Effectiveness of proximal femur reconstruction combined with total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of hip_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Lei , CHEN Min , LI Guoyuan , LUO Zhengliang , JI Xiaofeng , ZHANG Xiaoqi , WU Kerong , ZHU Chen ,  SHANG Xifu

Department of Orthopaedics, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei Anhui, 230000, P.R.China;

Corresponding author：

SHANG Xifu, Email: shangxifu@163.com

Keywords：

Total hip arthroplasty; proximal femur reconstruction; proximal femur deformity; developmental dysplasia of the hip

DOI：

10.7507/1002-1892.201911073

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Objective To investigate the early effectiveness of proximal femur reconstruction combined with total hip arthroplasty (THA) in the treatment of adult Crowe type Ⅳ developmental dysplasia of the hip (DDH).Methods Between May 2015 and March 2018, 29 cases (33 hips) suffering from Crowe type Ⅳ DDH were treated with proximal femur reconstruction combined with THA. Of the 29 cases, there were 6 males (7 hips) and 23 females (26 hips), aged from 24 to 74 years with an average age of 44.9 years. The preoperative Harris hip score was 44.0±12.0. Gait abnormalities were found in all of the 33 hips with positive Trendelenburg sign, and the lower limb discrepancy was (3.8±1.6) cm. Preoperative X-ray films and CT both indicated serious anatomical abnormalities, including complete dislocation of the affected hip with significant move-up of the greater trochanter, abnormal development of the femoral neck, abnormal anterversion angle and neck-shaft angle, dysplasia of proximal femur and dysplasia of medullary cavity. The operation time, intraoperative blood loss, transfusion rate, and complications were recorded. The Gruen and DeLee-Charnley zoning methods were used to evaluate the aseptic loosening of the prosthesis on X-ray films. The Harris score was used to evaluate hip function. The lower limb discrepancy was calculated and compared with the preoperative value.Results The operation time ranged from 80 to 240 minutes, with an average of 124.8 minutes. The intraoperative blood loss ranged from 165 to 1 300 mL, with an average of 568.4 mL. Seventeen patients (51.5%) received blood transfusion treatment. All the incisions healed by first intention without infection or deep vein thrombosis. All patients were followed up 19-53 months, with an average of 33 months. One patient had posterior hip dislocation because of falling from the bed at 4 weeks after operation, and was treated with manual reduction and fixation with abduction brace for 4 weeks, and no dislocation occurred during next 12-month follow-up. Two patients developed sciatic nerve palsy of the affected limbs after operation and were treated with mecobalamin, and recovered completely at 12 weeks later. Trendelenburg sign was positive in 3 patients and mild claudication occurred in 4 patients after operation. X-ray films showed that all the osteotomy sites healed at 3-6 months after operation, and no wire fracture was observed during the follow-up. The Harris score was 89.8±2.8 and lower limb discrepancy was (0.6±0.4) cm at last follow-up, both improved significantly (t=–22.917, P=0.000; t=11.958, P=0.000). The prosthesis of femur and acetabulum showed no obvious loosening and displacement, and achieved good bone ingrowth except 2 patients who had local osteolysis in the area of Gruen 1 and 7 around the femoral prosthesis, but no sign of loosening and sinking was observed.Conclusion The treatment of Crowe Ⅳ DDH with proximal femur reconstruction and THA was satisfactory in the early postoperative period. The reconstruction technique of proximal femur can effectively restore the anatomical structure of proximal femur, which is one of the effective methods to deal with the deformity of proximal femur.

Citation： TANG Lei, CHEN Min, LI Guoyuan, LUO Zhengliang, JI Xiaofeng, ZHANG Xiaoqi, WU Kerong, ZHU Chen, SHANG Xifu. Effectiveness of proximal femur reconstruction combined with total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of hip. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(6): 683-688. doi: 10.7507/1002-1892.201911073 Copy

