Objective To evaluate the results of rotational acetabular osteotomy (RAO) combined with debridement under arthroscope in the treatment of adult developmental dysplasia of the hip (DDH). Methods Between April 2002 and August 2007, 24 cases (29 hips) of DDH were treated with RAO combined with debridement under arthroscope. There were 2 males (2 hips) and 22 females (27 hips) with an average age of 37.7 years (range, 21-50 years). The locations were the left hip in 7 cases, the right hip in 12 cases, and both hips in 5 cases. The course of hip pain was 8-216 months (median, 30.5 months). According to Crowe DDH classification, there were 24 hips of type I and 5 hips of type II. According to Touml;nnis hip osteoarthritis classification, there were 20 hips of stage I and 9 hips of stage II. Results The mean operation time was 150 minutes (range, 120-180 minutes); the mean intraoperative blood loss was 600 mL (range, 500-700 mL); and the mean postoperative drainage volume was 200 mL(range, 50-400 mL). All incisions healed by first intention. Twenty-four cases were followed up 4.5 years on average (range, 3-8 years). At last follow-up, claudication disappeared in 16 hips and was improved in 8 hips. The Harris hip score was improved from 79.4 ± 9.8 preoperatively to 95.1 ± 8.6 postoperatively, showing significant difference (t=2.467, P=0.010). The visual analogue scale (VAS) score was improved from 5.1 ± 0.8 preoperatively to 1.1 ± 0.6 postoperatively, showing significant difference (t=2.118, P=0.011). The X-rayfilms showed union was achieved at 12-16 weeks (mean, 13.5 weeks). There were significant differences in the centre edge angle, Sharp angle, acetabular coverage rate, and acetabulum-head index between preoperation and postoperation (P lt; 0.05). Twenty hips at Touml;nnis stage I maintained after operation, among 9 hips at Touml;nnis stage II, 5 hips was improved to stage I and 4 hips maintained. Conclusion It has a satisfactory result to treat adult DDH by RAO combined with debridement under arthroscope, which may increase the congruency of hip joint, delay or prevent the progression of hip osteoarthritis.
Objective To investigate the short-term effectiveness of total hip arthroplasty with Wagner Cone stem combined with subtrochanteric shortening osteotomy for adult patients with Crowe Ⅳ developmental dysplasia of the hip (DDH). Methods A clinical data of 18 patients (20 hips) with Crowe Ⅳ DDH between January 2015 and June 2017 was retrospectively analyzed. There were 5 males (6 hips) and 13 females (14 hips), with an average age of 42 years (range, 20-67 years). There were 18 cases with unilateral DDH and 2 cases with bilateral DDHs. The " 4” sign and Trendelenburg sign of affected hip were positive. Preoperative Harris score and visual analogue scale (VAS) score were 41.95±6.90 and 5.05±1.15, respectively. The length discrepancy was (4.76±2.59) cm in patients with unilateral DDH. And the lengths of bilateral lower limbs in patients with bilateral DDH were equal. The acetabular anteversion angle, femoral anteversion angle, and combined anteversion angle were (32.82±2.79), (46.18±6.80), and (79.01±7.54) °, respectively. All patients were treated by total hip arthroplasty with Wagner Cone stem and subtrochanteric shortening osteotomy. The length of osteotomy ranged from 2.0 to 3.5 cm (mean, 2.38 cm). Results The operation time was 116-161 minutes (mean, 138.4 minutes); the volume of intraoperative blood loss was 600-1 200 mL (mean, 795 mL); the volume of drainage after operation was 100-630 mL (mean, 252 mL). All incisions healed by first intention. The symptom of sciatic nerve injury occurred in 1 case and relieved after symptomatic treatment. All patients were followed up 12-29 months (mean, 18.4 months). The " 4” sign and Trendelenburg sign of affected hip were negative. The Harris score and VAS score at last follow-up were 87.50±5.06 and 0.75±0.85, respectively. The acetabular anteversion angle, femoral anteversion angle, and combined anteversion angle were (16.21±4.84), (18.99±2.55), and (35.20±5.80)°, respectively. There were significant differences in above indexes between pre- and post-operation (P<0.05). The length discrepancy was (0.72±0.70) cm in patients with unilateral DDH, which was significant shorter than the preoperative value (t=7.751, P=0.000). And the lengths of bilateral lower limbs in patients with bilateral DDH were equal. X-ray films showed that the osteotomy of femur healed at 3-6 months (mean, 4.1 months) without the signs of loosening, sinking, osteolysis, and dislocation. Conclusion Total hip arthroplasty with Wagner Cone stem and subtrochanteric shortening osteotomy can obviously improve the hip joint function and restore the length of lower limb. The short-term effectiveness is satisfactory, but the long-term effectiveness and survival rate of prosthesis need to be further observed.
