Long-term effectiveness of total hip arthroplasty for Crowe type <b>Ⅳ</b> developmental dysplasia of the hip_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHOU Yixin ¹ , HUANG Yong ¹ , HE Ruizhe ¹ , CHU Yaming ¹ , GU Jianming ¹ , LI Hua ^2,3 , MA Ning ¹

1. Department of Orthopedics, Beijing Jishuitan Hospital (Fourth Clinical College of Peking University), Beijing, 100035, P.R.China;
2. Senior Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China;
3. National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China;

Corresponding author：

ZHOU Yixin, Email: orthoyixin@yahoo.com

Keywords：

Developmental dysplasia of the hip; Crowe type Ⅳ; total hip arthroplasty; long-term effectiveness

DOI：

10.7507/1002-1892.202107100

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Objective To investigate the long-term effectiveness of primary total hip arthroplasty (THA) in treatment of Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods A clinical data of Crowe type Ⅳ DDH patients treated with primary THA between January 2002 and August 2008 and followed up more than 13 years was retrospectively analyzed. Forty-two patients (45 hips) met the selection criteria and were enrolled in this study. There were 13 males and 29 females with an average age of 43.5 years (range, 18-65 years). There were 39 patients of unilateral hip and 3 of bilateral hips. The preoperative Harris score was 38.3±10.7 and leg length discrepancy of the patients treated with unilateral THA was (50.52±24.51) mm. During operation, 19 hips underwent subtrochanteric shortening osteotomy, with an average length of 25 mm (range, 15-35 mm). The Harris score, subjective satisfaction, prosthesis survival rate, complications, and related imaging indicators were summarized. Results All patients were followed up 13.0-19.6 years (mean, 15.0 years). The complications included 1 hip of femoral nerve palsy, 2 hips of dislocation, 1 hip of periprosthetic fracture, 1 hip of periprosthetic joint infection. At last follow-up, the Harris score was 82.1±9.3, which significantly improved when compared with preoperative one (t=−21.885, P=0.000). The subjective satisfaction was evaluated as very dissatisfactory in 3 hips, dissatisfactory in 1 hip, generally in 4 hips, satisfactory in 17 hips, and very satisfactory in 20 hips. X-ray films showed that the height of the greater trochanter of affected side was 3.01-51.60 mm (mean, 23.22 mm); the descending distance of greater trochanter was 3.95-98.06 mm (mean, 48.20 mm); the affected limb lengthened 3.95-61.63 mm (mean, 34.92 mm); the leg length discrepancy of patients treated with unilateral THA was (12.61±8.56) mm, which was significantly shorter than that before operation (t=11.721, P=0.000). The vertical distance between the center of rotation of the affected side and the teardrop line was (14.65±6.16) mm, and the difference was not significant when compared with (15.60±4.99) mm of the healthy side (t=−0.644, P=0.525); the horizontal distance was (22.21±5.14) mm, and the difference was significant when compared with (34.48±5.63) mm of the healthy side (t=−12.973, P=0.000). Except for the non-union of 1 hip subtrochanteric shortening osteotomy, the other subtrochanteric osteotomies healed well. During follow-up, all the femoral stems obtained bone ingrowth fixation without radiolucent line or radiopaque line. With any reoperation and aseptic loosening as the endpoint, the prosthetic survival rates were 88.64% [95%CI (63.73%, 96.82%)] and 89.19% [95%CI (65.61%, 96.94%)], respectively. Conclusion For Crowe type Ⅳ DDH patients, primary THA combined with subtrochanteric shortening osteotomy if necessary, can obtain satisfactory long-term effectiveness and prosthetic survival rate.

