Objective To explore the expressions of bone morphogenetic protein 2 (BMP-2) and runt-related transcription facotr 2 (Runx2) and microarchitecture of trabecular bone periacetabula in adult patients with developmental dysplasia of the hip (DDH). Methods Between March and September 2008, the trabecular bone periacetabulum was collected from 8 patients with DDH who were scheduled for total hip arthroplasty (aged 37-55 years, 3 males and 5 females, trial group) and from 8 patients with avascular necrosis of the femoral head (Ficat stage II) who were scheduled for hip resurfacing arthroplasty (aged 36-55 years, 3 males and 5 females, control group). The expressions of BMP-2 and Runx2 in the trabecular bone were determined by real-time quantitative PCR, and the microarchitecture was observed by micro-CT and the following parameters were determined: bone volume/total volume (BV/TV), connectivity density (Conn.Dens), trabecular number (Tb. N), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), and structure model index (SMI). Results The expressions of BMP-2 and Runx2 were significantly lower in trial group than in control group (P lt; 0.05). The micro-CT showed sparse trabecular bone in trial group and dense trabecular bone in control group. BV/TV and Tb.N in trial group were significantly lower than those in control group, and SMI and Tb.Sp in trial group were significantly higher than those in control group (P lt; 0.05); there was no significant difference in Conn.Dens and Tb.Th between 2 groups (P gt; 0.05). Conclusion The trabecular bone is in a low metabolism condition and its microarchitecture is tendency to be osteoporosis trabecualr bone in adult patients with DDH. It may be related with the acetabular component loosening after total hip arthroplasty.
Objective To explore the surgical technique and effectiveness of autologous femoral head bone graft in total hip arthroplasty (THA) for Crowe type Ⅲ developmental dysplasia of the hip (DDH) with acetabular bone defect. Methods Between July 2012 and September 2015, 12 cases (12 hips) of Crowe type Ⅲ DDH with acetabular bone defect were included. Of the 12 patients, 2 were male and 10 were female, with an average age of 54.3 years (range, 37-75 years). The Harris score before operation was 41.08±7.90. The preoperative leg length discrepancy was 0.53-4.28 cm, with an average of 2.47 cm. Autologous femoral head bone graft and cancellous screw fixation were used in all cases to reconstruct acetabula in THA. Four cases were performed with subtrochanteric shortening osteotomy at the same time. Results All incisions healed by first intention. Twelve cases were followed up 1 year and 10 months to 5 years, with an average of 3.0 years. X-ray films showed that bone healing was observed in all cases at 6 months to 1 year after operation. There was no bone graft osteolysis, absorption, bone graft collapse, and acetabular prosthesis loosening. At last follow-up, the Harris score was 89.50±2.78, showing significant difference when compared with preoperative value (t=–25.743, P=0.003). The length discrepancy was 0-1.81 cm at last follow-up with an average of 0.76 cm. Conclusion Autologous femoral head bone graft is effective for Crowe type Ⅲ DDH with acetabular bone defect, which has advantages of restoring pelvic bone stock, obtaining satisfied prosthetic stability and mid-term effectiveness.
ObjectiveTo explore the mid-term effectiveness of total hip arthroplasty (THA) with subtrochanteric shortening osteotomy in treatment of Crowe type Ⅳ developmental dysplasia of the hip (DDH).MethodsBetween September 2009 and March 2014, a total of 49 patients (57 hips) who were diagnosed with Crowe type Ⅳ DDH were treated with THA and subtrochanteric shortening osteotomy. Of the 49 patients, 7 were male and 42 were female with an average age of 44.6 years (range, 20-73 years). The preoperative Harris score was 44.68±3.39 and the preoperative leg length discrepancy was (5.27±0.55) cm.ResultsAll incisions healed primarily. All patients were followed up 32-87 months (mean, 52.1 months). At last follow-up, the Harris score was 85.67±2.89 and the leg length discrepancy was (1.12±0.48) cm, showing significant differences when compared with the preoperative values (t=–69.53, P=0.00; t=42.94, P=0.00). X-ray films showed that bone union of the femoral osteotomy end at 6 months after operation. There was no loosening and subsidence of prosthesis at last follow-up.ConclusionThe subtrochanteric shortening osteotomy with THA in treatment of Crowe type Ⅳ DDH can obtain satisfactory mid-term effectiveness with low risk of peripheral vascular and nerve traction injuries.