ObjectiveTo compare the effectiveness of three different fixation methods after subtrochanteric shortening osteotomy (SSO) in total hip arthroplasty (THA) for Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods A clinical data of 63 patients (78 hips) with Crowe type Ⅳ DDH, who underwent THA with SSO between November 2014 and May 2019, was retrospectively analyzed. Among them, 18 patients (20 hips) obtained stability by intramedullary pressure provided by the S-ROM modular prostheses (group A); 22 patients (30 hips) underwent prophylactic binding by stainless steel wire after osteotomy and before stem implantation (group B); 23 patients (28 hips) were fixed with autogenous cortical strut grafts and stainless steel wire or cables (group C). There was no significant difference in gender, age, body mass index, affected limb side, and preoperative Harris score between groups (P>0.05). The operation time, complications, imaging results, hip functional score of the three groups were recorded and compared. Results There was no significant difference in the operation time between groups (P>0.05). All incisions healed by first intention. All patients were followed up, and the follow-up time was 2.5-4.0 years (mean, 3.1 years) in group A, 1.5-5.5 years (mean, 3.2 years) in group B, and 1.0-5.0 years (mean, 1.6 years) in group C. There was no significant difference in Harris score or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between groups at 4 and 12 months after operation (P>0.05). X-ray films showed that there was no significant difference in osteotomy healing rate at 4, 8, and 12 months after operation and the osteotomy healing time between groups (P>0.05). There was no complications such as joint dislocation, prosthesis loosening, prosthetic joint infection, or heterotopic ossification during follow-up, except for the distal femoral fracture of 1 hip during operation in group B. Conclusion In THA for patients with Crowe type Ⅳ DDH, the stainless steel wire binding alone and autogenous cortical strut grafts combined with stainless steel wire or cable binding can not significantly promote the osteotomy healing compared with femoral prosthesis intramedullary compression fixation. For patients with nonmatched medullary cavity after SSO, it is recommended to apply autogenous cortical strut grafts with wire or cables for additional fixation.
Objective To investigate the effectiveness of subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip (DDH). Methods Between January 2004 and December 2010, 37 patients (44 hips) with Crowe type IV DDH underwent subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty with cementless prosthesis. There were 15 males (18 hips) and 22 females (26 hips) with an average age of 42 years (range, 24-46 years). Unilateral hip was involved in 30 cases and bilateral hips in 7 cases. Preoperative X-ray films showed complete dislocation of the femoral head and hypoplasia of the acetabulum and proximal femur. Before operation, the leg discrepancy was (5.5 ± 1.1) cm, and the Harris score was 32.1 ± 5.2. Results The mean operation time was 4.3 hours (range, 3-6 hours); the mean blood loss was 760 mL (range, 600-1 000 mL). All patients obtained primary healing of incision. The patients were followed up 1-8 years (mean, 6.7 years). Pain relief was achieved; 6 cases had mild claudication; 3 cases had femoral nerve palsy; and no stretch injury of sciatic nerve was observed. X-ray films showed that acetabular cups were in normal position. The healing time of fracture was 3-6 months (mean, 3.7 months). The leg discrepancy was (1.5 ± 1.0) cm at 1 day after operation, showing significant difference when compared with preoperative one (t=16.45, P=0.00). The Harris score was 94.3 ± 3.8 at 3 months after operation, showing significant difference when compared with preoperative score (t=59.15, P=0.00). No revision of acetabular and femoral prostheses was performed during follow-up. Conclusion Subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty is a safe method of restoring the anatomic hip center in Crowe type IV DDH in adults. It can avoid reduction difficulty caused by soft tissue contracture and injuries of sciatic nerve and femoral nerve caused by limb lengthening.