1.	Eskelinen A, Helenius I, Remes V, et al. Cementless total hip arthroplasty in patients with high congenital hip dislocation. J Bone Joint Surg (Am), 2006, 88(1): 80-91.
2.	Watts CD, Abdel MP, Hanssen AD, et al. Anatomic hip center decreases aseptic loosening rates after total hip arthroplasty with cement in patients with Crowe type-Ⅱ dysplasia: A concise follow-up report at a mean of thirty-six years. J Bone Joint Surg (Am), 2016, 98(11): 910-915.
3.	Wang D, Li LL, Wang HY, et al. Long-term results of cementless total hip arthroplasty with subtrochanteric shortening osteotomy in Crowe type Ⅳ developmental dysplasia. J Arthroplasty, 2017, 32(4): 1211-1219.
4.	Zhu J, Shen C, Chen X, et al. Total hip arthroplasty with a non-modular conical stem and transverse subtrochanteric osteotomy in treatment of high dislocated hips. J Arthroplasty, 2015, 30(4): 611-614.
5.	Archibeck MJ, Rosenberg AG, Berger RA, et al. Trochanteric osteotomy and fixation during total hip arthroplasty. J Am Acad Orthop Surg, 2003, 11(3): 163-173.
6.	Wronka KS, Cnudde PHJ. Union rates and midterm results after Extended Trochanteric Osteotomy in Revision Hip Arthroplasty. Useful and safe technique. Acta Orthop Belg, 2017, 83(1): 53-56.
7.	朱晨, 尚希福, 孔荣, 等. 改良股骨大转子滑移截骨术治疗初次全髋关节置换股骨近端严重畸形. 中国矫形外科杂志, 2018, 26(17): 1537-1543.
8.	Lakstein D, Kosashvili Y, Backstein D, et al. Trochanteric slide osteotomy on previously osteotomized greater trochanters. Clin Orthop Relat Res, 2010, 468(6): 1630-1634.
9.	Mortazavi SM, Restrepo C, Kim PJ, et al. Cementless femoral reconstruction in patients with proximal femoral deformity. J Arthroplasty, 2011, 26(3): 354-359.
10.	Krych AJ, Howard JL, Trousdale RT, et al. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-Ⅳ developmental dysplasia: surgical technique. J Bone Joint Surg (Am), 2010, 92(Suppl 1 Pt 2): 176-187.
11.	Lakstein D, Kosashvili Y, Backstein D, et al. The long modified extended sliding trochanteric osteotomy. Int Orthop, 2011, 35(1): 13-17.
12.	Gruen TA, Mcneice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: A radiographic analysis of loosening. Clin Orthop Relat Res, 1979, (141): 17-27.
13.	Delee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 20-32.
14.	游镇君, 孙俊英, 查国春, 等. 生物型人工全髋关节置换术治疗股骨近段畸形合并终极髋关节疾病. 中国修复重建外科杂志, 2015, 29(3): 265-269.
15.	Jarit GJ, Sathappan SS, Panchal A, et al. Fixation systems of greater trochanteric osteotomies: biomechanical and clinical outcomes. J Am Acad Orthop Surg, 2007, 15(10): 614-624.
16.	León SA, Mei XY, Sanders EB, et al. Does trochanteric osteotomy length affect the amount of proximal trochanteric migration during revision total hip arthroplasty? J Arthroplasty, 2019, 34(11): 2718-2723.