【Abstract】 Objective To summarize techniques of the total hi p arthroplasty (THA) in the treatment of developmental dysplasia of the hi p (DDH) with severe osteoarthritis in adults. Methods From March 2000 to January 2006, 24 patients (27 hips) with DDH were treated by THA with an cementless cup. There were 7 males and 17 females, withthe average age of 49.6 years (ranging from 26 years to 63 years). Unilateral DDH occurred in 21 patients and bilateral DDH occurred in 3 patients. Based on the Crowe classification, there were 16 hips in 15 patients of type I, 4 hips in 4 patients of type II, 4 hips in 3 patients of type III, 3 hips in 2 patients of type IV. Except for 3 patients with bilateral DDH, the other patients’ ill lower l imbs were 2-7 cm shorter than the healthy lower ones. Results All the patients were followed up from 9 months to 6.5 years and no one had infection, dislocation, femur fracture and so on after the operation. In 18 patients, the pain was completely rel ieved and the function of the hip joints was good. After the gluteus medius exercise, the claudication of 3 patients after the operation disappeared. In 3 patients, the ill lower l imbs were more than 1 cm shorter than the healthy lower ones and the other patients’ ill lower l imbs were less than 1 cm shorter than the healthy lower ones. Two patients’ lower l imbs were been lengthened 4-5 cm. All the patients’ sciatic nerves were not injured. The Harris scores were 46.5 ± 7.2 preoperatively and 84.0 ± 5.7 postoperatively (P lt; 0.05). Conclusion THA with deepening the medial wall of the acetabulum at the true acetabulum and choosing small cementless cup in adult could obtain favorable results.
Objective To summarize the techniques of the total hip arthroplasty in the treatment of osteoarthritis secondary to developmental dysplasia of the hip joint(DDH). Methods Between February 1986 and November2004, a total of 32 hips in 24 patients with advanced osteoarthritis secondary to DDH underwent the total hip arthroplasty. Among the patients, 4 were male and 20 were female, with their ages ranging from33 to 59 years and an average age of 47 years. The bilateral arthroplasty was performed in 8 patients and the unilateral arthroplasty in 16 patients. The patients mainly suffered from pain and claudication. According to the Hartofilakidis classification, semi-dislocation occurred in 2 hips, lowdislocation in 21 hips,and high-dislocation in 9 hips; and the Harris scores before operation were 56.70±2.75, 36.09±4.16, and 29.45±2.16, respectively. Results All the patients were followed up for 6 months to 8 years (averaged 3 yearsand 4 months). The Harris scores after operation were 93.10±2.10，92.7±3.20，and 88.09±3.67，respectively. The differences between peroperation and postoperation were significant(P＜0.01). All the patients were pain-free and there wasno sign of aseptic loosening and subsidence. Conclusion The total hip arthroplasty is an effective method for the treatment of osteoarthritis secondary to DDH. The key techniques for the total hip arthroplasty are as follows: deepening the medial wall of the acetabulum, improving the techniques of the bone graft, and firmly placing the acetabular component in the true acetabulum.
ObjectiveTo investigate the effectiveness of Bernese osteotomy for the treatment of developmental dysplasia of the hip (DDH) in adults. MethodsBetween August 2012 and April 2014, 16 patients with DDH were treated with Bernese osteotomy by S-P approach, and the clinical data were retrospectively analyzed. There were 4 males and 12 females with an average age of 27.8 years (range, 18-35 years). The left side was involved in 6 cases and the right side in 10 cases. The visual analogue scale (VAS) score was 4.8±0.5, and the Harris hip score was 81.2±5.4. The lateral center edge (CE) angle (the angle between the vertical center of the femoral head and the lateral edge of the acetabulum) was (6.5±8.7)°;the horizontal tilt angle was (25.6±5.9)°;and the femoral head extrusion index was 36.5%±6.5%. According to the Tonnis osteoarthritis classification, 12 hips were rated as Grade 0, 3 hips as Grade I, and 1 hip as Grade II. ResultsThe operation time was 90-135 minutes;the intraoperative blood loss was 400-800 mL;10 cases accepted blood transfusion and the amount of blood transfusion was 200-600 mL;the postoperative drainage volume was 100-300 mL;and the hospitalization time was 7-12 days. All the cases achieved primary healing of incision with no early complications. Two cases had numb in the lateral femoral cutaneous nerve innervating area. All patients were followed up 12-26 months (mean, 20 months). The X-ray examination showed osseous healing at osteotomy site, and the healing time was 12-16 weeks (mean, 13.5 weeks). No acetabulum fracture, heterotopic ossification, osteonecrosis, and internal fixation loosening occurred during follow-up. No progression of osteoarthritis or acetabular cystic change was observed. At last follow-up, the lateral CE angle was (27.7±6.8)°;the horizontal tilt angle was (16.2±4.8)°;the femoral head extrusion index was 19.7%±5.3%;VAS score was 0.8±0.3;the Harris hip score was 96.8±6.7;and all showed significant differences when compared with preoperative ones (P<0.05). ConclusionFor DDH adults, Bernese osteotomy can effectively increase the acetabulum tolerance, improve the joint function, and slow progress in osteoarthritis, and the short-term effectiveness is satisfactory.
