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.
Objective To compare the biomechanical effects between rotational acetabular osteotomy and Chiari osteotomy for developmental dysplasia of the hip (DDH) by biomechanical test. Methods Sixteen DDH models of 8 human cadaver specimens were prepared by resecting the upper edge and posterior edge of acetabulum. And the Wiberg central-edge angle (CE) of the DDH model was less than 20°. Then the rotational acetabular osteotomy was performed on the left hip and Chiari osteotomy on the right hip. When 600 N loading was loaded at 5 mm/minute by a material testing machine, the strain values of normal specimens, DDH specimens, and 2 models after osteotomies were measured. Results In normal specimens, the strain values of the left and right hips were 845.63 ± 533.91 and 955.94 ± 837.42 respectively, while the strain values were 1 439.03 ± 625.23 and 1 558.75 ± 1 009.46 respectively in DDH specimens, which was about 2 times that of normal hips. The morphology and X-ray examinations indicated that the DDH model was successfully established. The strain value was 574.94 ± 430.88 after rotational acetabular osteotomy, and was significantly lower than that of DDH specimens (t=4.176, P=0.004); the strain value was 1 614.81 ± 932.67 after Chiari osteotomy, showing no significant difference when compared with that of DDH specimens (t=0.208, P=0.841). The strain value relieved by rotational acetabular osteotomy was significantly higher than that by Chiari osteotomy (t= — 2.548, P=0.023). Conclusion Rotational acetabular osteotomy is better than Chiari osteotomy in relieving hip joint stress of DDH.
Objective To review research advances of revision surgery after primary total hip arthroplasty (THA) for patients with Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods The recent literature on revision surgery after primary THA in patients with Crowe type Ⅳ DDH was reviewed. The reasons for revision surgery were analyzed and the difficulties of revision surgery, the management methods, and the related prosthesis choices were summarized. Results Patients with Crowe type Ⅳ DDH have small anteroposterior diameter of the acetabulum, large variation in acetabular and femoral anteversion angles, severe soft tissue contractures, which make both THA and revision surgery more difficult. There are many reasons for patients undergoing revision surgery after primary THA, mainly due to aseptic loosening of the prosthesis. Therefore, it is necessary to restore anatomical structures in primary THA, as much as possible and reduce the generation of wear particles to avoid postoperative loosening of the prosthesis. Due to the anatomical characteristics of Crowe type Ⅳ DDH, the patients have acetabular and femoral bone defects, and the repair and reconstruction of bone defects become the key to revision surgery. The acetabular side is usually reconstructed with the appropriate acetabular cup or combined metal block, Cage, or custom component depending on the extent of the bone defect, while the femoral side is preferred to the S-ROM prosthesis. In addition, the prosthetic interface should be ceramic-ceramic or ceramic-highly cross-linked polyethylene wherever possible. Conclusion The reasons leading to revision surgery after primary THA in patients with Crowe type Ⅳ DDH and the surgical difficulties have been clarified, and a large number of clinical studies have proposed corresponding revision modalities based on which good early- and mid-term outcomes have been obtained, but further follow-up is needed to clarify the long-term outcomes. With technological advances and the development of new materials, personalized prostheses for these patients are expected to become a reality.
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 summarize the methods and complications of osteotomy in total hip arthroplasty (THA) to treat Crowe type ⅠV developmental dysplasia of the hip (DDH) so as to provide the reference for selection of surgical procedures. MethodsThe literature concerning THA for DDH was reviewed, and the effectiveness and complications were summarized in different methods. ResultsAt present, four osteotomies are commonly used in DDH, including transtrochanteric osteotomy, subtrochanteric osteotomy, lesser trochanteric osteotomy, and distal femoral osteotomy. Transtrochanteric osteotomy and subtrochanteric osteotomy can effectively adjust leg length, correct femoral anteversion and avoid nerve injury, but transtrochanteric osteotomy may cause bone fracture and abductor injury. Lesser trochanteric osteotomy is scarcely used because of its poor effectiveness. Distal femoral osteotomy is usually used in patients with knee deformity. ConclusionFor patients with Crowe type ⅠV DDH complicated by severe femoral dislocation and soft tissue spasm, subtrochanteric osteotomy should be selected, whereas it needs an associated standard focusing on how to select the osteotomy shape and length in subtrochanteric ostetomy, which needs an advanced research.
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.
ObjectiveTo review the imaging evaluation, treatment progress, and controversy related to developmental dysplasia of the hip (DDH) in adolescents and adults. Methods The domestic and abroad hot issues related to adolescents and adults with DDH in recent years, including new imaging techniques for assessing cartilage, controversies over the diagnosis and treatment of borderline DDH (BDDH), and the improvement and prospect of peracetabular osteotomy (PAO) were summarized and analyzed. ResultsDDH is one of the main factors leading to hip osteoarthritis. As the understanding of the pathological changes of DDH continues to deepen, the use of delayed gadolinium-enhanced MRI of cartilage can further evaluate the progress of osteoarthritis and predict the prognosis after hip preservation. There are still controversies about the diagnosis and treatment of BDDH. At the same time, PAO technology and concepts are still being improved. ConclusionCartilage injury and bony structure determine the choice of surgical methods and postoperative prognosis of hip preservation surgery. The hip preservation of adolescent and adult DDH patients will move towards the goal of individualization and accuracy.
