Effect Evaluation Of Total Hip Arthroplasty With Rotation Center Moving Up In The Treatment Of Crowe Type Ⅱ And Ⅲ DDH

Objective: To investigate the short-term curative effect and imaging results of Crowe ll and Ⅲ DDH treated with the method of rotation center up in total hip arthroplasty.Methods:Twenty-one patients(25 hips)of Cowe Ⅱ and Ⅲ type DDH who underwent primary total hip arthroplasty in our hospital from January 1,2019 to March 1,2022 were selected as the research group(high hip center group),including 13 males(16hips),8 females(9 hips),21 hips of Cowe Ⅱ type and 4 hips of COWEⅡ type.The patients were aged from 27 to 74 years old,with the average age of 55.9 years old,and the average preoperative Harris score was 40.80 points.Twenty-eight patients(30hips)of Cowe I type and aseptic necrosis of femoral head receiving THA at the same time were selected as the control group(in-situ mortar-making group),including 13males(14 hips),15 females(16 hips),18 hips of Cowe I type,and 10 cases(12 hips)of aseptic necrosis of femoral head.The patients were aged from 19 to 84,with the average age of 59.4 years,and the average preoperative Harris score of 40.93 points.The hip joint function score and abductor muscle strength after surgery were clinically compared between the two groups,and the vertical distance(V-COR),horizontal distance(H-COR),BWLA/ALA from the center of rotation to the lacrimal line were imagewise compared between the two groups.Results: The mean follow-up time was 19.16 months in the research group and the mean postoperative V-COR was 30.27mm;the mean follow-up time in the control group was22.56 months.The mean postoperative V-COR was 18.34 mm,and there was significant difference between the two(P<0.001).The mean H-COR values of the research group and the control group were 31.82 mm and 32.83 mm,respectively,and there was no significant difference between the two groups(P=0.384).The mean BWLA/ALA value of the research group was 1.68.The average value of the control group was 1.87,and the comparison was statistically significant(P=0.13).At the last follow-up,the Harris hip score was 92.72 in the study group and 93.10 in the control group,showing no statistical significance(P=0.559).The average postoperative LLD values of the two groups were 6.33 mm and 6.13 mm,and the difference was not statistically significant(P=0.874).The average postoperative muscle strength percentage of the research group and the control group was 84.05% and 85.42%,respectively.The difference was not statistically significant(p=0.537).No joint dislocation,periprosthetic fracture,infection,or neurovascular injury occurred in all patients during the follow-up period.Currently,all patients have no revision due to loosening,and their gait is good.Conclusion;High placement of the acetabular cup during total hip arthroplasty in patients with Crowe Ⅱ and Ⅲ DDH is a reliable surgical approach,combined with the use of an elongated neck or reducing the depth of the femoral head into the medullary cavity to restore the abductor muscle strength arm can obtain good abductor muscle strength and restore the difference in leg length,with satisfactory short-term efficacy and imaging results,easy surgical operation,avoiding subtrochanteric osteotomy and acetabular The operation is simple and avoids subtrochanteric osteotomy and acetabular implant,which is beneficial to the early recovery of the patient.