A Report on Three Consecutive Cases using Computer Tomography 3D Preoperative Planning for Conversion of Arthrodesed Hips to Total Hip Replacements.
BACKGROUND
Conversion of an arthrodesed hip to a total hip arthroplasty (THA) is a technically demanding procedure with high complication rates. One important issue is that determining the amount of correction for a leg length discrepancy (LLD) can be difficult at the planning stage.


OBJECTIVE
The aim of this study is to assess the reliable use of computer tomography (CT)-based three-dimensional (3D) preoperative planning for the conversion of arthrodesed hips to THAs.


METHODS
CT-based preoperative 3D planning was used to convert three arthrodesed hips to THAs. The efficacy of the planning was evaluated with postoperative radiographic measurements involving the amount of correction for LLD, position of components, difference between targeted and actual values, and ratio of the moment arms. The clinical assessment was performed with the Japanese Orthopaedic Association (JOA) hip score before and after THA.


RESULTS
The mean amount of LLD correction and median LLD after THA were 16 mm (range, 15-17 mm) and 4 mm (range, 1-10 mm), respectively. The components were implanted close to the positions recommended by the preoperative simulation. The ratio of the moment arms indicated that the converted hips were reconstructed in a biomechanically correct manner. The implants for the conversion to THA were successfully positioned with respect to anatomy and functional outcome. The median JOA hip score improved from 50 points (range, 30-66 points) preoperatively to 79 points (range, 72-86 points) at the latest follow-up.


CONCLUSIONS
CT-based preoperative 3D planning could be a powerful guidance tool for conversion of arthrodesed hips to THAs.
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507 Japan.
Yutaka
Y
Kuroda
Department of Orthopaedic Surgery, Gifu University, 1-1 Yanagido, Gifu City, Gifu 501-1194 Japan.
Haruhiko
H
Akiyama
Rehabilitation Unit, Kyoto University Hospital, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507 Japan.
Manabu
M
Nankaku
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507 Japan.
Kazutaka
K
So
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507 Japan.
Koji
K
Goto
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507 Japan.
Shuichi
S
Matsuda
arthrodesed hip; leg length discrepancy; preoperative planning; total hip arthroplasty