Abstract
BackgroundThe study aimed to evaluate the functional and radiographical results of asymmetrically reconstructed total hip arthroplasty in patients with bilateral dysplastic arthritic hips with one hip Crowe II–III and the other hip Crowe IV.Materials and methodsFrom April 2006 to April 2019, we evaluated 23 patients who had a reconstruction of one Crowe II–III hip with high hip center (HHC) and the other Crowe IV hip at the anatomical position (H group). The radiographic and clinical outcomes were compared with those of a control group of 19 patients with bilateral dysplasia who had one Crowe IV hip and the contralateral hip both reconstructed in the anatomical position (A group). Medical records and radiographs were reviewed, and a complete follow-up was conducted for all patients.ResultsThe mean vertical center of rotation (V-COR) and horizontal center of rotation (H-COR) in the H group were 30.6 ± 5.8 mm and 30.0 ± 5.5 mm, respectively. In the A group, the corresponding values were 14.0 ± 4.3 mm and 23.0 ± 2.3 mm, respectively. A significant difference was found in terms of V-COR and H-COR between the two groups, and no significant difference was shown regarding the cup inclination, abductor lever arm (ALA), ALA ratio, and leg length discrepancy (LLD). Three patients of the H group and four patients of the A group exhibited LLD > 10 mm. All seven patients who had LLD > 10 mm underwent the shortening subtrochanteric osteotomy (SSTO) of the Crowe IV hip. Subgroup analysis based on the presence and absence of SSTO showed that the LLD of the SSTO group was greater than that of the non-SSTO group in both groups, but the difference was only statistically significant in the A group. At the last follow-up, the mean Harris Hip Scores significantly improved in the two groups, and there was no revision during the follow-up period. In the H group, four patients presented with a slight limp and three patients with a moderate limp, while it was six patients and one patient in the A group, respectively.ConclusionsAsymmetrical reconstruction in patients with bilateral dysplastic arthritic hips with one hip Crowe II–III and the other Crowe IV is acceptable and comparable when compared with bilateral anatomical reconstruction.Level of evidenceIII, retrospective observational study.Trial registration Chinese Clinical Trail Registry. ChiCTR2000033848
Highlights
Total hip arthroplasty (THA) is a prevalent and efficacious procedure for secondary osteoarthritis in patients with developmental dysplasia of the hip (DDH) [1]
Asymmetrical reconstruction in patients with bilateral dysplastic arthritic hips with one hip Crowe II–III and the other Crowe IV is acceptable and comparable when compared with bilateral anatomical reconstruction
For patients with bilateral dysplastic arthritic hips with one Crowe II–III hip in high hip center and the other hip Crowe IV in the anatomical position, the imbalance of the center of rotation on the two sides may affect the restoration of leg length discrepancy (LLD), postoperative gait, and the longevity of prostheses
Summary
Total hip arthroplasty (THA) is a prevalent and efficacious procedure for secondary osteoarthritis in patients with developmental dysplasia of the hip (DDH) [1]. Nawabi et al [9] reviewed 32 patients with Crowe II– III dysplasia who were treated with HHC at a mean follow-up of 12 years, revealing Kaplan–Meier survivorship for all-cause revisions of 97%. For patients with bilateral dysplasia who had asymmetrical reconstruction of two hips, the result remains uncertain. For patients with bilateral dysplastic arthritic hips with one Crowe II–III hip in high hip center and the other hip Crowe IV in the anatomical position, the imbalance of the center of rotation on the two sides may affect the restoration of leg length discrepancy (LLD), postoperative gait, and the longevity of prostheses.
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