| Purpose:To find the influence of femoral head dislocation height on osteotomy,and to analyze the clinical efficacy with or without subtrochanteric osteotomy in total hiparthroplasty(THA)for highly dislocated hip dysplasia(DDH)in adults.Materials and Methods:A retrospective analysis of 15 patients(19 hips)with Crowe type ? hip dysplasia(DDH)with hip arthritis who underwent total hip replacement for the first time at the China-Japan Union Hospital of Jilin University from January 2014 to December 2019.There were 12 women and 3 men.Aged 23-58 years,with an average of 41.2 years.All selected patients had symptoms of pain and difficulty in moving their limbs before surgery.All total hip arthroplasty was performed with bio-type prosthesis(S-ROM)for true acetabular joint replacement,of which 7patients(11 hips))subtrochanteric osteotomy was used and 8 patients(8 hips)non-osteotomy was used during operation.They were divided into osteotomy group(group A)and non-osteotomy group(group B)according to whether they were osteotomy or not.There was no statistically significant difference in the basic personal information of the two groups of patients such as gender and age(P>0.05).Trapezium pads were used to fix both lower limbs early in the postoperative period,and lower limb muscle strength training was gradually transitioned to assisting And independent walking.X-ray irradiation was performed on the double hip joint and outpatient specialized examination before operation,the next day after operation,one month,three months,six months and one year respectively,and the height of the dislocation before surgery was recorded in the two groups.Preoperative and postoperative Harris scores,postoperative limb length differences,and complications to evaluate treatment effects.Preoperative and postoperative imaging results were used to evaluate the osteotomy end bone healing status,the presence or absence of prosthetic loosening,dislocation,false Body subsidence,fractures around the prosthesis,infection,osteolysis,etc.Result:All patients were followed up for 12 to 60 months,with an average of 36 months.The height of femoral head dislocation in group A was4.5-8.0cm with the average of 6.3cm while that in group B was 3.1 to 4.3cm with the average of3.8cm.Preoperative Harris score: 38.5±3.8 points in group A,40.8±3.4points in group B.postoperative Harris score: 86.9±2.0 points in group A,88.4±2.6points ingroup B.the difference of Harris score before and after operation in the two groups was statistically significant(p < 0.05).The average length difference between the 2lower limbs after operation was 9.3mm in group A and 8.7mm in group B respectively.Up to the last follow-up,there were no loosening and sinking of the prosthesis,no infection or osteolysis in both groups.In the group A,one case was found distal femoral fractures during the operation and was fixed with steel wire.One case was found delayed healing of fracture and one case suffered from dislocation of hip joint after operation,and dislocation occurred again one year after closed reduction.One patient in group B suffered from numbness of lower limbs after operation,and recovered after 2 months.Conclusion:1.Non-shortening osteotomy is safe and effective for patients with dislocation height less than 4.5cm,which will not cause neurovascular injury and is easier to operate than subtrochanteric osteotomy.2.For patients whose dislocation height is above 4.5 cm,subtrochanteric osteotomy may be a wise choice when it is difficult to reposition after soft tissue release,3.When adult DDH patients undergo THA surgery,subtrochanteric osteotomy or non-osteotomy can be selected according to the actual situation,and satisfactory clinical effects can be obtained. |
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