Objective To investigate the changes of low back pain (LBP) and spinal sagittal parameters in patients with unilateral Crowe type Ⅳ developmental dysplasia of the hip (DDH) after total hip arthroplasty (THA). Methods The clinical data of 30 patients who met the selection criteria between October 2018 and March 2020 were retrospectively analyzed. Patients were divided into LBP group (16 cases) and control group (14 cases) according to whether there was LBP before operation. There was no significant difference between the two groups of patients in gender, age, body mass index, affected sides, preoperative Harris score (P>0.05). Full-length lateral X-ray films of the spine were taken within 1 week before operation and at 1 year after operation, and the following imaging indicators were measured: sacral slope (SS), lumbar lordosis (LL ), spinal tilt (ST), spine-sacral angle (SSA), sagittal vertebral axis (SVA). The visual analogue scale (VAS) score, lumbar Oswestry disability index (ODI), the Harris score of the hip joint before operation and at 1 year after operation, and the occurrence of postoperative complications were collected and analysed. Results In the LBP group, LBP was relieved to varying degrees at 1 year after operation, of which 13 patients (81.3%) had complete LBP remission; VAS score decreased from 4.9±2.3 preoperatively to 0.3±0.8, ODI decreased from 33.5±22.6 preoperatively to 1.3±2.9, the differences were all significant (t=7.372, P=0.000; t=5.499, P=0.000). There was no new chronic LBP in the control group during follow-up. The Harris scores of the two groups significantly improved when compared with those before operation (P<0.05); there was no significant difference between the two groups at 1 year after operation (t=0.421, P=0.677). There was no significant difference in imaging indexes between the two groups before operation and the difference between pre- and post-operation (P>0.05). At 1 year after operation, ST and SVA in the LBP group, SSA in the control group, and SS in the two groups significantly improved when compared with those before operation (P<0.05); there was no significant difference in the other indexes between the two groups before and after operation (P>0.05). Conclusion Unilateral Crowe type Ⅳ DDH patients with LBP before operation were all relieved of LBP after THA. The relief of LBP may be related to the improvement of spinal balance, but not to lumbar lordosis and its changes.
Objective
To explore the surgical technique and effectiveness of autologous femoral head bone graft in total hip arthroplasty (THA) for Crowe type Ⅲ developmental dysplasia of the hip (DDH) with acetabular bone defect.
Methods
Between July 2012 and September 2015, 12 cases (12 hips) of Crowe type Ⅲ DDH with acetabular bone defect were included. Of the 12 patients, 2 were male and 10 were female, with an average age of 54.3 years (range, 37-75 years). The Harris score before operation was 41.08±7.90. The preoperative leg length discrepancy was 0.53-4.28 cm, with an average of 2.47 cm. Autologous femoral head bone graft and cancellous screw fixation were used in all cases to reconstruct acetabula in THA. Four cases were performed with subtrochanteric shortening osteotomy at the same time.
Results
All incisions healed by first intention. Twelve cases were followed up 1 year and 10 months to 5 years, with an average of 3.0 years. X-ray films showed that bone healing was observed in all cases at 6 months to 1 year after operation. There was no bone graft osteolysis, absorption, bone graft collapse, and acetabular prosthesis loosening. At last follow-up, the Harris score was 89.50±2.78, showing significant difference when compared with preoperative value (t=–25.743, P=0.003). The length discrepancy was 0-1.81 cm at last follow-up with an average of 0.76 cm.
Conclusion
Autologous femoral head bone graft is effective for Crowe type Ⅲ DDH with acetabular bone defect, which has advantages of restoring pelvic bone stock, obtaining satisfied prosthetic stability and mid-term effectiveness.
