A study of total hip arthroplasty with subtrochanteric osteotomy in Crowe type <b>Ⅳ</b> developmental dysplasia of hip _Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Jingyang ,  ZHOU Yonggang , GAO Zhisen , MA Haiyang , PIAO Shang , DU Yinqiao , WU Wenming , PENG Yawen

Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China;

Corresponding?author：

ZHOU Yonggang, Email: zhouyg@263.net

Keywords：

Total hip arthroplasty; developmental dysplasia of the hip; subtrochanteric osteotomy; Crowe classification

DOI：

10.7507/1002-1892.201708004

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ObjectiveTo evaluate the effectiveness of total hip arthroplasty (THA) combined with subtrochanteric osteotomy in the treatment of Crowe type Ⅳdevelopmental dysplasia of the hip (DDH).MethodsBetween April 2008 and June 2016, 71 patients with unilateral Crowe type Ⅳ DDH were treated with THA. Of 71 cases, 44 were performed with subtrochanteric osteotomy (osteotomy group) and 27 were performed without subtrochanteric osteotomy (non-osteotomy group). There was no significant difference in gender, age, body mass, height, body mass index, affected side, and preoperative Harris score between 2 groups (P>0.05). The complications were recorded and the effectiveness was assessed by Harris score. Besides, the femoral dislocation height and the settling depth of sleeve were measured in the pelvic anteroposterior X-ray film pre- and post-operatively.ResultsOsteotomy group was followed up 12-90 months (mean. 34.77 months), and non-osteotomy group was followed up 12-79 months (mean, 34.33 months). There was no significant difference in follow-up time between 2 groups (t=–0.088, P=0.930). There was 11 cases of intraoperative or postoperative complications in osteotomy group, and 3 cases of postoperative complications in non-osteotomy group. Among the osteotomy group, 1 case had nonunion due to infection and received revision after 20 months. No loosening or dislocation of the implant occurred in both 2 groups. Significant differences were found in femoral dislocation height and settling depth of sleeve between 2 groups (t=–8.452, P=0.000; t=6.783, P=0.000). Moreover, the osteotomy length was not correlated with the settling depth of sleeve (r=–0.038, P=0.806). At last follow-up, there was no significant difference in Harris score between 2 groups (t=–1.160, P=0.254).ConclusionTHA combined with subtrochanteric osteotomy can provide a favorable outcome for treating Crowe type Ⅳ DDH. Furthermore, patients with higher femoral dislocation and severely narrow femoral proximal canals are prone to be peformed with subtrochanteric osteotomy.

Citation： SUN Jingyang, ZHOU Yonggang, GAO Zhisen, MA Haiyang, PIAO Shang, DU Yinqiao, WU Wenming, PENG Yawen. A study of total hip arthroplasty with subtrochanteric osteotomy in Crowe type Ⅳ developmental dysplasia of hip . Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(2): 152-156. doi: 10.7507/1002-1892.201708004 Copy

1.	Zhou Y, Sun C, Wang Y. New method addressing the problem of using ceramic-on-ceramic bearing in too small acetabulum of high-riding DDH patients with THA. Seminars in Arthroplasty, 2012, 23(4): 226-31.
2.	Liu S, Zuo J, Li Z, et al. Study of three-dimensional morphology of the proximal femur in developmental adult dysplasia of the hip suggests that the on-shelf modular prosthesis may not be an ideal choice for patients with Crowe type Ⅳ hips. Int Orthop, 2017, 41(4): 707-713.
3.	Sonohata M, Kitajima M, Kawano S, et al. Nerve palsy after total hip arthroplasty without subtrochanteric femoral shortening osteotomy for a completely dislocated Hip joint. Open Orthop J, 2016, 10: 785-792.
4.	Kilicarslan K, Yalcin N, Cicek H, et al. What happens at the adjacent knee joint after total hip arthroplasty of Crowe type Ⅲ and Ⅳ dysplastic hips? J Arthroplasty, 2012, 27(2): 266-270.
5.	陳濤, 楊春喜. 人工全髖關節置換術治療 Crowe Ⅳ型先天性髖關節發育不良截骨術的研究進展. 中國修復重建外科雜志, 2015, 29(4): 444-447.
6.	Yan F, Chen G, Yang L, et al. A reduction technique of arthroplasty without subtrochanteric femoral shortening osteotomy for the treatment of developmental high dislocation of hip: a case series of 28 hips. J Arthroplasty, 2014, 29(12): 2289-2293.
7.	Zhao X, Zhu ZA, Xie YZ, et al. Total hip replacement for high dislocated hips without femoral shortening osteotomy. J Bone Joint Surg (Br), 2011, 93(9): 1189-1193.
8.	周勇剛, 張強, 王巖, 等. 兩種不同截骨方法治療 Crowe Ⅳ型先天性髖脫位的比較研究. 中華外科雜志, 2008, 46(17): 1288-1292.
9.	Krych AJ, Howard JL, Trousdale RT, et al. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-Ⅳ developmental dysplasia. J Bone Joint Surg (Am), 2009, 91(9): 2213-2221.
10.	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.
11.	Wang D, Li LL, Wang H Y, 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.
12.	汪強, 孫俊英, 金曄, 等. S-ROM 股骨柄假體的設計特征與初次全髖置換. 中國組織工程研究, 2012, 16(17): 3061-3064.
13.	趙唐永, 任原, 王志強. 股骨干骨折內固定術后骨折愈合情況及其影響因素分析. 中國骨與關節損傷雜志, 2015, 30(8): 869-870.
14.	馬海洋, 周勇剛, 鄭充, 等. Crowe Ⅳ型髖關節發育不良的新分型. 中國骨傷, 2016, 29(2): 119-124.
15.	Wu X, Li SH, Lou LM, et al. The techniques of soft tissue release and true socket reconstruction in total hip arthroplasty for patients with severe developmental dysplasia of the hip. Int Orthop, 2012, 36(9): 1795-1801.
16.	Wu X, Lou LM, Li SH, et al. Soft tissue balancing in total hip arthroplasty for patients with adult dysplasia of the hip. Orthop Surg, 2009, 1(3): 212-215.
17.	Li Y, Zhang X, Wang Q, et al. Equalisation of leg lengths in total hip arthroplasty for patients with Crowe type-Ⅳ developmental dysplasia of the hip: classification and management. Bone Joint J, 2017, 99-B(7): 872-879.
18.	Li YM, Li JH, Li B, et al. The radiological research for pelvis asymmetry of unilateral developmental dysplasia of the hip in adult. Saudi Med J, 2016, 37(12): 1344-1349.

