OBJECTIVETo investigate the mothod and therapeutic efficacy of total hip anthroplasties (THA) for osteoarthritis secondary to Crowe type IV developmental dysplasia of hip in adults.

METHODSFrom May 2006 to December 2013, THA was performed on 15 adult patients (17 hips) with Growe type IV acetabular dysplasia, including 13 females and 2 males, with a mean age of 30.9 years old (22 to 58 years old) and an average preoperative Harris score of (34.0 ± 6.5) points. Traction of the affected limb was not performed before surgery. After extensive release and lengthening of soft tissues, sub-trochanteric osteotomy of the femur was performed, hip joint center was rebuilt and the abduction function was restored.

RESULTSThe patients were followed up with a mean period of 33 months (ranged from 6 months to 5 years). The postoperative Harris score was 85.0 ± 7.3,higher than the preoperative score. The extended length of limb ranged from 1.6 to 5.4 cm, with a mean of (3.42 ± 0.65) cm. The shortening and malformation of the affected limb were corrected in the most patients,with the difference in length of the two legs less than 1.5 cm. After surgery, 1 patient experienced partial sciatic nerve injury, which was largely recovered after 3 months of conservative treatment. One patient experienced complete sciatic nerve injury, which was partially recovered after 6 months of conservative treatment; a foot-drop varus deformity was formed in the distal end of the affected limb, which was improved after tendon transposition and transplantation. Joint pain was relieved, and the joint function was restored significantly. Over the follow-up period, no severe complications such as dislocation, infection, prosthesis loosening, or subsiding occurred.

CONCLUSIONSatisfactory efficacy can be achieved for adult Growe type IV acetabular dysplasia associated with osteoarthritis by THA, with proper soft tissue release and lengthening, sub-trochanteric osteotomy of femur, joint functional restoration, appropriate choice of prosthesis, and careful protection of nerves and vessels.

Adult ; Arthroplasty, Replacement, Hip ; methods ; Female ; Hip Dislocation, Congenital ; complications ; Humans ; Leg Length Inequality ; therapy ; Male ; Middle Aged ; Osteoarthritis, Hip ; surgery

OBJECTIVETo compare differences between Crowe IV developmental dysplasia of the hip (DDH) with secondary acetabulum and Crowe IV DDH without secondary acetabulum,and determine whether it is necessary to divide Crowe IV DDH into two subtypes.

METHODSFrom June 2007 to May 2015,145 hips of 112 Crowe N patients who underwent total hip arthroplasty (THA) using S-ROM stem were divided into two groups: secondary acetabulum formaton group (group A) and no secondary acetabulum formaton group (group B). In group A,there were 12 females, 96 males,with an average age of (39.38 ± 11.19) years old. In group B, there were 2 females, 35 males, with an average age of (38.19 ± 10.92) years old. All the patients were evaluated by using Harris Hip Score. Radiographic evaluations were made preoperatively and during follow up. The differences between two groups were compared on dislocation height, canal flare index (CFI), subtrochanteric shortening osteotomy (SSTO) usage, pre- and post-operation Harris scores, complications.

RESULTSThe dislocation height for group A was (4.74 ± 1.57) cm, while the dislocation height for group B was (3.12 ± 1.15) cm. Significantly difference was detected between two groups. The CFI for group A was 2.69 ± 0.68, while the CFI for group B was 3.42 ± 0.79, and the significantly difference was detected between two groups. Harris scores were totally improved from 58.18 ± 15.67 preoperatively to 91.20 ± 3.79 post-operatively and the difference was significant. Pre-operative Harris scores was 58.1 ± 15.3 in group A, 58.3 ± 16.9 in group B. Post-operative Harris scores was 91.0 ± 4.1 in group A, 91.0 ± 5.1 in group B. No significant difference was found on Harris scores between A and B preoperatively and post-operatively. Complications of 4 cases peri-prosthesis fracture, 4 cases dislocation and 4 cases nerve injury occur in group A; While only one case dislocation and one case nerve injury occur in group B. No statistical significance was detected.

CONCLUSIONCrowe IV DDH with secondary acetabulum is significantly different from Crowe IV DDH without secondary acetabulum on dislocation height and femoral morphology, which causes the different selections of surgical techniques (SSTO usage or not). These important differences in fundamental parameters indicate the necessity to further divide Crowe IV DDH into IVA and IVB two subtypes.