Objective To evaluate the results of rotational acetabular osteotomy (RAO) combined with debridement under arthroscope in the treatment of adult developmental dysplasia of the hip (DDH). Methods Between April 2002 and August 2007, 24 cases (29 hips) of DDH were treated with RAO combined with debridement under arthroscope. There were 2 males (2 hips) and 22 females (27 hips) with an average age of 37.7 years (range, 21-50 years). The locations were the left hip in 7 cases, the right hip in 12 cases, and both hips in 5 cases. The course of hip pain was 8-216 months (median, 30.5 months). According to Crowe DDH classification, there were 24 hips of type I and 5 hips of type II. According to Touml;nnis hip osteoarthritis classification, there were 20 hips of stage I and 9 hips of stage II. Results The mean operation time was 150 minutes (range, 120-180 minutes); the mean intraoperative blood loss was 600 mL (range, 500-700 mL); and the mean postoperative drainage volume was 200 mL(range, 50-400 mL). All incisions healed by first intention. Twenty-four cases were followed up 4.5 years on average (range, 3-8 years). At last follow-up, claudication disappeared in 16 hips and was improved in 8 hips. The Harris hip score was improved from 79.4 ± 9.8 preoperatively to 95.1 ± 8.6 postoperatively, showing significant difference (t=2.467, P=0.010). The visual analogue scale (VAS) score was improved from 5.1 ± 0.8 preoperatively to 1.1 ± 0.6 postoperatively, showing significant difference (t=2.118, P=0.011). The X-rayfilms showed union was achieved at 12-16 weeks (mean, 13.5 weeks). There were significant differences in the centre edge angle, Sharp angle, acetabular coverage rate, and acetabulum-head index between preoperation and postoperation (P lt; 0.05). Twenty hips at Touml;nnis stage I maintained after operation, among 9 hips at Touml;nnis stage II, 5 hips was improved to stage I and 4 hips maintained. Conclusion It has a satisfactory result to treat adult DDH by RAO combined with debridement under arthroscope, which may increase the congruency of hip joint, delay or prevent the progression of hip osteoarthritis.
Objective To evaluate the three-dimensional acetabular orientation in asymptomatic population and patients of developmental dysplasia of the hip (DDH) using a semi-automated measurement software, which provides data for the differential diagnosis, surgical planning, surgical instrument design, and postoperative evaluation of hip related diseases. MethodsEighty-four cases of CT data in asymptomatic population (asymptomatic group) and 47 cases of CT data in DDH patients (DDH group) were collected. There was no significant difference in gender and age (including age of male and female subgroups) between the two groups (P<0.05). MaxTHA, a semi-automatic measurement software, was used to measure acetabular inclination and anteversion, including operative inclination (OI), radiographic inclination (RI), anatomic inclination (AI), operative anteversion (OA), radiographic anteversion (RA), and anatomic anteversion (AA). Comparisons were made between the two populations, between different Crowe classification subgroups, between different gender subgroups, and between left and right sides of acetabula. Results The comparison between asymptomatic group, healthy side of DDH group, and affected side of DDH group showed that there was no significant difference in acetabular orientation between asymptomatic group and healthy side of DDH group (P>0.05). The OI, RI, and AI of affected side of DDH group were significantly higher than those in healthy side of DDH group and asymptomatic group, and AA was significantly lower than that in healthy side of DDH group and asymptomatic group (P<0.05). The comparison between the normal acetabula and DDH acetabula with different Crowe classifications showed that there was no significant difference in the acetabulum orientation between Crowe Ⅰ group and the normal group (P>0.05). The OI, RI, and AI of Crowe Ⅱ, Ⅲ, and Ⅳ groups were significantly higher than those of normal group (P<0.05), the OI of Crowe Ⅲ group, RI and AI of Crowe Ⅳ group were significantly higher than those of Crowe Ⅰ group (P<0.05), the AI of Crowe Ⅳ group was significantly higher than that of Crowe Ⅱ group (P<0.05), and the OA, RA, and AA of Crowe Ⅲ group were significantly lower than other subgroups (P<0.05) except Crowe Ⅰ group. The OA, RA, and AA in asymptomatic female group, and the OA and AI in DDH female group were significantly higher than those in all male groups (P<0.05). The OI, RI, AI, and OA of the right acetabula in asymptomatic male group, and the RI and AI of the right acetabula in asymptomatic female group were significantly higher than those on the left side (P<0.05). ConclusionThere were significant differences in acetabular orientation between asymptomatic and DDH populations, inter-group differences among Crowe classification subgroups, inter-gender differences among subgroups, and bilateral differences among asymptomatic individuals.
