Clinical Analysis Of Total Hip Arthroplasty Combined With Subtrochanteric Transverse Osteotomy In The Treatment Of Adult Crowe Ⅳ DDH

BackgroundDue to long-term pathological changes of the hip joint in patients with DDH,it is often difficult or impossible to reduce the hip joint due to high soft tissue tension during total hip arthroplasty,and excessive soft tissue release must be performed.In addition,excessive stretching of the periarticular structures,including muscles and tendons,may lead to dysfunction of the abductor muscle,especially the gluteus medius,hip stiffness,and early loosening of the joint prosthesis.Sciatic nerve and femoral nerve may also be damaged due to excessive traction,so osteotomy is often required.There are many kinds of osteotomy methods.Compared with other technologies,subtrochanteric transverse osteotomy is simple and convenient to adjust the Angle of femoral neck pronation and correct the rotation deformity,which has become the primary choice of osteotomy treatment at present.PurposeThis study evaluated the clinical efficacy of total hip replacement combined with subtrochanteric transverse osteotomy in the treatment of Crowe IV hip dysplasia.Materials and methodsWe retrospectively analyzed 32 patients(32 hips)with Crowe IV DDH who underwent total hip replacement combined with subtrochanteric transverse osteotomy between 2013 and 2018,including 6 males and 26 females,with an average age of 45 years,and an average follow-up time of 3 years(1-5 years).Harris hip score,leg length difference,lumbosacral VAS pain score,neurological status,osteotomy healing and stability were used as evaluation criteria.All complications were recorded.ResultsThe average Harris hip score(HSS)increased from 43.7±6.7 points before surgery to 80.3±2.7 points(P< 0.01),the average limb length difference decreased from 5.1±0.6 cm to 0.2±0.1 cm(P< 0.01),and the preoperative lumbosacral VAS score decreased from 6.5±1.4 points to 1.2±1.0 point(P< 0.01).No dislocation,no transient nerve palsy,no nonunion,2 cases of fracture.During the follow-up,there were no obvious signs of loosening in the imaging examination.ConclusionTotal hip arthroplasty combined with subtrochanteric osteotomy is a reliable method to restore limb normality,improve quality of life and achieve satisfactory clinical results.