Efficacy Analysis Of Shortened Osteotomy Combined With THA In The Treatment Of Adult DDH

OBJECTIVE: To analyze the clinical efficacy and complications of total hip arthroplasty using S-ROM matched prosthesis combined with subrotor transverse femoral shortening osteotomy technique in the treatment of patients with osteoarthritis of the hip secondary to Crowe IV developmental dysplasia of the hip.METHODS: A retrospective analysis of 22 patients(22 hips)with osteoarthritis of the hip secondary to Crowe type IV developmental hip dysplasia treated by total hip arthroplasty with subrotor transverse femoral shortening osteotomy in the Department of Joint Surgery,Wuhan Fourth Hospital between 2016 and 2021,including 4 males and 18 females,with patient ages ranging from 27 to 62 years(42.68 ± 9.21 years).The clinical data and imaging data of the study subjects were collected and compiled,including the patients’ gender,age,underlying diseases,preoperative and postoperative Harris hip scores,preoperative shortening of the affected limb compared with the healthy side,operative records,operative time,intraoperative bleeding,whether a proximal femoral fracture was produced intraoperatively,postoperative bilateral lower limb length difference,preoperative and postoperative walking posture,postoperative wound recovery and osteotomy healing,and postoperative osteotomy healing.The data collected were statistically analyzed.Statistical analysis was performed on the collected data.RESULTS: The mean follow-up time was 32 months,and the patients had preoperative Harris hip scores of 29-44(37.09±4.26),postoperative Harris scores of 73-86(82.05±3.03)at the 1-month follow-up,and postoperative Harris scores of 76-92(85.41±3.54)at the last follow-up.The difference was statistically significant(P < 0.05),and the postoperative hip function was significantly improved compared with the preoperative one,and all the pain symptoms disappeared.All 22 patients had positive Trendelenburg test before surgery,and all of them turned negative at the last follow-up after surgery.The affected limb was shortened 35-80 mm(57.36±12.84 mm)compared with the healthy side before surgery,and0-25 mm(9.95±6.83 mm)compared with the healthy side after surgery,and the length of the affected limb recovered 35-70 mm(47.41±9.83 mm)before and after surgery,and the difference was statistically significant(P<0.05).The intraoperative bleeding volume of patients was 600-1200 ml(931.82±167.29 ml),and the duration of surgery was 120-225 min(176.36±26.65 min).The surgical incisions of all study subjects were healed in stage A,and no incisional infections occurred.Conclusion: The transverse femoral shortening osteotomy is simple and effective,helping to reconstruct the center of rotation of the hip joint in the true socket position,restore the length of the lower limb,improve the postoperative hip function,and reduce the occurrence of complications;the modular design of the S-ROM grouping prosthesis has excellent adaptability for patients with Crowe IV DDH,great adjustability of correction,good rotational stability,and satisfactory clinical results.This treatment modality is worthy of wide application.