Combined Anteversion Technique in Total Hip Arthroplasty for Crowe IV Developmental Dysplasia of the Hip

2017 ◽  
Vol 27 (6) ◽  
pp. 589-594 ◽  
Author(s):  
Biao Zhu ◽  
Changzheng Su ◽  
Yeteng He ◽  
Xingyu Chai ◽  
Zhen Li ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Anteversion ◽  
Safe Zone ◽  
Developmental Dysplasia ◽  
Acetabular Anteversion ◽  
Combined Anteversion ◽  
The Mean ◽  
Postoperative Dislocation ◽  
Dysplasia Of The Hip

Background A high rate of postoperative dislocation in total hip arthroplasty (THA) for Crowe IV developmental dysplasia of the hip (DDH) has been reported, 1 of the main reasons being higher true acetabular anteversion. If the cup is fixed with normal anteversion, the anterior rim will be excessively exposed, which reduces the contact areas of the cup and bone, affects prosthesis stability, and leads to iliopsoas tendinitis and persistent hip pain after THA. The aim of this study was to demonstrate that when cup anteversion is larger, adjusting femoral anteversion to bring the combined anteversion (CA) into the “safe zone” might prevent dislocation. Methods After having fixed the cup in the acetabulum according to the patients’ native acetabular anteversion, we shortened and rotated the proximal femur to reduce femoral anteversion, adjusting the CA into the “safe zone”. The Harris Hip Score (HHS) was used to evaluate hip joint function. Computerised tomography scanning was used to measure the anteversion angles. Results All patients were followed up without any dislocation. Preoperative and 12 months after surgery, the mean HHS were 43.3 ± 2.6 (38-47) and 88.1 ± 3.3 (78-92) respectively. Pre- and post-operation, the mean CA angles were 88.6° ± 9.4° (80.3°-119.4°) and 49.2° ± 2.6° (43.4°-54.4°) respectively. The bone healing time of femoral osteotomy ranged from 4 to 14 months, with a mean time of 7.5 months. Conclusions This CA technique in THA for Crowe IV DDH can effectively prevent postoperative dislocation and provide good hip function.

How to equalize the leg length in total hip arthroplasty for patients with unilateral Crowe type IV developmental dysplasia of the hip

2020 ◽  
Author(s):  
Yinqiao Du ◽  
Jingyang Sun ◽  
Haiyang Ma ◽  
Sen Wang ◽  
Ming Ni ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Developmental Dysplasia ◽  
Leg Length ◽  
Greater Trochanter ◽  
Femoral Length ◽  
Total Hip ◽  
Type Iv ◽  
The Mean ◽  
Dysplasia Of The Hip

Abstract Background: The purpose of this study was to explore that how to equalize the leg length in total hip arthroplasty (THA) with shortening subtrochanteric osteotomy (SSTO) or not for unilateral Crowe type IV developmental dysplasia of the hip (DDH) through the evaluation of the postoperative full-length anteroposterior radiographs. Methods: The postoperative radiographs of 60 patients with unilateral Crowe type IV DDH from July 2012 to May 2019 were retrospectively reviewed. These data included leg length, femoral length, height of center of rotation (COR) of hip, height of greater trochanter, and depth of the sleeve or cone. Patients with leg length discrepancy (LLD) < 10 mm were defined as the non-LLD group. Results: In the non LLD group (26 patients of SSTO and 22 of non-SSTO), the femoral length both SSTO and non-SSTO groups were significantly shorter on operated side, compared with the contralateral side, and the mean discrepancy in SSTO group was approximately equal to the mean length of SSTO. The mean height of COR of hip on operated sides both SSTO and non-SSTO groups were 13.2 mm, and the contralateral sides were 15.2 mm and 15.5 mm, respectively. The depth of the sleeve or cone between SSTO and non-SSTO groups were 21.7 mm and 30.6 mm, respectively. The depth of the sleeve or cone in SSTO group was negatively correlated with the length of SSTO. The height of the greater trochanter of the operated and contralateral sides were 5.3 mm and 16.6 mm in SSTO group, and those in the non-SSTO group were 13.2 mm and 17.2 mm. Conclusions: SSTO leaded to femoral shortening on the operated side for patients with unilateral Crowe type IV DDH. The position of sleeve or cone should be close to the apex of greater trochanter to compensate the lengh of SSTO.

scholarly journals High Hip Center Technique in Total Hip Arthroplasty for Crowe Type II-III Developmental Dysplasia: Results of Midterm Follow-up

2020 ◽  
Author(s):  
Junmin Shen ◽  
Jingyang Sun ◽  
Haiyang Ma ◽  
Yinqiao Du ◽  
Tiejian Li ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Confidence Interval ◽  
Hip Arthroplasty ◽  
Developmental Dysplasia ◽  
Harris Hip Score ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Dysplasia Of The Hip