Objective To evaluate early to medium-term effectiveness of total hip arthroplasty (THA) in patients with a history of hip preservation surgery with secondary severe osteoarthritis for developmental dysplasia of the hip (DDH). Methods The clinical data of 25 DDH patients (31 hips) who had severe osteoarthritis after hip preservation surgery and received THA between September 2009 and March 2021 were retrospectively analyzed. There were 1 male and 24 females; the age ranged from 18 to 65 years, with an average age of 43 years; 8 hips were classified into Crowe type Ⅰ, 9 hips were type Ⅱ, 3 hips were type Ⅲ, and 11 hips were type Ⅳ. The time between osteotomy and THA ranged from 31 to 51 years, with an average of 31.96 years. Preoperative hip flexion range of motion was (69.31±29.72)°, abduction range of motion was (24.00±14.79)°; and Harris hip score was 45.3±15.5. Postoperative Harris hip score, hip range of motion, complications, radiographic findings, and implant survival rate were analyzed. Results Patients in both groups were followed up 2-132 months, with an average of 51 months. During the follow-up, periprosthetic fracture occurred in 1 case; there was no complication such as dislocation, periprosthetic infection, nerve palsy, or deep vein thrombosis. At last follow-up, the hip flexion range of motion was (109.52±11.17)°, abduction range of motion was (41.25±5.59)°, showing significant differences when compared with preoperative values (t=8.260, P=0.000; t=6.524, P=0.000). The Harris hip score was 91.5±4.1, and the difference was significant when compared with preoperative score (t=11.696, P=0.000); among them, 13 cases were excellent and 12 cases were good. Radiographic evaluation showed that the center of acetabular rotation moved up 0-18 mm (mean, 6.35 mm). The cup abductor angle was 28°-49° (mean, 37.74°) and the coverage rate was 69.44%-98.33% (mean, 81.04%). All femoral stems were fixed in neutral position without varus or valgus. No osteolysis, radiolucent line, or implant migration was observed. By the end of follow-up, none of the patients underwent revision and the survival rate of prothesis was 100%. ConclusionTHA is still the gold standard for the treatment of DDH patients with secondary osteoarthritis after hip preservation surgery. The postoperative joint function can be rapidly restored, the patients’ quality of life can significantly improve, and the early to medium-term survival rate of the prosthesis is satisfactory.
ObjectiveTo evaluate the effectiveness of the total hip arthroplasty (THA) for severe development dysplasia of the hip (DDH) in adults. MethodsBetween July 2007 and January 2013, 25 patients (27 hips) with severe DDH underwent THA with cementless prosthesis. There were 10 males (11 hips) and 15 females (16 hips) with an average age of 38.6 years (range, 21-57 years). The left hip was involved in 10 cases, the right hip in 13 cases, and bilateral hips in 2 cases. There were 8 cases (9 hips) of Crowe type III and 17 cases (18 hips) of Crowe type IV. The main clinical manifestations were unilateral or bilateral hip pain, claudication, and limited motion of the hip. All patients had leg discrepancy with a length difference of (4.9±0.8) cm. Harris score was 32.7±2.9. ResultsAll patients obtained primary healing of incision; no infection, dislocation, periprosthetic fracture, and lower extremity deep venous thrombosis occurred. All patients were followed up 1-5 years (mean, 3.7 years). Pain relief of the hip was obtained. The motion of the hip was improved obviously. At last follow-up, the length difference between lower limbs was (1.5±0.3) cm, showing significant difference (t=36.703,P=0.000) when compared with preoperative one. Normal gait was observed in the others except 3 cases having mild claudication. Harris score was 89.6±3.2, showing significant difference (t=-65.498,P=0.000) when compared with preoperative one. The X-ray films showed bone union of the acetabular structural bone graft and femoral osteotomy ends, and the union time was 3-5 months (mean, 4.6 months). No complication occurred as follows:dislocation, infection, prosthesis loosening or subsidence, and heterotopic ossification. ConclusionTHA in the treatment of severe DDH in adults can obtain satisfactory short-term effectiveness, but long-term effectiveness needs further observation.