1. Zhou Y, Sun C, Wang Y. New method addressing the problem of using ceramic-on-ceramic bearing in too small acetabulum of high-riding DDH patients with THA. Seminars in Arthroplasty, 2012, 23(4): 226-31.
2. Liu S, Zuo J, Li Z, et al. Study of three-dimensional morphology of the proximal femur in developmental adult dysplasia of the hip suggests that the on-shelf modular prosthesis may not be an ideal choice for patients with Crowe type Ⅳ hips. Int Orthop, 2017, 41(4): 707-713.
3. Sonohata M, Kitajima M, Kawano S, et al. Nerve palsy after total hip arthroplasty without subtrochanteric femoral shortening osteotomy for a completely dislocated Hip joint. Open Orthop J, 2016, 10: 785-792.
4. Kilicarslan K, Yalcin N, Cicek H, et al. What happens at the adjacent knee joint after total hip arthroplasty of Crowe type Ⅲ and Ⅳ dysplastic hips? J Arthroplasty, 2012, 27(2): 266-270.
5. 陳濤, 楊春喜. 人工全髖關節置換術治療 Crowe Ⅳ型先天性髖關節發育不良截骨術的研究進展. 中國修復重建外科雜志, 2015, 29(4): 444-447.
6. Yan F, Chen G, Yang L, et al. A reduction technique of arthroplasty without subtrochanteric femoral shortening osteotomy for the treatment of developmental high dislocation of hip: a case series of 28 hips. J Arthroplasty, 2014, 29(12): 2289-2293.
7. Zhao X, Zhu ZA, Xie YZ, et al. Total hip replacement for high dislocated hips without femoral shortening osteotomy. J Bone Joint Surg (Br), 2011, 93(9): 1189-1193.
8. 周勇剛, 張強, 王巖, 等. 兩種不同截骨方法治療 Crowe Ⅳ型先天性髖脫位的比較研究. 中華外科雜志, 2008, 46(17): 1288-1292.
9. Krych AJ, Howard JL, Trousdale RT, et al. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-Ⅳ developmental dysplasia. J Bone Joint Surg (Am), 2009, 91(9): 2213-2221.
10. 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.
11. Wang D, Li LL, Wang H Y, 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.
12. 汪強, 孫俊英, 金曄, 等. S-ROM 股骨柄假體的設計特征與初次全髖置換. 中國組織工程研究, 2012, 16(17): 3061-3064.
13. 趙唐永, 任原, 王志強. 股骨干骨折內固定術后骨折愈合情況及其影響因素分析. 中國骨與關節損傷雜志, 2015, 30(8): 869-870.
14. 馬海洋, 周勇剛, 鄭充, 等. Crowe Ⅳ型髖關節發育不良的新分型. 中國骨傷, 2016, 29(2): 119-124.
15. Wu X, Li SH, Lou LM, et al. The techniques of soft tissue release and true socket reconstruction in total hip arthroplasty for patients with severe developmental dysplasia of the hip. Int Orthop, 2012, 36(9): 1795-1801.
16. Wu X, Lou LM, Li SH, et al. Soft tissue balancing in total hip arthroplasty for patients with adult dysplasia of the hip. Orthop Surg, 2009, 1(3): 212-215.
17. Li Y, Zhang X, Wang Q, et al. Equalisation of leg lengths in total hip arthroplasty for patients with Crowe type-Ⅳ developmental dysplasia of the hip: classification and management. Bone Joint J, 2017, 99-B(7): 872-879.
18. Li YM, Li JH, Li B, et al. The radiological research for pelvis asymmetry of unilateral developmental dysplasia of the hip in adult. Saudi Med J, 2016, 37(12): 1344-1349.

Chinese Journal of Reparative and Reconstructive Surgery

A study of total hip arthroplasty with subtrochanteric osteotomy in Crowe type Ⅳ developmental dysplasia of hip

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