Abstract Background: High hip center technique is still controversial about the survivorship of prothesis and postoperative complications. We aimed to show the utility of high hip center technique used in patients with Crowe II-III developmental dysplasia of the hip at the midterm follow-up and evaluated the clinical and radiographic results between different heights of hip center.Methods: We retrospectively evaluated 69 patients (85 hips) with Crowe II-III dysplasia who underwent a high hip center cementless total hip arthroplasty at a mean follow up of 8.9 years (range, 6.0-14.1years). The patients were divided into two groups according to the height of hip center, respectively group A (≥22mm and <28mm) and group B (≥28mm). Radiographic, functional and survivorship outcomes were evaluated.Results: The mean location of the hip center from the inter-teardrop was 25.1mm vertically and 30.0mm horizontally in the group A, and 33.1mm vertically and 31.4mm horizontally in the group B. There were no statistically significant differences between two groups in postoperative femoral offset, abductor lever arm, leg length discrepancy and cup inclination. At the final follow up, the mean WOMAC and Harris hip score were significantly improved in both groups. Of the 85 hips, 7 hips (8.2%) showed a positive Trendelenburg sign. Additionally, 6 patients (8.7%) presented with a limp. No significant differences were shown regarding the Harris hip score, WOMAC score, Trendelenburg sign and limp between two groups. The Kaplan-Meier implants survivorship rates at the final follow-up for all-causes revisions in the group A and group B were similar (96.7% [95% confidence interval, 90.5%-100%] and 96.2% [95% confidence interval, 89.0%-100%], respectively).Conclusions: The high hip center technique is a valuable alternative to achieve excellent midterm results for Crowe II-III developmental dysplasia of the hip. Further, we reported good results and could not demonstrate any significant differences in outcomes or survivorship between the groups with differing degrees of HHC in our study, however the relatively small sample size must be considered and larger comparative studies are required to confirm the value of high hip center technique.

The Use of Combined Anteversion in Total Hip Arthroplasty for Patients With Developmental Dysplasia of the Hip

2014 ◽  
Vol 29 (3) ◽  
pp. 621-625 ◽  
Author(s):  
Jingwei Zhang ◽  
Liao Wang ◽  
Yuanqing Mao ◽  
Huiwu Li ◽  
Huifeng Ding ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Developmental Dysplasia ◽  
Total Hip ◽  
Combined Anteversion ◽  
Dysplasia Of The Hip

scholarly journals Mid-term results of total hip arthroplasty with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jing-Yao Jin ◽  
Taek-Rim Yoon ◽  
Kyung-Soon Park ◽  
Sheng-Yu Jin ◽  
Dong-Min Jung ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Developmental Dysplasia ◽  
Harris Hip Score ◽  
Trochanteric Osteotomy ◽  
Leg Length ◽  
Total Hip ◽  
Type Iv ◽  
The Mean ◽  
Dysplasia Of The Hip

Abstract Background This study aimed to explore mid-term clinical results of cementless total hip arthroplasty (THA) with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip (DDH). Methods Thirteen patients (13 hips) with Crowe type IV DDH who underwent THA with modified trochanteric osteotomy between May 2013 and October 2015 were retrospectively analyzed. The mean follow-up duration was 5.2 years (range, 4.9–6.1 years). Results The mean Harris Hip Score (HHS) significantly (p < 0.05) improved from 30.7 (range, 22–38) to 87.5 (range, 83–93). The mean leg length discrepancy (LLD) was 53.4 mm (range, 42.1–68.5 mm) preoperatively. The final LLD was 5.6 mm (range, 2.4–9.1 mm; p < 0.05). The mean leg length after surgery was 47.4 mm (range, 33.6–67.2 mm) and the femur shortening distance was 43.8 mm (range, 31.2–53.4 mm). The average duration of bone union for the greater trochanter (GT) was 2.5 months (range, 1.5–3.6 months). There was no infection, GT non-union, or loosening (septic or aseptic) of the stem or cup in any case. Conclusions THA with modified trochanteric osteotomy with a cementless cup is an effective treatment for Crowe type IV DDH. It can rebuild complex biomechanics and biology of hip dysplasia without increasing complications.

scholarly journals Treatment of Crowe IV developmental dysplasia of the hip with cementless total hip arthroplasty and shortening subtrochanteric osteotomy

2019 ◽  
Vol 47 (7) ◽  
pp. 3223-3233 ◽  
Author(s):  
Tang Liu ◽  
Sisi Wang ◽  
Guoliang Huang ◽  
Wanchun Wang
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Developmental Dysplasia ◽  
Harris Hip Score ◽  
Acetabular Cup ◽  
Total Hip ◽  
Cementless Total Hip Arthroplasty ◽  
The Mean ◽  
Dysplasia Of The Hip