Citation： ZHOU Yixin, HUANG Yong, HE Ruizhe, CHU Yaming, GU Jianming, LI Hua, MA Ning. Long-term effectiveness of total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of the hip. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(12): 1531-1536. doi: 10.7507/1002-1892.202107100 Copy

1.	Hartofilakidis G, Stamos K, Karachalios T, et al. Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg (Am), 1996, 78(5): 683-692.
2.	Wang D, Li LL, Wang HY, et al. Long-term results of cementless total hip arthroplasty with subtrochanteric shortening osteotomy in Crowe type Ⅳdevelopmental dysplasia. J Arthroplasty, 2017, 32(4): 1211-1219.
3.	Sun C, Zhang Y, Li LT, et al. Long-term outcomes of total hip arthroplasty with transverse subtrochanteric shortening osteotomy and modular stem in Crowe Ⅳ developmental dysplasia. J Arthroplasty, 2021, 36(2): 630-635.
4.	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.
5.	Tang H, Du H, Tang Q, et al. Chinese patients’ satisfaction with total hip arthroplasty: what is important and dissatisfactory? J Arthroplasty, 2014, 29(12): 2245-2250.
6.	DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 20-32.
7.	Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res, 1990, (257): 107-128.
8.	Takao M, Ohzono K, Nishii T, et al. Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia. J Bone Joint Surg (Am), 2011, 93(6): 548-555.
9.	Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
10.	Vreim Holm AG, Terjesen T, Reikerås O. Subtrochanteric shortening and uncemented arthroplasty in hips with high dislocation—a cohort study with 13-30 years follow-up. J Orthop, 2018, 16(1): 80-85.
11.	Hartofilakidis G, Babis GC, Lampropoulou-Adamidou K, et al. Results of total hip arthroplasty differ in subtypes of high dislocation. Clin Orthop Relat Res, 2013, 471(9): 2972-2979.
12.	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.
13.	Liu T, Wang S, Huang G, et al. Treatment of Crowe Ⅳ developmental dysplasia of the hip with cementless total hip arthroplasty and shortening subtrochanteric osteotomy. J Int Med Res, 2019, 47(7): 3223-3233.
14.	Peng H, Zhang G, Xu C, et al. Is pseudoacetabulum an important factor determining SSTO application in total hip arthroplasty for Crowe Ⅳ hips? A retrospective cohort study. J Orthop Surg Res, 2019, 14(1): 201. doi: 10.1186/s13018-019-1216-8.
15.	Necas L, Hrubina M, Melisik M, et al. Cementless hip arthroplasty and transverse shortening femoral osteotomy with the S-ROM stem for Crowe type Ⅳdevelopmental dysplasia. Eur J Orthop Surg Traumatol, 2019, 29(5): 1025-1033.
16.	Mu W, Yang D, Xu B, et al. Midterm outcome of cementless total hip arthroplasty in Crowe Ⅳ-Hartofilakidis type Ⅲ developmental dysplasia of the hip. J Arthroplasty, 2016, 31(3): 668-675.
17.	Nagoya S, Kaya M, Sasaki M, et al. Cementless total hip replacement with subtrochanteric femoral shortening for severe developmental dysplasia of the hip. J Bone Joint Surg (Br), 2009, 91(9): 1142-1147.
18.	Krych AJ, Howard JL, Trousdale RT, et al. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-Ⅳdevelopmental dysplasia: surgical technique. J Bone Joint Surg (Am), 2010, 92 Suppl 1 Pt 2: 176-187.
19.	Ding ZC, Zeng WN, Mou P, et al. Risk of dislocation after total hip arthroplasty in patients with Crowe type Ⅳ developmental dysplasia of the hip. Orthop Surg, 2020, 12(2): 589-600.
20.	Kim YH, Seo HS, Kim JS. Outcomes after THA in patients with high hip dislocation after childhood sepsis. Clin Orthop Relat Res, 2009, 467(9): 2371-2378.
21.	Yang Y, Yu QP, Wang SL, et al. Outcomes after total hip arthroplasty using a cementless S-ROM modular stem for patients with high hip dislocation secondary to hip pyogenic arthritis. Orthop Surg, 2019, 11(3): 460-466.
22.	Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg (Am), 1979, 61(1): 15-23.
23.	Eggli S, Hankemayer S, Müller ME. Nerve palsy after leg lengthening in total replacement arthroplasty for developmental dysplasia of the hip. J Bone Joint Surg (Br), 1999, 81(5): 843-845.