Adolescent ; Adult ; Aged ; Female ; Hip Dislocation, Congenital ; classification ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; therapy

Curved periacetabular osteotomy (CPO) was developed for the treatment of dysplastic hips in 1995. In CPO, the exposure of osteotomy sites and osteotomy of the ischium are made in the same manner as Bernese periacetabular osteotomy, and iliac and pubic osteotomies are performed in the same manner as rotational acetabular osteotomy. We studied the dynamic instabilities of 25 dysplastic hips before and after CPO using triaxial accelerometry. Overall magnitude of acceleration was significantly decreased from 2.30 +/- 0.57 m/sec2 preoperatively to 1.55 +/- 0.31 m/sec2 postoperatively. Pain relief and improvement of acetabular coverage resulting from acetabular reorientation seem to be related with reduction of dynamic instabilities of dysplastic hips. Isokinetic muscle strengths of 24 hips in 22 patients were measured preoperatively and after CPO. At 12 months postoperatively, the mean muscle strength exceeded the preoperative values. These results seem to be obtained due to no dissection of abductor muscles in CPO. The preoperative presence of acetabular cysts did not influence the results of CPO. An adequate rotation of the acetabular fragment induced cyst remodeling. Satisfactory results were obtained clinically and radiographically after CPO in patients aged 50 years or older. CPO alone for the treatment of severe dysplastic hips classified as subluxated hips of Severin group IV-b with preoperative CE angles of up to -20degrees could restore the acetabular coverage, weight-bearing area and medialization of the hip joint. CPO without any other combined procedure, as a treatment for 17 hips in 16 patients with Perthes-like deformities, produced good mid-term clinical and radiographic results. We have been performing CPO in conjunction with osteochondroplasty for the treatment of acatabular dysplasia associated with femoroacetabular impingement since 2006. The combined procedure has been providing effective correction of both acetabular dysplasia and associated femoral head-neck deformities without any increased complication rate. We have encountered an obturator artery injury in one case and two intraoperative comminuted fractures. Although serious complications such as motor nerve palsy, deep infection, necrosis of the femoral head or acetabulum, and delayed union or nonunion of the ilium were reported, such complications have never occurred in our 700 cases so far.
Acetabulum/physiopathology/*surgery ; Hip Dislocation, Congenital/complications/physiopathology/*surgery ; Humans ; Osteoarthritis, Hip/etiology/physiopathology/*surgery ; Osteotomy/adverse effects/*methods ; Recovery of Function

OBJECTIVETo retrospectively compare the therapeutic effects of simple Pemberton's ilium osteotomy and combined unter-trochanter derotation-varisation osteotomy for developmental dysplasia of the hip (DDH).

METHODSClinical data of 141 DDH patients who received either simple Pemberton's ilium osteotomy (n=57; 12 male and 45 female; age range 3-8 years) or combined unter-trochanter derotation-varisation osteotomy (n=84; 15 male and 69 female; age range 4-9 years) from January 2004 to January 2009 were collected. Postoperative complications, Severin's radiological outcomes and therapeutic outcomes as evaluated by Mcay criteria were compared between the two groups 2 years after operation.

RESULTSThe patients in simple Pemberton group were followed-up for 30-52 months (mean 38 months) and the patients in the combination group were followed-up for 32-51 months (mean 37 months). There were 7 cases of dislocation, 4 cases of avescular necrosis of femoral head and 5 cases of joint stiffness in simple Pemberton group vs 0 case of dislocation, contraction of the limb and ANFH,2 cases of joint stiffness in the combination group. Two years after surgery, the result as evaluated by McKay criteria was excellent in 27 cases, good in 18 cases and fair in 12 cases in simple Pemberton group vs. 52, 25 and 7 cases in the combination group. The overall clinical outcome in the combination group was better than that in simple Pemberton group. Severin X-ray evaluation showed excellent in 27 cases, good in 15 cases and fair in 15 cases in simple Pemberton group vs. 53, 22 and 9 cases in the combination group,indicating that the overall result in the combination group was better than that in simple Pemberton group.

CONCLUSIONThe overall clinical outcome of the combination group is better than that of simple Pemberton group in the treatment of pediatric DDH, especially in reducing postoperative complications and functional recovery. The patients in the combination group reported a higher postoperative satisfaction as compared with those in simple Pemberton group.

Bone Diseases, Developmental ; etiology ; surgery ; Child ; Child, Preschool ; Female ; Femur ; surgery ; Hip Dislocation, Congenital ; complications ; surgery ; Humans ; Ilium ; surgery ; Male ; Osteotomy ; methods

OBJECTIVETo evaluate the clinical effects of total hip arthroplasty (THA) for Crowe type IV developmental dysplasia of the hip (DDH) and analyze perioperative complications.

METHODSFrom March 2000 to March 2010, 19 patients (23 hips, of them, 4 patients with bilateral hips) with Crowe type IV DDH underwent THA. There were 5 males and 14 females, with average age of 61.3 years (ranged, 41 to 72 years). All hips were treated with small acetabular components combined with medial protrusion technique in acetabular reconstruction, as well as subtrochanteric shortening osteotomy in femur. Joint function of hips were evaluated according to Harris scoring.