【Abstract】 Objective To summarize techniques of the total hi p arthroplasty (THA) in the treatment of developmental dysplasia of the hi p (DDH) with severe osteoarthritis in adults. Methods From March 2000 to January 2006, 24 patients (27 hips) with DDH were treated by THA with an cementless cup. There were 7 males and 17 females, withthe average age of 49.6 years (ranging from 26 years to 63 years). Unilateral DDH occurred in 21 patients and bilateral DDH occurred in 3 patients. Based on the Crowe classification, there were 16 hips in 15 patients of type I, 4 hips in 4 patients of type II, 4 hips in 3 patients of type III, 3 hips in 2 patients of type IV. Except for 3 patients with bilateral DDH, the other patients’ ill lower l imbs were 2-7 cm shorter than the healthy lower ones. Results All the patients were followed up from 9 months to 6.5 years and no one had infection, dislocation, femur fracture and so on after the operation. In 18 patients, the pain was completely rel ieved and the function of the hip joints was good. After the gluteus medius exercise, the claudication of 3 patients after the operation disappeared. In 3 patients, the ill lower l imbs were more than 1 cm shorter than the healthy lower ones and the other patients’ ill lower l imbs were less than 1 cm shorter than the healthy lower ones. Two patients’ lower l imbs were been lengthened 4-5 cm. All the patients’ sciatic nerves were not injured. The Harris scores were 46.5 ± 7.2 preoperatively and 84.0 ± 5.7 postoperatively (P lt; 0.05). Conclusion THA with deepening the medial wall of the acetabulum at the true acetabulum and choosing small cementless cup in adult could obtain favorable results.
Objective To summarize the effectiveness of acetabulum reconstruction with autologous femoral head structural bone graft in total hip arthroplasty (THA) for Hartofilakidis type Ⅱ developmental dysplasia of the hip (DDH). Methods A clinical data of 24 patients (27 hips) with Hartofilakidis type Ⅱ DDH, who underwent acetabulum reconstruction with autologous femoral head structural bone graft in primary THA between October 2012 and October 2020, was retrospectively analyzed. There were 3 males and 21 females, with an average age of 40 years (range, 20-58 years). The body mass index was 19.5-35.0 kg/m2 with an average of 25.0 kg/m2. There were 21 cases of unilateral hip and 3 cases of bilateral hips. The hip Harris score was 51.1±10.0. The leg length discrepancy of unilateral hip patients was (19.90±6.24) mm. The intraoperative blood loss, wound healing, and complications were recorded. The postoperative bone union, coverage rates of acetabular prosthesis and bone graft, and aseptic loosening of the prosthesis were evaluated based on X-ray films, and the improvement of hip function was observed by Harris score. Results The intraoperative blood loss was 50-1000 mL (median, 350 mL). All incisions healed by first intention, and no fracture, hematoma, infection, or other complications occurred. Sciatic nerve injury occurred in 1 case (1 hip) and deep venous thrombosis occurred in 1 case (1 hip). All patients were followed up 15-103 months (median, 40.5 months). At last follow-up, Harris score was 92.6±4.1 and the difference was significant when compared with preoperative value (t=?28.043, P=0.000). No hip prosthesis needed revision. X-ray films showed that the coverage rate of acetabular prosthesis was 91%-100% (mean, 97.8%), and the coverage rate of bone graft was 13%-46% (mean, 23.8%). The healing time of bone graft was 3-6 months (mean, 4.7 months). At last follow-up, all bone grafts completely healed without any signs of collapse. There was no graft resorption, ectopic ossification or osteolysis, or obvious aseptic loosening of the acetabular and femoral prostheses. The leg length discrepancy of unilateral hip patients was (2.86±2.18) mm, and the difference was significant when compared with preoperative value (t=17.028, P=0.000). Conclusion For Hartofilakidis type Ⅱ DDH patients, if the lateral acetabular prosthesis not covered by the host bone exceeds 5 mm in primary THA, autologous femoral head can be used for structural bone grafting, and the short- and mid-term effectiveness are favorable.
