Cementless Total Hip Replacement for the Management of Severe Developmental Dysplasia of the Hip in the Middle Eastern Population: A Prospective Analysis.

Mohamed A Imam,Mohamed Nabil,Ismail Fathalla,Fadhil Kashif,James Holton

doi:10.3389/fsurg.2016.00031

Mohamed A Imam, Mohamed Nabil + Show 3 more

Open Access

https://doi.org/10.3389/fsurg.2016.00031

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Abstract

In the Middle East, severe developmental dysplasia of the hip with subsequent high dislocation is often seen. We assessed the efficiency of total hip replacement (THR) with subtrochanteric shortening femoral osteotomy and trochanteric advancement in this population. This prospective study assessed 25 female patients with symptomatic and severe (Crowe IV). Pre- and postoperative Harris hip score (HHS) and Oxford hip score (OHS) were performed alongside assessment of leg length discrepancy (LLD) and the ability to sit in a cross-legged position. The mean HHS and OHS improved pre-operatively at 1 and 10 years, respectively (p-value < 0.001). The mean postoperative LLD was 3 mm (0-8 mm). Functionally, 22/25 patients were able to sit cross-legged. None of the 25 hips underwent revision during this period. Total hip replacement with subtrochanteric shortening osteotomy in combination with trochanteric advancement is sufficient for the management of Crowe type IV hips in this population.

Highlights

Severe and untreated developmental dysplasia of the hip (DDH) with subsequent high dislocation is not frequently encountered in the developed world due to hip screening and early active treatment
The mean Harris hip score (HHS) improved from 38.4 points preoperatively to 88 and 88.6 points at 1 and 10 years postoperatively, respectively (p-value < 0.001)
The high prevalence of DDH has been linked to consanguinity in the Middle East where 25–49% of DDH cases are from consanguineous parents [22]

Summary

Introduction

Severe and untreated developmental dysplasia of the hip (DDH) with subsequent high dislocation is not frequently encountered in the developed world due to hip screening and early active treatment. In developing countries, the end stage of DDH sequelae is more frequently encountered and requires total hip replacement (THR) as hip preservation procedures are not feasible. These patients are often young and the procedure is technically challenging [1,2,3]. Subtrochanteric femoral shortening osteotomy has been proposed as a concomitant procedure that is carried out simultaneously to overcome this problem [2,3,4,5,6,7] This helps avoid stretching of the Cementless THR for Severe DDH neurovascular structures once the femoral head is close to the anatomical position

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