17.	Huffman GR, Ries MD. Combined vertical and horizontal cable fixation of an extended trochanteric osteotomy site. J Bone Joint Surg (Am), 2003, 85(2): 273-277.
18.	Crowninshield RD, Maloney WJ, Wentz DH, et al. The role of proximal femoral support in stress development within hip prostheses. Clin Orthop Relat Res, 2004, (420): 176-180.
19.	Sambandam SN, Duraisamy G, Chandrasekharan J, et al. Extended trochanteric osteotomy: current concepts review. Eur J Orthop Surg Traumatol, 2016, 26(3): 231-245.
20.	Ollivier M, Abdel MP, Krych AJ, et al. Long-term results of total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe Ⅳ developmental dysplasia. J Arthroplasty, 2016, 31(8): 1756-1760.
21.	卢玮, 曾敏, 雷鹏飞, 等. Wagner Cone 生物型股骨假体置换联合转子下短缩截骨术治疗成人 Crowe Ⅳ型髋关节发育不良. 中国修复重建外科杂志, 2019, 33(8): 929-934.
22.	Ozden VE, Dikmen G, Beksac B, et al. Total hip arthroplasty with step-cut subtrochanteric femoral shortening osteotomy in high riding hip dislocated patients with previous femoral osteotomy. J Orthop Sci, 2017, 22(3): 517-523.
23.	Chen G, Nie Y, Xie J, et al. Gait analysis of leg length discrepancy-differentiated hip replacement patients with developmental dysplasia: A midterm follow-up. J Arthroplasty, 2018, 33(5): 1437-1441.
24.	Luo Z, Chen M, Hu F, et al. Cementless total hip arthroplasty with extended sliding trochanteric osteotomy for high congenital hip dislocation: A retrospective study. Medicine (Baltimore), 2017, 96(14): e6581.
25.	Deng X, Liu J, Qu T, et al. Total hip arthroplasty with femoral osteotomy and modular prosthesis for proximal femoral deformity. J Orthop Surg Res, 2019, 14(1): 282.
26.	Chen M, Luo Z, Zhu C, et al. A reliable femoral osteotomy in total hip arthroplasty for hartofilakidis type C developmental dysplasia of the hip: Proximal femoral reconstruction. J Arthroplasty, 2019, 34(6): 1162-1167.
27.	Yao K, Min L, Tang F, et al. First application of three-dimensional designing total hip arthroplasty with long uncemented stem for fibrous dysplasia patients combined with hip joint osteoarthritis. BMC Musculoskelet Disord, 2019, 20(1): 222.
28.	Younger TI, Bradford MS, Magnus RE, et al. Extended proximal femoral osteotomy. A new technique for femoral revision arthroplasty. J Arthroplasty, 1995, 10(3): 329-338.
29.	Erdem Y, Bek D, Atbasi Z, et al. Total hip arthroplasty with rectangular stems and subtrochanteric transverse shortening osteotomy in Crowe type IV hips: a retrospective study. Arthroplast Today, 2019, 5(2): 234-242.