Objective This study was performed to document the clinical and radiographic results of consecutive patients with Crowe IV developmental dysplasia of the hip (DDH) treated by cementless total hip arthroplasty (THA) using an S-ROM femoral component with shortening derotational subtrochanteric osteotomy. Methods Twenty-three hips of 21 patients with Crowe IV DDH were treated by cementless THA combined with shortening derotational subtrochanteric osteotomy from January 2005 to January 2011. The mean preoperative modified Harris hip score (mHHS) and University of California, Los Angeles (UCLA) activity score were 40.7 and 4.2, respectively. Results The mean follow-up was 105 months. The mean mHHS and UCLA score improved to 87.0 and 9.1, respectively, at the latest follow-up. Nine of the 23 hips had a negative Trendelenburg sign. One of the 23 hips was outside the Lewinnek acetabular cup inclination safe range, and 3 of the 23 hips were outside the Lewinnek acetabular cup anteversion safe range. The probability of prosthesis survival was 100% at 5 years and 91.3% at 10 years. Conclusion Patients with Crowe IV DDH can be treated by cementless THA combined with shortening derotational subtrochanteric osteotomy. This method can greatly improve hip joint function and relieve pain without significant complications.

scholarly journals A propensity score-matched analysis between patients with high hip dislocation after childhood pyogenic infection and Crowe IV developmental dysplasia of the hip in total hip arthroplasty with subtrochanteric shortening osteotomy

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Enze Zhao ◽  
Zunhan Liu ◽  
Zichuan Ding ◽  
Zhenyu Luo ◽  
Hao Li ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Propensity Score ◽  
Median Time ◽  
Hip Arthroplasty ◽  
Hip Dislocation ◽  
Developmental Dysplasia ◽  
Shortening Osteotomy ◽  
Significant Difference ◽  
The Mean ◽  
Dysplasia Of The Hip

Abstract Background Whether satisfactory clinical and radiological outcomes of total hip arthroplasty (THA) with subtrochanteric shortening osteotomy (SSO) in high hip dislocation after childhood pyogenic infection can be achieved as in Crowe IV developmental dysplasia of the hip (DDH) remains unclear. Methods Between September 2009 and December 2016, 151 primary THAs performed at our institution using similar SSO technique and prosthetic design were retrospectively reviewed. After excluding patients who met exclusion criteria, 29 patients were identified as high dislocation (Crowe IV) after childhood infection (HDACI) and 107 as Crowe IV developmental dysplasia of the hip (DDH). Propensity score matching was used to select 29 Crowe IV DDH patients as a control group for the HDACI group with comparable preoperative conditions. Clinical and radiological outcomes and complication were compared and analyzed. The mean follow-up duration of the 2 groups was 5.0 years. Results The mean Harris hip score (HHS) and the mean score in range of motion (ROM) domain of the modified Merle d’Aubigné-Postel (MAP) were 84.6 and 4.5 in the HDACI group, compared with 88.3 and 4.9 in the DDH group; there was significant difference between the 2 groups in these parameters (P = 0.015 and 0.035, respectively). Meanwhile, in the HDACI group, the median time of osteotomy union was 4 months and osteotomy nonunion rate was 3%; no significant difference was detected in the median time of osteotomy union and osteotomy nonunion rate between the 2 groups (P = 0.388 and 1.000, respectively). And no significant difference was found in the rate of complications between two groups. Conclusions HDACI patients who received THA combined with SSO could achieve similar satisfactory results as DDH patients in Crowe type IV. The fixation technique of autogenous cortical bone struts had a positive influence on osteotomy healing of SSO in this specific setting.

scholarly journals Mid-term results of total hip arthroplasty with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip

2020 ◽  
Author(s):  
Jing Yao Jin ◽  
Taek Rim Yoon ◽  
Kyung Soon Park ◽  
Sheng Yu Jin ◽  
Yue Ju Liu ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Developmental Dysplasia ◽  
Harris Hip Score ◽  
Trochanteric Osteotomy ◽  
Leg Length ◽  
Total Hip ◽  
Type Iv ◽  
The Mean ◽  
Dysplasia Of The Hip

Abstract Introduction: The objective of this study was to explore mid-term clinical results of cementless total hip arthroplasty (THA) with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip (DDH).Patients and method: Thirteen patients (13 hips) with Crowe type IV DDH who underwent THA used modified trochanteric osteotomy between May 2013 and October 2019 were retrospectively analyzed. Mean follow-up was 5.2 ± 0.8 years (range, 4.9-6.1 years).Results: Mean Harris Hip Score (HHS) significantly (p < 0.05) improved from 30.7 ± 5.8 (range, 22-38) to 87.5 ± 3.6 (range, 83-93). The mean leg length discrepancy (LLD) was 53.4 ± 9.1 mm (range, 42.1-68.5 mm) preoperatively. The final LLD was 5.6 ± 2.4 mm (range, 2.4-9.1 mm). The mean leg length after surgery was 47.4 ± 10 mm (range, 33.6-67.2 mm). The average duration of bone union for greater trochanter (GT) was 2.5 ± 0.6 months (range, 1.5-3.6 months). There was no infection, GT non-union, or loosening (septic or aseptic) of the stem or cup in any case.Conclusions: THA with modified trochanteric osteotomy with cementless cup is an effective treatment for Crowe type IV developmental dysplasia of the hip. It can rebuild complex biomechanics and biology of hip dysplasia without increasing complications.

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