Total Hip Arthroplasty For Crowe Type Ⅲ Or Ⅳ Developmental Dysplasia Of Hip In Adults

Background: Total hip arthroplasty(THA)was an effective and mature operation for curing end-stage diseases of hip. Due to the presence of anatomical abnormalities, THA for developmental dysplasia of hip(DDH)was always a challenge for surgeons, mainly in the acetabulum reconstruction, femoral prosthesis selection, soft tissue release and the balance of leg length. This study was a retrospective analysis to explore the surgical treatment and effectiveness of THA for Crowe type Ⅲ and Ⅳ developmental dysplasia of hip in adults.Methods: Between March 2007 and March 2015, 32 patients(36 hips) was selected for a retrospective study in The First Hospital of Jilin University, including 4 males and 28 males with a mean age of 47 years(16 to 66 years). There was 7 hips of Crowe type III and 29 hips of Crowe type IV. Based on the preoperative imaging data, individualized surgical treatment was designed. The preoperative and postoperative differences of Harris hip score and SF-36 was to assess clinical results. The preoperative and postoperative imaging data was to evaluate the position of the prosthesis, the loosening, osteolysis, the osteotomy and bone grafting healing. Measuring the leg length discrepancy. Complications were recorded and the reasons were analyzed.Results:All patients were followed up mean 33 months(10 to 106 months). Harris hip score improved from 41.91±7.92 points to 84.38±7.11; SF-36 improved from 40.24±5.20 points to 80.27±3.47; The mean leg length discrepancy reduced from mean 3.36 cm to mean 1.00 cm. All the difference were statistically significant(P<0.05). But postoperative limp was graded as mild(14 cases), moderate(10 cases), and severe(3 cases). The proportion of moderate and severe limp was up to 40.6%. Comparing femoral osteotomy group with non osteotomy group, there was significant difference in hospitalization days, operation time, intraoperative blood loss and postoperative HHS between 2 groups(P<0.05) except for postoperative leg length discrepancy(P > 0.05). All prosthesis were in good position, no loosening. Acetabular and the greater trochanter osteolysis were found only in one case because of the severe wear of the polyethylene liner. All osteotomies were healed well and the average time in radiographic union was 6.8 months(3-12 months). The overall complication rate was 34%, no joint dislocation and postoperative infection. Periprosthetic fractures: 3 cases, numbness in the exterior of lower leg: 4 cases, anterior patella pain: 3 cases, severe wear of the polyethylene liner: 1 case.Conclusions: The clinical and radiographic outcomes of THA for patients with Crowe type III or IV DDH were encouraging. Before surgery, adequate preparation was necessary. In the operation, individualized reconstruction of the acetabular and femoral was combined with intraoperative conditions. After surgery, prevention and treatment of complications will become the priority.