 0.351 | 0.010* |
| AS-ASA | 0.423 | 0.002** |
| S-ASA | 0.339 | 0.013* |
| PS-ASA | 0.724 | < 0.001** |
| P-ASA | 0.618 | < 0.001** |
*P < 0.05, **P < 0.01
Based on the heat mapping results, the localization of the insufficient bone contact could be clearly visualized. The remarkable exposed portion of cups was mainly (> 70%) concentrated on the posterosuperior and posterior wall. Further, a notably uncovered area located in the area between 1 and 3 o’clock on almost all the cups, as shown in crimson (Fig. 3). In the anteroinferior direction, there also existed 60–80% uncovered concentration. Anteriorly, 50–60% of uncovered portions were oriented between the 9 to 11 o’clock positions due to the relatively insufficient anterior bone stock of Crowe IV dysplastic hips.
Fig. 3.
3D bone defect mapping. The distribution frequency of the uncovered portion on intact cup is shown in different colors. A clock pattern was drawn on the component to show the location of the uncovered portion in the reference of the left acetabulum
Discussion
In this study, we presented a quantitative evaluation of acetabular shape, cup-related morphology and 2D/3D coverage parameters in patients with Crowe IV dysplastic hips by utilizing the 3D simulated implantation. According to the absence or presence of false acetabulum, we also found a series of anatomical distinctions between IVa and IVb acetabula. Based on 3D bone mapping, the bone stock in the posterosuperior and posterior direction played a critical role in determining the 3D component coverage.
Compared with other Crowe types, the true acetabulum in Crowe IV is thoroughly separated from the dislocated femoral head, resulting in remarkable dysplasia and deformation [10, 19]. According to clinical experience, surgeons found that the acetabular anatomy and bone stock distribution were relatively constant in Crowe IV acetabular reconstruction [10, 20]. Similarly, we found the acetabular shape parameters and cup size were not influenced by induvial height or BMI. A Crowe IV acetabulum presents as a narrow, shallow, and low-volume socket. Regarding the false acetabulum, studies revealed a series of notably morphological distinctions in high-dislocated femurs [13, 21]. The existence of stress stimulation not only restrains the excessive dislocation of the affected femur, but plays an important role in bone remodeling and femoral reconstruction strategy [14; 22–24]. However, there existed no significant difference in acetabular size and volume between IVa and IVb subgroups.
According to our previous reports [2, 10], the 3D simulated implantation provides reliable and repeatable guidance for hip reconstruction. During simulated implantation, shallow and inadequate bone stock in dysplastic hips severely compromised the component positioning and mechanical stability. The Crowe IV acetabulum tended to be sharply abductive, with a smaller Cup-CE and larger Cup-Sharp. There was no component size distinct between DDH subgroups, while the IVa acetabula had larger Cup-CE (24.74 ± 7.08 vs. 20.70 ± 7.59) and smaller Cup-Sharp than those of IVb acetabula. Considered of the insufficient lateral bone coverage, Takao et al. [25] revealed that bone-cup contact of more than 8.4° of the Cup-CE angle was large enough for press-fit cups to resist superior directed loads during a minimum 6-year follow-up. Subsequent biomechanical and clinical follow-up studies confirmed that even Cup-CE angle greater than 0° can also ensure satisfactory bony fixation without additional graft [26, 27]. Hence, both DDH acetabula can provide considerable bone contact to accommodate a standard-sized cup with sufficient lateral coverage. With the stimulation of the false acetabulum, the acetabular anteversion of IVb acetabula tended to larger (36.49 ± 5.37 vs. 30.17 ± 9.06), similar with previous study [16]. Regarding of the excessive anteversion in both acetabular and femoral side [13, 28], Modular prosthesis and combined anteversion [29] should be fully taken into systematic consideration during high-riding hip reconstruction.
