| ABSTRACT objective Total hip arthroplasty (THA) in CROWE IV developmental dysplasia of the hip (DDH) is more complex than the normal hip, with large replacement risks and many complications. Although nonosteotomy THA is convenient to perform, subtrochanteric osteotomy shortening can avoid blood vessel and nerve traction injuries. This study aimed to compare osteotomy THA with nonosteotomy to determine reasonable options for operative management of DDH.
Methods Data on 35 CROWE type IV DDH patients who underwent THA were analyzed retrospectively. The patients were divided into two groups: Group A 15 cases (nonosteotomy), and group B 20 cases (osteotomy). There was no significant difference in age, gender, body mass index, between two groups(P>0.05). The operative time, bleeding volume, hospitalization duration, patients’ satisfaction, Harris hip score and the limb length discrepancy (LLD) were evaluated. Data were analyzed by using paired?sample Student’s t?test, independent?sample Student’s t?test, and Pearson’s Chi?square test; the test level was α =0.05.
Results All of the patients were followed up for 3months-48 months, no prosthesis loosening or infection occurred by the end of follow-up. in group A, One case had occurred by sciatic nerve injury and one case developed cutaneous branch injury of the femoral nerve ,both of which were spontaneously recovered completely without treatment after 3 months. One case of dislocation occurred in group B, after closed reduction, dislocation did not recur; three cases had proximal femoral crack fractures and received steel plate fixation; no reoperation was needed. There was significant difference in operation duration, bleeding volume ,and hospitalization days between two groups (P<0.05).The Harris score at last follow-up was significantly increased when compared with preoperative score in two groups (P<0.05), but there was no significant difference between two groups (P>0.05). The postoperative discrepancy of bilateral lower limbs had significant difference (P<0.05).
Conclusion THA with no femoral shortening osteotomy can achieve good clinical results in
patients with unilateral Crowe IV developmental dysplasia of hip. Comparing with subtrochanteric osteotomy, the procedure of no femoral shortening osteotomy is easier technically. For unilateral high dislocation DDH patients with limb lengthening ≤4 cm and good tissue conditions, THA without femoral osteotomy may be considered. |