ObjectiveTo investigate the application and effectiveness of the biological type acetabular cup (diameter ＜44 mm) in adult Crowe type IV developmental dysplasia of the hip (DDH). MethodsBetween April 2001 and August 2013, biological type acetabular cup was used in total hip arthroplasty for the treatment of Crowe type IV DDH in 16 cases (20 hips). There were 3 males and 13 females, aged 31-69 years (mean, 49 years). Unilateral hip was involved in 12 cases, and bilateral hips in 4 cases. The patients showed pain of the hip joint and inequality of lower limb (shortening of affected limb 1.8-6.0 cm in length, 3.5 cm on average). Acetabular deformity, the relationship and the severity of femoral head dislocation were comfirmed on the X-ray films. The preoperative Harris score was 34.0±6.9. ResultsAll patients achieved healing of incision by first intention, with no complication of infection or neurovascular injury. Sixteen cases were followed up 4-12 years (mean, 7.5 years). At 2 weeks after operation, dislocation occurred in 2 cases, and were fixed with plaster for 3 weeks after reduction of the hip. Postoperative X-ray films showed complete reduction of femoral head; the average acetabular coverage of the cup of the weight-bearing area was 98.5% (range, 98.2%-99.1%). The cup from the Ranawat triangle was 4.6-7.0 mm (mean, 5.8 mm) in medial shifting, and was 4.5-7.9 mm (mean, 6.2 mm) in elevation, it located at cup lateral surface area inside the iliopectineal line and the Kohler line (＜40%); the cup abduction angle was (45±5)°, and the anteversion angle was (10±5)°. The other patients had no prosthesis loosening except 1 patient having extensive acetabular prosthesis loosening because of acetabular osteolysis at 12 years after operation. The hip Harris score was significantly improved to 85.0±7.5 at 1 year after operation (t=14.34, P=0.01). ConclusionThe acetabular grinding process to retain enough bone combined with a small cup of biological prosthesis treating adult Crowe type IV DDH has the advantages of satisfactory coverage and initial acetabular fixation, so good early and mid-term effectiveness can be obtained.
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 investigate the effects of femoral offset and mechanical axis of the lower extremity on hip after osteotomy for adult developmental dysplasia of the hip (DDH). Methods A clinical data of 62 adult patients with DDH (62 hips), who underwent periacetabular osteotomy combined with femoral osteotomy between January 2016 and May 2019 and met selective criteria, was retrospectively analyzed. There were 6 males and 56 females. The age ranged from 18 to 38 years, with an average of 24.4 years. Body mass index ranged from 15.8 to 31.8 kg/m2, with an average of 21.8 kg/m2. There were 44 cases of Hartofilakidis typeⅠ and 18 cases of typeⅡ. According to the modified Tönnis osteoarthritis staging, 46 cases were stage 0 and 16 cases were stageⅠ. There were 13 cases with pelvic anteversion, 40 cases with normal pelvis, and 9 cases with pelvic retroversion. Intraoperative blood loss, length of hospital stay, and complications were recorded. Postoperative hip function was evaluated by Harris score and International Hip Outcome Tool (iHOT) score. The femoral offset, collo-diaphyseal angle, hip-knee-ankle angle (HKA), knee valus angle, CE (Wiberg central-edge angle), anterior CE angle, and acetabular index angle were measured and the osteotomy healing was observed on X-ray films. Patients were grouped according to postoperative femoral offset (≥48 mm or <48 mm) and HKA [varus group (HKA<177°), normal group (HKA 177°-183°), and valgus group (HKA>183°)]. Harris score and iHOT score were compared between groups. Results Intraoperative blood loss ranged from 200 to 1 550 mL, with an average of 476 mL. The length of hospital stay ranged from 8 to 21 days, with an average of 13.3 days. All incisions healed by first intention. All patients were followed up 2.0-4.5 years, with an average of 2.8 years. At 1 year after operation, the Harris score and iHOT score of the hip joint significantly increased when compared with those before operation (P<0.05); there were significant differences in the femoral offset, collo-diaphyseal angle, HKA, knee valus angle, CE angle, anterior CE angle, and acetabular index angle between pre- and post-operation (P>0.05). According to the modified Tönnis osteoarthritis staging, 38 cases were stage 0 and 24 cases were stageⅠ; and there was no significant difference between pre- and post-operation (χ2=2.362, P=0.124). There were 11 cases with pelvic anteversion, 38 cases with normal pelvis, and 13 cases with pelvic retroversion, showing no significant difference when compared with that before operation (χ2=0.954, P=0.623). The pubic branch osteotomy did not heal in 9 cases, proximal femur osteotomy did not heal in 2 cases, and inferior pubic ramus stress fracture occurred in 5 cases. There were significant differences (P<0.05) in the Harris score and iHOT score between femoral offset≥48 mm group (n=10) and femoral offset<48 mm group (n=52). There was no significant difference (P>0.05) in Harris score and iHOT score between varus group (n=13), normal group (n=40), and valgus group (n=9). Conclusion Periacetabular osteotomy combined with femoral osteotomy can improve the femoral offset and mechanical axis of the lower extremity of patients with DDH, and improve the functional score of the hip. However, excessive increase of femoral offset during femoral osteotomy is not desirable, resulting in low postoperative functional score.