RESULTSAll patients were followed up with an average of 4.2 years (ranged, 1 to 8 years). Postoperative X-ray films showed all acetabular prosthesis were in true acetabulum. No loosening and nonunion were found in all patients. Harris scoring improved from preoperative 34.0 +/- 6.9 to postoperative 85.0 +/- 7.5. Complications occurred in 11 cases in the patients, including femoral split fracture in 3 cases, nerve injury in 3 cases, delayed union in 2 cases, dislocation in 3 cases.

CONCLUSIONTotal hip arthroplasty using small acetabular component, medial protrusion, femoral subtrochanteric shortening osteotomy technique for the Crowe type IV DDH can effectively restore hip function and leg length. But incidence of complications is high. The long-term follow-up is necessary for further study.

Adult ; Aged ; Arthroplasty, Replacement, Hip ; adverse effects ; Female ; Follow-Up Studies ; Hip Dislocation, Congenital ; surgery ; Humans ; Incidence ; Joint Dislocations ; etiology ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; prevention & control

PURPOSE: The purpose of this study was to evaluate the clinical and radiological results of total hip arthroplasty using a proximal modular femoral stem in patients who had secondary coxarthrosis associated with a dysplastic hip. MATERIALS AND METHODS: Forty-two patients (45 hips) with secondary coxarthrosis were evaluated after undergoing primary total hip arthroplasty using an S-ROM proximal modular femoral stem. The average follow-up was 80 months (range: 60 to 96 months). Clinical and radiological assessments were performed based on the Harris hip score and the radiological changes around the prosthesis. RESULTS: The average Harris hip score improved from 52.2 points to 88.5 points. All femoral stems showed stable fixation; there were 37 cases by bony ingrowth and 8 cases by stable fibrous ingrowth. Neither osteolysis nor progressive radiolucent lines around the femoral stem were found at the last follow-up. Forty-one hips (91.9%) revealed excellent or good clinical results at the most recent follow-up. CONCLUSION: For advanced secondary coxarthrosis, total hip arthroplasty with the use of the proximal modular femoral stem yielded good mid-term results with respect to the clinical and radiological criteria.
Adult ; Aged ; Arthroplasty, Replacement, Hip/adverse effects/*methods ; Female ; Femur/*pathology ; Hip Dislocation, Congenital/complications/pathology/*surgery ; *Hip Prosthesis ; Humans ; Joint Deformities, Acquired/complications/pathology/*surgery ; Male ; Middle Aged ; Osteoarthritis, Hip/etiology/surgery ; Postoperative Complications/pathology

BACKGROUND: Cotyloplasty is a technique that involves making a perforation of the medial wall of a shallow acetabulum and then inserting an acetabular cup with the medial aspect of its dome beyond the Kohler line. The purpose of this study was to evaluate the results of cementless total hip arthroplasty (THA) using cotyloplasty with focusing on the amount of medial cup protrusion. METHODS: Sixteen hips with insufficient acetabulum in sixteen patients were treated by cementless THA using cotyloplasty. The average patient age was 47 years. The diagnoses included dysplastic hip (12) and infection sequelae (4). All the patients were followed up for at least 2 years. Clinically, the Harris hip scores were assessed and radiologically, the amount of cup protrusion, the hip center movement and cup fixation were evaluated. RESULTS: The average Harris hip score improved from 57 to 94 postoperatively. The average proportion of cup surface beyond the Kohler line was 44.1% and the hip centers were medialized by an average of 23 mm. Stable fixation of the acetabular cup was achieved in all the cases except one. In this one case, migration of the cup was detected 2 weeks postoperatively and a reoperation was performed. CONCLUSIONS: Using cotyloplasty, good coverage of the acetabular cup was obtained without a block bone graft, and the hip joint centers were medialized. However, the safety margin for the amount of protrusion should be established.
Acetabulum/*pathology/radiography/*surgery ; Adult ; Arthritis, Infectious/complications/pathology ; *Arthroplasty, Replacement, Hip ; Female ; Hip Dislocation, Congenital/pathology/surgery ; Hip Joint/radiography ; *Hip Prosthesis ; Humans ; Male ; Middle Aged