Objective To investigate the effectiveness of Salter osteotomy combined with subtrochanteric shortening and derotational osteotomy in treating Tönnis type Ⅲ and Ⅳ developmental dysplasia of the hip (DDH) in children and explore the urgical timing. Methods A retrospective collection was performed for 74 children with Tönnis type Ⅲ and Ⅳ DDH who were admitted between January 2018 and January 2020 and met the selection criteria, all of whom were treated with Salter osteotomy combined with subtrochanteric shortening and derotational osteotomy. Among them, there were 38 cases in the toddler group (age, 18-36 months) and 36 cases in the preschool group (age, 36-72 months). There was a significant difference in age between the two groups (P<0.05), and there was no significant difference in gender, side, Tönnis typing, and preoperative acetabular index (AI) (P>0.05). During follow-up, hip function was assessed according to the Mckay grade criteria; X-ray films were taken to observe the healing of osteotomy, measure the AI, evaluate the hip imaging morphology according to Severin classification, and assess the occurrence of osteonecrosis of the femoral head (ONFH) according to Kalamchi-MacEwen (K&M) classification criteria. Results All operations of both groups were successfully completed, and the incisions healed by first intention. All children were followed up 14-53 months, with an average of 27.9 months. There was no significant difference in the follow-up time between the two groups (P>0.05). At last follow-up, the excellent and good rates according to the Mckay grading were 94.73% (36/38) in the toddler group and 83.33% (30/36) in the preschool group, and the difference between the two groups was significant (P<0.05). The imaging reexamination showed that all osteotomies healed with no significant difference in the healing time between the two groups (P>0.05). There was no significant difference in AI between the two groups at each time point after operation (P>0.05), and the AI in the two groups showed a significant decreasing trend with time extension (P<0.05). The result of Severin classification in the toddler group was better than that in the preschool group at last follow-up (P<0.05). There was no significant difference in the incidence of ONFH between the two groups (P>0.05). In the toddler group, 2 cases were K&M type Ⅰ; in the preschool group, 3 were type Ⅰ, and 1 type Ⅱ. There was no dislocation after operation.ConclusionSalter osteotomy combined with subtrochanteric shortening and derotational osteotomy is an effective way to treat Tönnis type Ⅲ and Ⅳ DDH in children, and surgical interventions for children aged 18-36 months can achieve better results.
ObjectiveTo evaluate the effectiveness of the total hip arthroplasty (THA) for severe development dysplasia of the hip (DDH) in adults. MethodsBetween July 2007 and January 2013, 25 patients (27 hips) with severe DDH underwent THA with cementless prosthesis. There were 10 males (11 hips) and 15 females (16 hips) with an average age of 38.6 years (range, 21-57 years). The left hip was involved in 10 cases, the right hip in 13 cases, and bilateral hips in 2 cases. There were 8 cases (9 hips) of Crowe type III and 17 cases (18 hips) of Crowe type IV. The main clinical manifestations were unilateral or bilateral hip pain, claudication, and limited motion of the hip. All patients had leg discrepancy with a length difference of (4.9±0.8) cm. Harris score was 32.7±2.9. ResultsAll patients obtained primary healing of incision; no infection, dislocation, periprosthetic fracture, and lower extremity deep venous thrombosis occurred. All patients were followed up 1-5 years (mean, 3.7 years). Pain relief of the hip was obtained. The motion of the hip was improved obviously. At last follow-up, the length difference between lower limbs was (1.5±0.3) cm, showing significant difference (t=36.703,P=0.000) when compared with preoperative one. Normal gait was observed in the others except 3 cases having mild claudication. Harris score was 89.6±3.2, showing significant difference (t=-65.498,P=0.000) when compared with preoperative one. The X-ray films showed bone union of the acetabular structural bone graft and femoral osteotomy ends, and the union time was 3-5 months (mean, 4.6 months). No complication occurred as follows:dislocation, infection, prosthesis loosening or subsidence, and heterotopic ossification. ConclusionTHA in the treatment of severe DDH in adults can obtain satisfactory short-term effectiveness, but long-term effectiveness needs further observation.