1. Eskelinen A, Helenius I, Remes V, et al. Cementless total hip arthroplasty in patients with high congenital hip dislocation. J Bone Joint Surg (Am), 2006, 88(1): 80-91.
2. Watts CD, Abdel MP, Hanssen AD, et al. Anatomic hip center decreases aseptic loosening rates after total hip arthroplasty with cement in patients with Crowe type-Ⅱ dysplasia: A concise follow-up report at a mean of thirty-six years. J Bone Joint Surg (Am), 2016, 98(11): 910-915.
3. Wang D, Li LL, Wang HY, et al. Long-term results of cementless total hip arthroplasty with subtrochanteric shortening osteotomy in Crowe type Ⅳ developmental dysplasia. J Arthroplasty, 2017, 32(4): 1211-1219.
4. Zhu J, Shen C, Chen X, et al. Total hip arthroplasty with a non-modular conical stem and transverse subtrochanteric osteotomy in treatment of high dislocated hips. J Arthroplasty, 2015, 30(4): 611-614.
5. Archibeck MJ, Rosenberg AG, Berger RA, et al. Trochanteric osteotomy and fixation during total hip arthroplasty. J Am Acad Orthop Surg, 2003, 11(3): 163-173.
6. Wronka KS, Cnudde PHJ. Union rates and midterm results after Extended Trochanteric Osteotomy in Revision Hip Arthroplasty. Useful and safe technique. Acta Orthop Belg, 2017, 83(1): 53-56.
7. 朱晨, 尚希福, 孔荣, 等. 改良股骨大转子滑移截骨术治疗初次全髋关节置换股骨近端严重畸形. 中国矫形外科杂志, 2018, 26(17): 1537-1543.
8. Lakstein D, Kosashvili Y, Backstein D, et al. Trochanteric slide osteotomy on previously osteotomized greater trochanters. Clin Orthop Relat Res, 2010, 468(6): 1630-1634.
9. Mortazavi SM, Restrepo C, Kim PJ, et al. Cementless femoral reconstruction in patients with proximal femoral deformity. J Arthroplasty, 2011, 26(3): 354-359.
10. Krych AJ, Howard JL, Trousdale RT, et al. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-Ⅳ developmental dysplasia: surgical technique. J Bone Joint Surg (Am), 2010, 92(Suppl 1 Pt 2): 176-187.
11. Lakstein D, Kosashvili Y, Backstein D, et al. The long modified extended sliding trochanteric osteotomy. Int Orthop, 2011, 35(1): 13-17.
12. Gruen TA, Mcneice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: A radiographic analysis of loosening. Clin Orthop Relat Res, 1979, (141): 17-27.
13. Delee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 20-32.
14. 游镇君, 孙俊英, 查国春, 等. 生物型人工全髋关节置换术治疗股骨近段畸形合并终极髋关节疾病. 中国修复重建外科杂志, 2015, 29(3): 265-269.
15. Jarit GJ, Sathappan SS, Panchal A, et al. Fixation systems of greater trochanteric osteotomies: biomechanical and clinical outcomes. J Am Acad Orthop Surg, 2007, 15(10): 614-624.
16. León SA, Mei XY, Sanders EB, et al. Does trochanteric osteotomy length affect the amount of proximal trochanteric migration during revision total hip arthroplasty? J Arthroplasty, 2019, 34(11): 2718-2723.
17. Huffman GR, Ries MD. Combined vertical and horizontal cable fixation of an extended trochanteric osteotomy site. J Bone Joint Surg (Am), 2003, 85(2): 273-277.
18. Crowninshield RD, Maloney WJ, Wentz DH, et al. The role of proximal femoral support in stress development within hip prostheses. Clin Orthop Relat Res, 2004, (420): 176-180.
19. Sambandam SN, Duraisamy G, Chandrasekharan J, et al. Extended trochanteric osteotomy: current concepts review. Eur J Orthop Surg Traumatol, 2016, 26(3): 231-245.
20. Ollivier M, Abdel MP, Krych AJ, et al. Long-term results of total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe Ⅳ developmental dysplasia. J Arthroplasty, 2016, 31(8): 1756-1760.
21. 卢玮, 曾敏, 雷鹏飞, 等. Wagner Cone 生物型股骨假体置换联合转子下短缩截骨术治疗成人 Crowe Ⅳ型髋关节发育不良. 中国修复重建外科杂志, 2019, 33(8): 929-934.
22. Ozden VE, Dikmen G, Beksac B, et al. Total hip arthroplasty with step-cut subtrochanteric femoral shortening osteotomy in high riding hip dislocated patients with previous femoral osteotomy. J Orthop Sci, 2017, 22(3): 517-523.
23. Chen G, Nie Y, Xie J, et al. Gait analysis of leg length discrepancy-differentiated hip replacement patients with developmental dysplasia: A midterm follow-up. J Arthroplasty, 2018, 33(5): 1437-1441.
24. Luo Z, Chen M, Hu F, et al. Cementless total hip arthroplasty with extended sliding trochanteric osteotomy for high congenital hip dislocation: A retrospective study. Medicine (Baltimore), 2017, 96(14): e6581.
25. Deng X, Liu J, Qu T, et al. Total hip arthroplasty with femoral osteotomy and modular prosthesis for proximal femoral deformity. J Orthop Surg Res, 2019, 14(1): 282.
26. Chen M, Luo Z, Zhu C, et al. A reliable femoral osteotomy in total hip arthroplasty for hartofilakidis type C developmental dysplasia of the hip: Proximal femoral reconstruction. J Arthroplasty, 2019, 34(6): 1162-1167.
27. Yao K, Min L, Tang F, et al. First application of three-dimensional designing total hip arthroplasty with long uncemented stem for fibrous dysplasia patients combined with hip joint osteoarthritis. BMC Musculoskelet Disord, 2019, 20(1): 222.
28. Younger TI, Bradford MS, Magnus RE, et al. Extended proximal femoral osteotomy. A new technique for femoral revision arthroplasty. J Arthroplasty, 1995, 10(3): 329-338.
29. Erdem Y, Bek D, Atbasi Z, et al. Total hip arthroplasty with rectangular stems and subtrochanteric transverse shortening osteotomy in Crowe type IV hips: a retrospective study. Arthroplast Today, 2019, 5(2): 234-242.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of proximal femur reconstruction combined with total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of hip

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