OBJECTIVE: To investigate the surgical techniques and clinical outcomes of total hip replacement for patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip. METHODS: From May 2004 to March 2008, a total of 36 total hip replacements were performed in 32 patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip. The acetabulum cup was reconstructed in the corresponding anatomical position in all cases. Cemented components were used in 16 hips, and cementless components in the other 20 hips. The mean follow-up was 31.3 months. Clinical outcomes were determined with Harris hip score. Radiographs were taken after the surgery and in every follow-up examination for further reference. RESULTS: All patients postoperatively gained a limb lengthening with an average of (3.4+/-1.3) cm. Three patients had complications, 2 had nondisplaced fractures of the proximal part of the femur,and 1 sciatic nerve palsy which disappeared after 3 months. There was no infection, dislocation and symptomatic deep vein thrombosis. Compared with preoperation, the mean Harris hip scores on the 3rd day, the 14th day after the operation and at the last follow-up were all improved significantly (all P<0.05). There was no loosening, migration, heterotopic ossification radiographically, and no revision during the follow-up. CONCLUSION Total hip replacement is an effective treatment for patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip. The key is to place the acetabulum cup in the corresponding anatomical position, and choose proper prosthesises during the surgery.
Adult ; Arthroplasty, Replacement, Hip ; adverse effects ; methods ; Female ; Hip Dislocation, Congenital ; complications ; surgery ; Humans ; Male ; Middle Aged ; Orthopedic Procedures ; methods ; Osteoarthritis ; etiology ; surgery ; Treatment Outcome

OBJECTIVETo investigate the method and the outcome of the acetabular reconstruction in the Crowe III dysplastic hip.

METHODSFrom January 2001 to June 2007, 43 cases (54 hips) were diagnosed osteoarthritis secondary to Crowe III dysplastic hip. Total hip arthroplasty was performed in all cases. The Harris score was 39 pre-operation. The method of the acetabular reconstruction included acetabular deepening (group A), medial-wall osteotomy (group B), femoral head bone grafting (group C). Radiography data and Harris score were taken to evaluate the clinical outcome.

RESULTSThe method of the acetabular reconstruction included acetabular deepening in 27 cases (34 hips), medial-wall osteotomy in 12 cases (15 hips), femoral head bone grafting in 4 cases (5 hips). Forty cases were followed up by the mean time of 29 months. The bone union time of the osteotomy and bone grafting were 4 - 5 months postoperation. In the three groups the obliquity angle of the cup were (41.0 +/- 7.5) degrees , (46.0 +/- 7.7) degrees , (39.0 +/- 11.0) degrees ; the anteversion angle of the cup were (10.0 +/- 2.8) degrees , (9.0 +/- 2.5) degrees , (4.0 +/- 1.9) degrees ; the rotation center of the hip was shift superiorly (8.4 +/- 3.6) mm, (7.3 +/- 2.6) mm, (1.2 +/- 0.5) mm; the rotation center of the hip were shift internally (7.0 +/- 1.5) mm, (9.9 +/- 1.7) mm, (-2.7 +/- 1.2) mm, and the Harris score were 89, 91, 86 at the follow up. The complication included deep venous thrombosis in 2 cases, pulmonary embolism in 2 cases, sciatic nerve palsy in 4 cases.

CONCLUSIONAcetabular deepening, medial-wall osteotomy, femoral head bone grafting can be used in reconstruction of the acetabular in the Crowe III dysplastic hip.

Acetabulum ; surgery ; Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; methods ; Bone Transplantation ; Female ; Follow-Up Studies ; Hip Dislocation, Congenital ; complications ; surgery ; Humans ; Male ; Middle Aged ; Osteoarthritis, Hip ; etiology ; surgery ; Osteotomy ; Treatment Outcome

OBJECTIVETo assess clinical result of soft tissue balancing in primary total hip arthroplasty for severe developmental dysplasia of the hip in adults.

METHODSFrom December 2000 to August 2006, 26 primary cementless total hip arthroplasties combined with soft tissue balancing were performed in 21 cases for the treatment of severe developmental dysplasia of the hip. Patients were classified as type III (20 hips) and type IV (6 hips) according to Crowe classification. All acetabular cups were placed in their original anatomic location by soft tissue releasing and subtrochanteric shortening osteotomy. Thereafter, postoperative clinical and radiological results were evaluated.

RESULTSThe mean length of follow-up was 4.8 years (range, 13 months-7 years). Limp improved by at least one grade in 62% of the cases. Leg-length discrepancy was corrected significantly and osteotomy was undertaken in 13 hips with a mean decrease length of 0.9 cm by effective releasing. Harris scores improved significantly from a mean of 41.2 preoperatively to 89.6 postoperatively. No dislocations, infections and prosthesis loosening were found at the final follow-up evaluation.

CONCLUSIONSoft tissue balancing in total hip arthroplasty can facilitate acetabular reconstruction to normalize the hip center in severe developmental dysplasia of the hip, as a result, satisfactory short-term result can be obtained by restoring normal function and anatomic structure.

Adult ; Aged ; Arthroplasty, Replacement, Hip ; methods ; Connective Tissue ; surgery ; Female ; Follow-Up Studies ; Hip Dislocation, Congenital ; surgery ; Humans ; Male ; Middle Aged ; Osteotomy ; adverse effects ; Postoperative Complications ; prevention & control ; Treatment Outcome