Objective To summarize the techniques of the total hip arthroplasty in the treatment of osteoarthritis secondary to developmental dysplasia of the hip joint(DDH). Methods Between February 1986 and November2004, a total of 32 hips in 24 patients with advanced osteoarthritis secondary to DDH underwent the total hip arthroplasty. Among the patients, 4 were male and 20 were female, with their ages ranging from33 to 59 years and an average age of 47 years. The bilateral arthroplasty was performed in 8 patients and the unilateral arthroplasty in 16 patients. The patients mainly suffered from pain and claudication. According to the Hartofilakidis classification, semi-dislocation occurred in 2 hips, lowdislocation in 21 hips,and high-dislocation in 9 hips; and the Harris scores before operation were 56.70±2.75, 36.09±4.16, and 29.45±2.16, respectively. Results All the patients were followed up for 6 months to 8 years (averaged 3 yearsand 4 months). The Harris scores after operation were 93.10±2.10，92.7±3.20，and 88.09±3.67，respectively. The differences between peroperation and postoperation were significant(P＜0.01). All the patients were pain-free and there wasno sign of aseptic loosening and subsidence. Conclusion The total hip arthroplasty is an effective method for the treatment of osteoarthritis secondary to DDH. The key techniques for the total hip arthroplasty are as follows: deepening the medial wall of the acetabulum, improving the techniques of the bone graft, and firmly placing the acetabular component in the true acetabulum.
ObjectiveTo explore the mid-term effectiveness of total hip arthroplasty (THA) with subtrochanteric shortening osteotomy in treatment of Crowe type Ⅳ developmental dysplasia of the hip (DDH).MethodsBetween September 2009 and March 2014, a total of 49 patients (57 hips) who were diagnosed with Crowe type Ⅳ DDH were treated with THA and subtrochanteric shortening osteotomy. Of the 49 patients, 7 were male and 42 were female with an average age of 44.6 years (range, 20-73 years). The preoperative Harris score was 44.68±3.39 and the preoperative leg length discrepancy was (5.27±0.55) cm.ResultsAll incisions healed primarily. All patients were followed up 32-87 months (mean, 52.1 months). At last follow-up, the Harris score was 85.67±2.89 and the leg length discrepancy was (1.12±0.48) cm, showing significant differences when compared with the preoperative values (t=–69.53, P=0.00; t=42.94, P=0.00). X-ray films showed that bone union of the femoral osteotomy end at 6 months after operation. There was no loosening and subsidence of prosthesis at last follow-up.ConclusionThe subtrochanteric shortening osteotomy with THA in treatment of Crowe type Ⅳ DDH can obtain satisfactory mid-term effectiveness with low risk of peripheral vascular and nerve traction injuries.
Objective To investigate the effects of femoral offset and mechanical axis of the lower extremity on hip after osteotomy for adult developmental dysplasia of the hip (DDH). Methods A clinical data of 62 adult patients with DDH (62 hips), who underwent periacetabular osteotomy combined with femoral osteotomy between January 2016 and May 2019 and met selective criteria, was retrospectively analyzed. There were 6 males and 56 females. The age ranged from 18 to 38 years, with an average of 24.4 years. Body mass index ranged from 15.8 to 31.8 kg/m2, with an average of 21.8 kg/m2. There were 44 cases of Hartofilakidis typeⅠ and 18 cases of typeⅡ. According to the modified T?nnis osteoarthritis staging, 46 cases were stage 0 and 16 cases were stageⅠ. There were 13 cases with pelvic anteversion, 40 cases with normal pelvis, and 9 cases with pelvic retroversion. Intraoperative blood loss, length of hospital stay, and complications were recorded. Postoperative hip function was evaluated by Harris score and International Hip Outcome Tool (iHOT) score. The femoral offset, collo-diaphyseal angle, hip-knee-ankle angle (HKA), knee valus angle, CE (Wiberg central-edge angle), anterior CE angle, and acetabular index angle were measured and the osteotomy healing was observed on X-ray films. Patients were grouped according to postoperative femoral offset (≥48 