Generally, the whole component coverage was found to be 79.39 ± 5.97% for standard-sized cup implantation in DDH hips, without subgroup distinct by the false acetabulum. Compare with the controsl group, the coverage sector angles in DDH hips were significantly smaller in all the directions, except for the posterior direction of IVb hips. Due to great anteversion, the segmental coverage of IVb acetabula was larger in the posterosuperior and posterior directions, while smaller in the anterosuperior and superior directions than that of IVa acetabula. Though acetabular distinctions exist between subgroups, the false acetabulum is regarded as stronger indication of challenge in shortening osteotomy and leg length discrepancy during femoral reconstruction [15, 30]. Corresponding distinctions in the acetabulum may attribute to the development of iliac shape and active gait. In terms of the correlation analysis, sector angles in the posterosuperior and posterior directions were determined to be highly positive correlation factors with component coverage. Through the 3D bone mapping, the distribution and probability of the uncovered portion was presented visually. The remarkable concentration of uncover area on the posterosuperior and posterior wall was consistent with the correlation analysis. The 3D visual results also verified that the posterosuperior bone stock plays a vital role in acetabular reaming reconstruction [3, 5]. Regarding the insufficient bone stock, 3D simulation provides full benefit of avoiding anterior wall destruction and acetabular malposition [31, 32]. In light of the aforementioned challenge, 3D preoperative application [33, 34] and robotic-assisted technique [35] highly improved the precision and reproducibility of prosthetic implantation. Accordingly, the intervention ensured precise and controllable surgical manipulation, which contributes to reducing the intraoperative complications and adverse events.
The limitations of our study should be noted. First, the sample size was limited. However, Crowe IV hips are uncommon and the sample size was comparable with previous Crowe IV DDH studies. Second, all the meaningful results are based on 3D reconstruction analysis without clinical verification. Even the results of the statistical analysis indicated reliable reproducibility, further PSI-assisted or robotic-assisted studies are being conducted to confirm our findings. Third, the CT images were standardized by APP for morphological measurements, which could be influenced by the individual variations of pelvic orientation. Considered that the majority of high-riding patients were relatively young without the spinopelvic rigid deformity. Meanwhile, several studies [36, 37] stated that THA significantly alters the pelvic tilt to restore the normal alignment for DDH patients postoperatively.
Conclusions
Based on distinctively triangular acetabulum, presence of the false acetabulum contributes to significant anteversion and segmental coverage distinctions in Crowe IV DDH. As indicated in the literature, particular implant orientation should be considered in acetabular and femoral reconstruction. 3D bone mapping provided defect distribution visually, revealing that management of posterosuperior and posterior bone stock plays an important role for ideal component coverage.
Acknowledgements
Not applicable.
Author contributions
Study design: YHY, DYC and QJZ. 3D reconstruction and measurement performance: YHY and BCZ. Data collection: QTL, LYH and DYC. Data analysis and data interpretation: YCM. Drafting manuscript: YHY. Approving final version of manuscript: QJZ and YCM. QJZ takes responsibility for the integrity of the data analysis. All authors read and approved the final manuscript.
Funding
This study was supported by Guangdong Basic and Applied Basic Research Foundation (2023A1515110657, 2023A1515220181), Ganzhou Science and Technology Research Fund(20222ZDX7952).
Data availability
No datasets were generated or analysed during the current study.
Declarations
Ethics approval and consent to participate
This study was approved by the institutional review board of Guangdong Provincial People’s Hospital (IRB: S2023-1026-01). All methods were carried out in accordance with relevant guidelines and regulations. Informed consent was obtained in writing from all the individual participants included in the study.
Consent for publication
Written informed consent was obtained from all patients for publication of this study and any accompanying images.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Yuhui Yang and Duanyong Chen contributed equally to this work.
Contributor Information
Yuanchen Ma, Email: mayuanchen@gdph.org.cn.
Qiujian Zheng, Email: zhengqiujian@gdph.org.cn.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
No datasets were generated or analysed during the current study.