HIGH HIP CENTER IN TOTAL HIP

ARTHROPLASTY WITH ACETABULAR

DEFICIENCY
A Functional and Radiological Studies
Hendrika W*, Kisworo B**
*Fellow of Indonesian Hip and Knee Society
**Consultant Hip and Knee Panti Rapih Hospital,
Jogjakarta
 Background
Operative
Strategies

High placement of
Approximate hip
center rotation of
center
the hip

The Objective
determine the clinical outcomes after total hip
replacement with high placement of hip center in patients
with osteoarthritis with acetabular deficiency.
Determination of the center of rotation
using the method described by Ranawat
et al.
A perpendicular line with a length of
20% of the pelvic height (c) was plotted
on the vertical of the Köhler line
connecting the teardrops, starting at the
lower edge of the teardrop. A parallel
line of the same length was then drawn
laterally, starting from the most proximal
point of the first segment. Finally, the
end points of these two segments were
connected with a line. The triangular
area enclosed by these lines defines the
anatomically correct acetabular region
 Patients and method
Five patients (six hips) post Total Hip
Arthroplasty, including two bilateral THA were
observed within 2 years.

Harris Hip Score

Oxford Hip Score

limb discrepancy

radiology measurement
 Material and Methode
Followed within 2
years and has
osteoarthritis with Five Patient
acetabular deficiency
problem

Three Patients Two Patients had

had Total Hip Bilateral Total
Arthroplasty Hip Arthroplasty.

Followed clinically and

Without
radiographically
administered with Harris
acetabular
hip score and Oxford Hip augmentation of
Score the bone loss
Any radiolucent line greater than three
millimeters wide was classified
arbitrarily as osteolysis.

Periacetabular radiolucency classifying according to location with use of DeLee

and Charnley methode
A change in the position of the acetabular component of thirty-five
millimeters from tear drops or more was defined as migration.
 Results
Harris Hip Score and Oxford Hip Score of five
patients are good (89,5 & 45,8) and may not
require any formal treatment.

The leg Length discrepancy was minimal (mean

<0,5cm). There were no sign of loosening
around the hip.
 Discussion

In the past The results

• Allografts have been less satisfactory at a shorter
• Surgeons recommended the duration of follow-up than those reported here.
• Autogenous grafts from the femoral head to
use of adjuvant bulk allograft compensate for acetabular deficiency in total hip
/ autogenous bone graft to arthroplasty, with an eleven-year follow-up, the rate
of loosening of the acetabular component was 47
restore the acetabular per cent, which is three times the rate in the current
study. The results were similar, at an average of ten
component to the years of follow-up, in patients in whom a bulk
allograft from the femoral head was used as a
anatomical position. structural member in the acetabular reconstruction
of a total hip replacement.
 Discussion
The most common criticism of the high hip center  suboptimum biomechanics of the hip.

Brand and Delp and

Johnston et al Doehring et al
Pedersen Maloney
• A two- • Isolated • Movement of • A two
centimeter the hip center centimeter
displacement
superior displacement
superiorly
of the hip displaceme does not of the hip
center nt increases affect the center
superiorly, 5 % of the magnitude or superiorly,
posteriorly, direction of reduced 44 %
and laterally hip-joint joint force. the force-
increase 22 % force. capability of
resultant joint the hip
force. abductors.
 Technical problems associated with
reconstruction using a proximally
placed center of the hip
• Small or so-called mini sizes of acetabular.
• The length of the limb will be reduced unless
the length of the femoral part of the
reconstruction is increased by use of a femoral
component with a longer neck or of a calcar-
type femoral component.
 Gore et al.
Evaluated the strength of the abductors of the hip
in patients who had had a total hip arthroplasty
with a relatively proximal center of the hip and
displacement of the greater trochanter.

Results: difference in the strength of the abductors

when proximal placement of the acetabular
component was compensated by an increase in the
length of the femoral neck.
 Important finding
Proximal displacement of the center of the hip
was not associated with concomitant
lateralization.
 Callaghan et al.
• In a study of revision total hip arthroplasty,
noted that 30 of 73 hips that had a loose
acetabular component had a center that was
at least 35 millimeters proximal to the
interteardrop line.

• However, most of these centers were laterally

as well as proximally displaced.
 Our recommendation
Place the acetabular component at a more
proximal but not more lateral position of the
center of the hip in difficult acetabular
reconstructions
 Conclusions
High Hip Center in THA result in good clinical
outcome.

The use of a high hip center did not adversely

affect the function of the abductor muscles, and
the minimal limb-length discrepancy of limping
gait were not exaggerated.
THANK YOU