Total Hip Arthroplasty After Rotational Acetabular Osteotomy for Developmental Dysplasia of the Hip

Background: Total hip arthroplasty after osteotomy is more technically challenging than primary total hip arthroplasty, especially with regards to cup placement. This is due to bone morphological abnormalities caused by acetabular bone loss and osteophyte formation. This study aimed to investigate the clinical and radiological outcomes of total hip arthroplasty after rotational acetabular osteotomy compared with primary total hip arthroplasty, focusing mainly on acetabular deformity and cup position. Methods: The study included 22 hips that had undergone rotational acetabular osteotomy and 22 hips in an age and sex-matched control group in total hip arthroplasties performed between 2005 and 2020. We analyzed cup abduction and anteversion angle, lateral, anterior, and posterior cup center-edge angle, hip joint center position, femoral anteversion angle, and presence of acetabular defect using postoperative radiography and computed tomography. Operative results and clinical evaluations were also analyzed.Results: The clinical evaluation showed that the postoperative range of motion was lower in total hip arthroplasty after rotational acetabular osteotomy than in primary total hip arthroplasty. The lateral cup center-edge angle was significantly higher and the posterior cup center-edge angle was significantly lower in the total hip arthroplasty after rotational acetabular osteotomy, suggesting a posterior bone defect existed in the acetablum. In total hip arthroplasty after rotational acetabular osteotomy, the hip joint center was located significantly superior and lateral to the primary total hip arthroplasty.Conclusions: In total hip arthroplasty after rotational acetabular osteotomy, the cup tended to be placed in the superior and lateral positions, where there was more bone volume. The deformity of the acetabulum and the high hip center should be considered for treatment success because they may cause cup instability, limited range of motion, and impingement.