Abstract
BackgroundWhether satisfactory clinical and radiological outcomes of total hip arthroplasty (THA) with subtrochanteric shortening osteotomy (SSO) in high hip dislocation after childhood pyogenic infection can be achieved as in Crowe IV developmental dysplasia of the hip (DDH) remains unclear.MethodsBetween September 2009 and December 2016, 151 primary THAs performed at our institution using similar SSO technique and prosthetic design were retrospectively reviewed. After excluding patients who met exclusion criteria, 29 patients were identified as high dislocation (Crowe IV) after childhood infection (HDACI) and 107 as Crowe IV developmental dysplasia of the hip (DDH). Propensity score matching was used to select 29 Crowe IV DDH patients as a control group for the HDACI group with comparable preoperative conditions. Clinical and radiological outcomes and complication were compared and analyzed. The mean follow-up duration of the 2 groups was 5.0 years.ResultsThe mean Harris hip score (HHS) and the mean score in range of motion (ROM) domain of the modified Merle d’Aubigné-Postel (MAP) were 84.6 and 4.5 in the HDACI group, compared with 88.3 and 4.9 in the DDH group; there was significant difference between the 2 groups in these parameters (P = 0.015 and 0.035, respectively). Meanwhile, in the HDACI group, the median time of osteotomy union was 4 months and osteotomy nonunion rate was 3%; no significant difference was detected in the median time of osteotomy union and osteotomy nonunion rate between the 2 groups (P = 0.388 and 1.000, respectively). And no significant difference was found in the rate of complications between two groups.ConclusionsHDACI patients who received THA combined with SSO could achieve similar satisfactory results as DDH patients in Crowe type IV. The fixation technique of autogenous cortical bone struts had a positive influence on osteotomy healing of SSO in this specific setting.
Highlights
Pyogenic arthritis of the hip is still a common disease for children in less-developed countries [1]
HDACI patients who received total hip arthroplasty (THA) combined with shortening osteotomy (SSO) could achieve similar satisfactory results as developmental dysplasia of the hip (DDH) patients in Crowe type IV
The comparisons of the demographic data between two groups are summarized in Table 1; there were no significant differences between the 2 groups before the surgery
Summary
Pyogenic arthritis of the hip is still a common disease for children in less-developed countries [1]. Restoration of the hip rotation center into the true acetabulum in THA has been reported to ensure a more durable prosthesis [4,5,6,7,8,9] It remains an intractable problem in patients with chronic high hip dislocation. To our knowledge, limited studies in the literature have reported the results of THA with SSO in patients with high hip dislocation after childhood pyogenic infection [13,14,15,16,17,18]. Whether satisfactory clinical and radiological outcomes of total hip arthroplasty (THA) with subtrochanteric shortening osteotomy (SSO) in high hip dislocation after childhood pyogenic infection can be achieved as in Crowe IV developmental dysplasia of the hip (DDH) remains unclear
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