1. Hartofilakidis G, Stamos K, Karachalios T, et al. Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg (Am), 1996, 78(5): 683-692.
2. Wang D, Li LL, Wang HY, et al. Long-term results of cementless total hip arthroplasty with subtrochanteric shortening osteotomy in Crowe type Ⅳdevelopmental dysplasia. J Arthroplasty, 2017, 32(4): 1211-1219.
3. Sun C, Zhang Y, Li LT, et al. Long-term outcomes of total hip arthroplasty with transverse subtrochanteric shortening osteotomy and modular stem in Crowe Ⅳ developmental dysplasia. J Arthroplasty, 2021, 36(2): 630-635.
4. 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.
5. Tang H, Du H, Tang Q, et al. Chinese patients’ satisfaction with total hip arthroplasty: what is important and dissatisfactory? J Arthroplasty, 2014, 29(12): 2245-2250.
6. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 20-32.
7. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res, 1990, (257): 107-128.
8. Takao M, Ohzono K, Nishii T, et al. Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia. J Bone Joint Surg (Am), 2011, 93(6): 548-555.
9. Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
10. Vreim Holm AG, Terjesen T, Reikerås O. Subtrochanteric shortening and uncemented arthroplasty in hips with high dislocation—a cohort study with 13-30 years follow-up. J Orthop, 2018, 16(1): 80-85.
11. Hartofilakidis G, Babis GC, Lampropoulou-Adamidou K, et al. Results of total hip arthroplasty differ in subtypes of high dislocation. Clin Orthop Relat Res, 2013, 471(9): 2972-2979.
12. 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.
13. Liu T, Wang S, Huang G, et al. Treatment of Crowe Ⅳ developmental dysplasia of the hip with cementless total hip arthroplasty and shortening subtrochanteric osteotomy. J Int Med Res, 2019, 47(7): 3223-3233.
14. Peng H, Zhang G, Xu C, et al. Is pseudoacetabulum an important factor determining SSTO application in total hip arthroplasty for Crowe Ⅳ hips? A retrospective cohort study. J Orthop Surg Res, 2019, 14(1): 201. doi: 10.1186/s13018-019-1216-8.
15. Necas L, Hrubina M, Melisik M, et al. Cementless hip arthroplasty and transverse shortening femoral osteotomy with the S-ROM stem for Crowe type Ⅳdevelopmental dysplasia. Eur J Orthop Surg Traumatol, 2019, 29(5): 1025-1033.
16. Mu W, Yang D, Xu B, et al. Midterm outcome of cementless total hip arthroplasty in Crowe Ⅳ-Hartofilakidis type Ⅲ developmental dysplasia of the hip. J Arthroplasty, 2016, 31(3): 668-675.
17. Nagoya S, Kaya M, Sasaki M, et al. Cementless total hip replacement with subtrochanteric femoral shortening for severe developmental dysplasia of the hip. J Bone Joint Surg (Br), 2009, 91(9): 1142-1147.
18. Krych AJ, Howard JL, Trousdale RT, et al. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-Ⅳdevelopmental dysplasia: surgical technique. J Bone Joint Surg (Am), 2010, 92 Suppl 1 Pt 2: 176-187.
19. Ding ZC, Zeng WN, Mou P, et al. Risk of dislocation after total hip arthroplasty in patients with Crowe type Ⅳ developmental dysplasia of the hip. Orthop Surg, 2020, 12(2): 589-600.
20. Kim YH, Seo HS, Kim JS. Outcomes after THA in patients with high hip dislocation after childhood sepsis. Clin Orthop Relat Res, 2009, 467(9): 2371-2378.
21. Yang Y, Yu QP, Wang SL, et al. Outcomes after total hip arthroplasty using a cementless S-ROM modular stem for patients with high hip dislocation secondary to hip pyogenic arthritis. Orthop Surg, 2019, 11(3): 460-466.
22. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg (Am), 1979, 61(1): 15-23.
23. Eggli S, Hankemayer S, Müller ME. Nerve palsy after leg lengthening in total replacement arthroplasty for developmental dysplasia of the hip. J Bone Joint Surg (Br), 1999, 81(5): 843-845.

Chinese Journal of Reparative and Reconstructive Surgery

Long-term effectiveness of total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of the hip

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