mm or <48 mm) and HKA [varus group (HKA<177°), normal group (HKA 177°-183°), and valgus group (HKA>183°)]. Harris score and iHOT score were compared between groups. Results Intraoperative blood loss ranged from 200 to 1 550 mL, with an average of 476 mL. The length of hospital stay ranged from 8 to 21 days, with an average of 13.3 days. All incisions healed by first intention. All patients were followed up 2.0-4.5 years, with an average of 2.8 years. At 1 year after operation, the Harris score and iHOT score of the hip joint significantly increased when compared with those before operation (P<0.05); there were significant differences in the femoral offset, collo-diaphyseal angle, HKA, knee valus angle, CE angle, anterior CE angle, and acetabular index angle between pre- and post-operation (P>0.05). According to the modified T?nnis osteoarthritis staging, 38 cases were stage 0 and 24 cases were stageⅠ; and there was no significant difference between pre- and post-operation (χ2=2.362, P=0.124). There were 11 cases with pelvic anteversion, 38 cases with normal pelvis, and 13 cases with pelvic retroversion, showing no significant difference when compared with that before operation (χ2=0.954, P=0.623). The pubic branch osteotomy did not heal in 9 cases, proximal femur osteotomy did not heal in 2 cases, and inferior pubic ramus stress fracture occurred in 5 cases. There were significant differences (P<0.05) in the Harris score and iHOT score between femoral offset≥48 mm group (n=10) and femoral offset<48 mm group (n=52). There was no significant difference (P>0.05) in Harris score and iHOT score between varus group (n=13), normal group (n=40), and valgus group (n=9). Conclusion Periacetabular osteotomy combined with femoral osteotomy can improve the femoral offset and mechanical axis of the lower extremity of patients with DDH, and improve the functional score of the hip. However, excessive increase of femoral offset during femoral osteotomy is not desirable, resulting in low postoperative functional score.
Objective To investigate the morphological changes of the proximalfemur and their implication to the total hip arthroplasty in patients with Crowe Ⅱ/Ⅲ developmental dysplasia of the hip (DDH). Methods The experimental gr oup was composed of 15 hips in 14 patients (Crowe Ⅱ, 9 hips; Crowe Ⅲ, 6 hips ) with osteoarthritis secondary to Crowe Ⅱ/Ⅲ DDH (2 males, 12 females; age, 35-61 years). None of the patients had accepted any osteotomy treatment. The control group was composed of 15 normal hips in 15 patients with unilateral DDH (3 males, 12 females; age, 35-57 years). Twelve hips came from the experimental group and the other 3 came from the patients with unilateral Crowe Ⅰ DDH. The femurswere examined with the CT scanning. The following parameters were measured: theheight of the center of the femoral head (HCFH), the isthmus position (IP), theneckshaft angle(NS), the anteversion angle, the canal flare index, and the canal width. Then, the analysis of the data was conducted. Results HCFH and IP in theexperimental group and the control group were 50.1±6.7 mm, 50.1±7.4 mm, and 107.4±21.5 mm, 108.7±18.1 mm，respectively, which had no significant differencebetween the two groups（Pgt;0.05）. In the experimental group and the control group, the NS were 138.3±10.0° and 126.7±5.7°，the anteversion angles were 36.5±15.9° and 18.8±5.4°, and the canal flare indexes were 4.47±0.40and 5.01±0.43. There was a significant difference between the two groups in the above 3 parameters （Plt;0.05）. As for the canal width of the femur, therewasa significant difference in the interior/exterior widths and the anterior/posterior widths at the level of 2 cm above the lesser trochanter and 4 cm belowthe lesser trochanter between the two groups （Plt;0.05）; however, there was nosignificant difference in the canal width of the femur at the isthmus between the two groups（P＞0.05）. Conclusion It is necessary to evaluate the morphology of the proximal femur before the total hip arthroplasty performed in patients with Crowe Ⅱ/Ⅲ DDH. The straight and smaller femoral prosthesis should be chosen and implanted in the proper anteversion position duringoperation.
