【Abstract】 Objective To evaluate the flexibil ity of the treatment of osteoarthritis secondary to acetabular dysplasiaby total hip arthroplasty (THA) , in which the acetabular component is placed in the true acetabulum and femoral osteotomy is not performed. Methods From January 1999 to December 2005, 35 THA procedures were performed in 32 patients with 35 hips, including 6 males with 7 hips and 26 females with 28 hips, with the average age of 53 years (ranging from 28 years to 72 years). On the basis of Crowe classification, type I included 10 patients with 11 hips, type II included 14 patients with 15 hips, type III included 5 patients with 6 hips, and type IV included 3 patients with 3 hips. All patients experienced severe pain and dysfunction. In 19 cases, the leg length discrepancy was from 3 cm to 6 cm. The Harris score was 41.49 ± 10.13 before the operation. In all procedures, the soft tissue was released entirely and the acetabular component was placed in the true acetabulum, but femoral osteotomy was not performed. Results The average operation time of unilateral THA was 50 minutes. All patients were given transfusion from 2 U to 4 U. All incisions healed at the first stage. After the operation, the leg was lengthened 2-6 cm, and the two legs were equally long. The follow-up lasted for 12 to 60 months. The Harris score was 84.71 ± 9.34 after the operation, showing statistically significant differece (P lt; 0.05). According to cl inical outcomes and X-ray films, no dislocation, femoral fracture, femoral or sciatic nerve palsy was detected. Conclusion It is effective to use THA procedures for osteoarthritis secondary to acetabular dysplasia. If the soft tissue is released entirely, the leg will be lengthened 4-6 cm without nerve palsy.
ObjectiveTo investigate the mid-term effectiveness of periacetabular osteotomy (PAO) through modified ilioinguinal approach for acetabular dysplasia in adults. MethodsBetween January 2016 and December 2018, 39 patients (43 hips) with acetabular dysplasia who met the selection criteria were enrolled in the study and their clinical data were retrospectively analyzed. All patients were treated with PAO via modified ilioinguinal approach (firstly, the skin and superficial facia were cut via the traditional ilioinguinal approach, and the deep tissues were cut via the modified iliac-femoral approach). There were 3 males (3 hips) and 36 females (40 hips) with an average age of 36 years (range, 18-51 years). Among them, 35 cases of lesions involved single hip and 4 cases of lesions involved bilateral hips. The disease duration ranged from 4 to 96 months, with a median of 18 months. According to the modified Tönnis grading for osteoarthritis, 35 hips were classified as grade 0, 6 hips as grade Ⅰ, and 2 hips as grade Ⅱ. All patients had different degrees of hip pain. The preoperative visual analogue scale (VAS) score of pain was 4.7±0.8, and the modified Harris hip score was 78.5±8.6. The lateral centre-edge angle (LCEA) was (10.52±10.83)°, and the acetabular index (AI) was (26.89±9.07) °. The operation time, intraoperative blood loss, and the incidence of complications were recorded. LCEA, AI, and the progression of osteoarthritis were reviewed by X-ray films. The function and pain of hip joint were evaluated by modified Harris hip score and VAS score. ResultsAll operations were successfully completed. The operation time was 90-150 minutes, with an average of 130 minutes. The volume of intraoperative blood loss was 350-600 mL, with an average of 500.6 mL. All patients were followed up 17-52 months, with an average of 32.7 months. Postoperative numbness of the lateral femoral cutaneous nerve occurred in 3 cases, and no other complications occurred. At last follow-up, the modified Harris hip score was 97.7±3.7 and VAS score was 0.9±1.1, both of which were better than those before operation (P<0.05). At 1 year after operation, X-ray films showed that the all osteotomies healed. In term of the modified Tönnis grading for osteoarthritis, 1 hip downgraded from grade 1 to grade 0, while the remaining hips stayed unchanged. At last follow-up, LCEA and AI were (27.54±8.49) ° and (11.30±5.53) °, respectively, which were significantly different from those before operation (P<0.05). ConclusionPAO through modified ilioinguinal approach is effective in relieving pain and restoring hip function in adults with acetabular dysplasia, which can overcome the disadvantages of the traditional ilioinguinal approach, and may delay the development of osteoarthritis.