ObjectiveTo assess the effectiveness of two osteotomy methods in total hip arthroplasty (THA) for treating Crowe type ⅠV adult developmental dysplasia of the hip (DDH), trochanteric osteotomy and subtrochanteric osteotomy. MethodsA retrospective analysis was made on the clinical data of 36 patients (43 hips) with Crowe type ⅠV DDH undergoing THA between June 2007 and December 2013. In THA, 19 patients (23 hips) underwent trochanteric osteotomy (group A) and 17 patients (20 hips) underwent subtrochanteric osteotomy (group B). There was no significant difference in age, gender, body mass index, side, preoperative Harris score, and limb length difference between 2 groups (P>0.05). The operation duration, bleeding volume, hospitalization duration, intraoperative and postoperative complications were compared between 2 groups. ResultsThere was no significant difference in operation duration, bleeding volume, and hospitalization days between 2 groups (P>0.05). The rate of intraoperative complication was 21.7% (5/23) in group A and 5.0% (1/20) in group B, showing no significant difference between 2 groups (P>0.05). The rate of postoperative complications was 10.5% (2/19) in group A and 22.2% (4/18) in group B, showing no significant difference between 2 groups (P>0.05). Thirty-one patients (37 hips) were followed up 1-7 years (mean, 3 years), including 16 cases (19 hips) in group A and 15 cases (18 hips) in group B. X-ray films showed good position of the prostheses. The Harris score at last follow-up was significantly increased when compared with preoperative score in 2 groups (P<0.05), but there was no significant difference between 2 groups (P>0.05). The postoperative discrepancy of bilateral lower limbs had no significant difference (t=-1.343, P=0.188). ConclusionTHA with trochanteric osteotomy or subtrochanteric osteotomy both can effectively treat Crowe type ⅠV DDH. THA with subtrochanteric osteotomy has an advantage in correcting lower limb discrepancy.
Objective?To discuss the clinical application of total hip arthroplasty (THA) with collum femoris preserving (CFP) prosthesis and to analyze the mid-term effectiveness.?Methods?Between January 2004 and February 2007, 45 patients (48 hips) underwent THA with CFP prosthesis. There were 29 males (31 hips) and 16 females (17 hips) with an average age of 48.8 years (range, 38-60 years), including 20 left hips, 22 right hips, and 3 bilateral hips. The causes of hip replacement were osteoarthritis (20 cases), avascular necrosis of femoral head (13 cases), dysplasia (4 cases), rheumatoid arthritis (3 cases), post-traumatic osteoarthritis (2 cases), ankylosing spondylitis (2 cases), and Perths disease (1 case). The average disease duration was 6.1 years (range, 2-13 years). Harris scores, visual analogue scale (VAS) score, and the hip range of motion (ROM) were recorded at pre- and post-operation. The X-ray films were taken at pre- and post-operation to observe the position, loosening of the prosthesis, and ectopic ossification. The gait of patients were also evaluated during follow-up. Short-form 36 health survey scale (SF-36) was used to evaluate the life quality of patients.?Results?All 45 patients were followed up 5-8 years with an average of 6.4 years. All the incisions healed by first intention. No infection, hip dislocation, nerve injury, or deep vein thrombosis occurred. Six cleavage fractures (13.3%) of the lateral femoral diaphysis at the distal prosthesis occurred during operation, which healed at 8 months postoperatively without any treatment. Mild ectopic ossification occurred in 4 patients (8.9%) who had no discomfort. Five patients (11.1%) had bone mineral density loss in the region of the proximal femur. The survival rates of the cups and stems were all 100% at last follow-up. The results of Harris score, VAS score, and ROM of the hip joint at 1 year postoperatively and last follow-up were significantly better than preoperative ones (P lt; 0.05). No significant difference was found in VAS score and ROM of the hip joint between at 1 year postoperatively and at last follow-up (P gt; 0.05) except the Harris score (P lt; 0.05). According to Harris functional assessment at last follow-up, the results were excellent in 31 hips, good in 11 hips, and fair in 6 hips with an excellent and good rate of 87.5%. The physiological role, body pain, and total health scores were significantly lower than the reference value of urban men from Sichuan province (P lt; 0.05), but no significant difference was found in the other scores of the SF-36 when compared with the reference value (P gt; 0.05).?Conclusion?THA with CFP prosthesis is a good option for the young patient with complete collum femoris and without osteoporosis, and can achieve good mid-term effectiveness.
Objective To analyze the main reasons of acetabular component initial instabil ity after primary total hip arthroplasty (THA) and to disscuss the prevention and management. Methods The cl inical data were retrospectively analyzed from 19 patients undergoing revision for acetabular component initial instabil ity after primary THA between January 2003 and June 2010. There were 11 males and 8 females, aged from 55 to 79 years (mean, 67.2 years). The locations were lefthip in 9 cases and right hip in 10 cases. The cementless hip prosthesis was used in 12 cases and cement hip rosthesis in 7 cases. The revisions were performed at 3 weeks to 6 months after primary THA. The reasons of early failure were analyzed. Both the coverage rate of acetabulum-bone and the Harris hip score were compared between pre- and post-revision. Results The main reason of acetabular component initial instabil ity after primary THA may be unsuitable treatment of acetabulum, improper selection of acetabular component, and incorrect place angle of acetabular component. Sciatic nerve palsy occurred in 1 case and recovered at 7 weeks after revision. Sl ight fracture of the acetabulum in 1 case and healed at 3 months after revision. All incisions healed by first intention. No infection, vessel injury, displacement of acetabular component, or deep vein thrombosis occurred. The patients were followed up 11-73 months (mean, 28 months). At last follow-up, no acetabular component instabil ity was observed. The coverage rate of acetabulum-bone was increased from 67.9% ± 5.5% before revision to 87.7% ± 5.2% after revision, showing significant difference (t=11.592，P=0.003). The Harris hip score at last follow-up (84.4 ± 4.6) was significantly higher than that at pre-revision (56.5 ± 9.3) (t=11.380，P=0.005). Conclusion Detailed surgical plan, proper choice of component, correct place angle and elaborative planning, and proficient surgical skill are necessary to achieve the initial stability of acetabular component in THA．