ObjectiveTo explore the effect of false acetabulum on the development and anatomical morphology of proximal femur in Crowe type Ⅳ developmental dysplasia of the hip (DDH), providing a theoretical basis for the development of femoral reconstruction strategy and prosthesis selection for total hip arthroplasty. Methods The medical records of 47 patients (54 hips) with Crowe type Ⅳ DDH between February 2008 and March 2020 were retrospectively analyzed, of which 21 patients (26 hips) were Crowe type Ⅳa (type Ⅳa group) and 26 patients (28 hips) were Crowe type Ⅳb (type Ⅳb group). There was no significant difference in general data such as gender, age, height, weight, body mass index, and side between the two groups (P>0.05), which were comparable. The height of femoral head dislocation, the height of pelvis, and the proportion of dislocation were measured based on preoperative anteroposterior pelvic X-ray film. Based on the preoperative femoral CT scan data, the anatomical parameters of the femur and femoral medullary cavity were measured after three-dimensional reconstruction using Mimics19.0 software to calculate the canal fare index; and the femoral medullary cavity parameters were matched with the modular S-ROM prosthesis parameters. ResultsThe results of X-ray film measurement showed that the height of femoral head dislocation and the proportion of dislocation in type Ⅳa group were significantly higher than those in type Ⅳb group (P<0.05). There was no significant difference in the height of pelvis between the two groups (P>0.05). The results of CT three-dimensional reconstruction measurements showed that compared with the type Ⅳb group, the type Ⅳa group had less isthmus height, smaller femoral head, shorter femoral neck, narrower neck-shaft angle, increased anteversion angle, and higher greater trochanter, and the differences were significant (P<0.05). There was no significant difference in the height of femoral head, femoral offset, and height difference between greater trochanter and femoral head between the two groups (P>0.05). There was no significant difference in the mediolateral width (ML), anteroposterior width (AP), and diameter of the isthmus (Ci level) and the AP of the medullary cavity in the plane 40 mm distal to the most prominent point on the medial side of the lesser trochanter (C–40 level) (P>0.05), and the size of medullary cavity was significantly smaller in type Ⅳa group than in type Ⅳb group at the other levels (P<0.05). Compared with the type Ⅳb group, the difference between the outer diameter of the prosthetic sleeve and the diameter of the medullary cavity fitting circle in the plane where the center of femoral head rotation was located from the medial most prominent point of the lesser trochanter (C0 level) in type Ⅳa group was smaller, and the proportion of negative values was greater (P<0.05). The difference between the longest diameter of the prosthetic sleeve triangle and the ML of the medullary cavity in the plane 10 mm proximal to the most prominent point on the medial side of the lesser trochanter (C+10 level) in type Ⅳa group was smaller, and the proportion of negative values was greater (P<0.05). ConclusionFalse acetabulum has a significant impact on the morphology of the proximal femur and medullary cavity in patients with Crowe type Ⅳ DDH, and the application of three-dimensional reconstruction technique can accurately evaluate the femoral morphology and guide the selection of femoral prosthesis.
【Abstract】 Objective To summarize techniques of the total hi p arthroplasty (THA) in the treatment of developmental dysplasia of the hi p (DDH) with severe osteoarthritis in adults. Methods From March 2000 to January 2006, 24 patients (27 hips) with DDH were treated by THA with an cementless cup. There were 7 males and 17 females, withthe average age of 49.6 years (ranging from 26 years to 63 years). Unilateral DDH occurred in 21 patients and bilateral DDH occurred in 3 patients. Based on the Crowe classification, there were 16 hips in 15 patients of type I, 4 hips in 4 patients of type II, 4 hips in 3 patients of type III, 3 hips in 2 patients of type IV. Except for 3 patients with bilateral DDH, the other patients’ ill lower l imbs were 2-7 cm shorter than the healthy lower ones. Results All the patients were followed up from 9 months to 6.5 years and no one had infection, dislocation, femur fracture and so on after the operation. In 18 patients, the pain was completely rel ieved and the function of the hip joints was good. After the gluteus medius exercise, the claudication of 3 patients after the operation disappeared. In 3 patients, the ill lower l imbs were more than 1 cm shorter than the healthy lower ones and the other patients’ ill lower l imbs were less than 1 cm shorter than the healthy lower ones. Two patients’ lower l imbs were been lengthened 4-5 cm. All the patients’ sciatic nerves were not injured. The Harris scores were 46.5 ± 7.2 preoperatively and 84.0 ± 5.7 postoperatively (P lt; 0.05). Conclusion THA with deepening the medial wall of the acetabulum at the true acetabulum and choosing small cementless cup in adult could obtain favorable results.