Objective To investigate the morphological changes of the proximalfemur and their implication to the total hip arthroplasty in patients with Crowe Ⅱ/Ⅲ developmental dysplasia of the hip (DDH). Methods The experimental gr oup was composed of 15 hips in 14 patients (Crowe Ⅱ, 9 hips; Crowe Ⅲ, 6 hips ) with osteoarthritis secondary to Crowe Ⅱ/Ⅲ DDH (2 males, 12 females; age, 35-61 years). None of the patients had accepted any osteotomy treatment. The control group was composed of 15 normal hips in 15 patients with unilateral DDH (3 males, 12 females; age, 35-57 years). Twelve hips came from the experimental group and the other 3 came from the patients with unilateral Crowe Ⅰ DDH. The femurswere examined with the CT scanning. The following parameters were measured: theheight of the center of the femoral head (HCFH), the isthmus position (IP), theneckshaft angle(NS), the anteversion angle, the canal flare index, and the canal width. Then, the analysis of the data was conducted. Results HCFH and IP in theexperimental group and the control group were 50.1±6.7 mm, 50.1±7.4 mm, and 107.4±21.5 mm, 108.7±18.1 mm，respectively, which had no significant differencebetween the two groups（Pgt;0.05）. In the experimental group and the control group, the NS were 138.3±10.0° and 126.7±5.7°，the anteversion angles were 36.5±15.9° and 18.8±5.4°, and the canal flare indexes were 4.47±0.40and 5.01±0.43. There was a significant difference between the two groups in the above 3 parameters （Plt;0.05）. As for the canal width of the femur, therewasa significant difference in the interior/exterior widths and the anterior/posterior widths at the level of 2 cm above the lesser trochanter and 4 cm belowthe lesser trochanter between the two groups （Plt;0.05）; however, there was nosignificant difference in the canal width of the femur at the isthmus between the two groups（P＞0.05）. Conclusion It is necessary to evaluate the morphology of the proximal femur before the total hip arthroplasty performed in patients with Crowe Ⅱ/Ⅲ DDH. The straight and smaller femoral prosthesis should be chosen and implanted in the proper anteversion position duringoperation.
Objective To evaluate the three-dimensional acetabular orientation in asymptomatic population and patients of developmental dysplasia of the hip (DDH) using a semi-automated measurement software, which provides data for the differential diagnosis, surgical planning, surgical instrument design, and postoperative evaluation of hip related diseases. MethodsEighty-four cases of CT data in asymptomatic population (asymptomatic group) and 47 cases of CT data in DDH patients (DDH group) were collected. There was no significant difference in gender and age (including age of male and female subgroups) between the two groups (P<0.05). MaxTHA, a semi-automatic measurement software, was used to measure acetabular inclination and anteversion, including operative inclination (OI), radiographic inclination (RI), anatomic inclination (AI), operative anteversion (OA), radiographic anteversion (RA), and anatomic anteversion (AA). Comparisons were made between the two populations, between different Crowe classification subgroups, between different gender subgroups, and between left and right sides of acetabula. Results The comparison between asymptomatic group, healthy side of DDH group, and affected side of DDH group showed that there was no significant difference in acetabular orientation between asymptomatic group and healthy side of DDH group (P>0.05). The OI, RI, and AI of affected side of DDH group were significantly higher than those in healthy side of DDH group and asymptomatic group, and AA was significantly lower than that in healthy side of DDH group and asymptomatic group (P<0.05). The comparison between the normal acetabula and DDH acetabula with different Crowe classifications showed that there was no significant difference in the acetabulum orientation between Crowe Ⅰ group and the normal group (P>0.05). The OI, RI, and AI of Crowe Ⅱ, Ⅲ, and Ⅳ groups were significantly higher than those of normal group (P<0.05), the OI of Crowe Ⅲ group, RI and AI of Crowe Ⅳ group were significantly higher than those of Crowe Ⅰ group (P<0.05), the AI of Crowe Ⅳ group was significantly higher than that of Crowe Ⅱ group (P<0.05), and the OA, RA, and AA of Crowe Ⅲ group were significantly lower than other subgroups (P<0.05) except Crowe Ⅰ group. The OA, RA, and AA in asymptomatic female group, and the OA and AI in DDH female group were significantly higher than those in all male groups (P<0.05). The OI, RI, AI, and OA of the right acetabula in asymptomatic male group, and the RI and AI of the right acetabula in asymptomatic female group were significantly higher than those on the left side (P<0.05). ConclusionThere were significant differences in acetabular orientation between asymptomatic and DDH populations, inter-group differences among Crowe classification subgroups, inter-gender differences among subgroups, and bilateral differences among asymptomatic individuals.