ObjectiveTo investigate the effectiveness of sliding trochanteric osteotomy (STO) in total hip arthroplasty (THA) for Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods Between July 2016 and April 2021, 52 patients (57 hips) with Crowe type Ⅳ DDH who underwent primary THA were enrolled according to inclusion criteria. There were 5 males and 47 females with a median age of 51 years (range, 18-76 years). There were 47 cases of single hip and 5 cases of bilateral hips. The leg length discrepancy (LLD) was 50.50 (44.00, 55.00) mm, visual analogue scale (VAS) score was 8.0 (6.0, 9.0), and Harris score was 58.0±5.0 before operation. Trendelenburg sign was positive in 46 patients (46 hips). All patients underwent STO and THA using Wagner-cone stem. The operation time, intraoperative blood loss, blood transfusion volume, Trendelenburg sign, and related complications were observed. During follow-up, VAS and Harris scores were recorded to evaluate the hip pain and function. X-ray film was used to measure the LLD and observe the bone union situations. Results The operation time was 90-125 minutes (mean, 105 minutes). Introperative blood loss was 420-800 mL (mean, 640 mL). Ten patients underwent blood transfusion and the amount of allogeneic blood transfusion was 2-4 U (mean, 3 U). All incisions healed by first intention after operation. All patients were followed up 4-60 months (median, 24 months). At last follow-up, LLD was 6.00 (4.00, 7.75) mm, showing significant difference when compared with that before operation (Z=?6.278, P=0.000). After operation, 51 hips (89.5%) achieved bone union at the osteotomy site, 4 hips (7.0%) had fibrous union, and 2 hips (3.5%) had nonunion. The healing time of osteotomy was 3-12 months, with an average of 6 months. At last follow-up, the VAS score was 3.0 (2.0, 5.0) and the Harris score was 85.0±6.0. The differences between pre- and post-operation were significant (Z=?6.176, P=0.000; t=?25.285, P=0.000). Trendelenburg sign remained positive in 4 patients (4 hips) at last follow-up and the difference was significant when compared with preoperative (χ2=67.947, P=0.000). One patient had a medial femoral cortical fracture when Wagner-cone stem was implanted during operation, and 2 patients had early symptoms of sciatic nerve palsy after operation, and no other related complications occurred. Conclusion For Crowe type Ⅳ DDH patients, STO applied in THA can reduce the resected bone mass, provide better exposure of hip as well as improve function of hip abductor muscle. Wagner-cone stem is recommended.
ObjectiveTo explore the mid-term effectiveness of total hip arthroplasty (THA) with subtrochanteric shortening osteotomy in treatment of Crowe type Ⅳ developmental dysplasia of the hip (DDH).MethodsBetween September 2009 and March 2014, a total of 49 patients (57 hips) who were diagnosed with Crowe type Ⅳ DDH were treated with THA and subtrochanteric shortening osteotomy. Of the 49 patients, 7 were male and 42 were female with an average age of 44.6 years (range, 20-73 years). The preoperative Harris score was 44.68±3.39 and the preoperative leg length discrepancy was (5.27±0.55) cm.ResultsAll incisions healed primarily. All patients were followed up 32-87 months (mean, 52.1 months). At last follow-up, the Harris score was 85.67±2.89 and the leg length discrepancy was (1.12±0.48) cm, showing significant differences when compared with the preoperative values (t=–69.53, P=0.00; t=42.94, P=0.00). X-ray films showed that bone union of the femoral osteotomy end at 6 months after operation. There was no loosening and subsidence of prosthesis at last follow-up.ConclusionThe subtrochanteric shortening osteotomy with THA in treatment of Crowe type Ⅳ DDH can obtain satisfactory mid-term effectiveness with low risk of peripheral vascular and nerve traction injuries.