Method and curative effect of acetabulum reconstruction by total hip arthroplasty in treatment of developmental dysplasia of hip of Crowe typeII/III

Abstract

Objective To study the method and effect of the treatment of bone defects above the acetabular prosthesis and anatomic reconstruction of acetabulum in total hip replacement for developmental dysplasia of the hip (DDH) of Crowe typeⅡ/Ⅲwith secondary osteoarthritis (OA). Methods A retrospective analysis was carried out in 38 patients of CroweⅡ/Ⅲ DDH who had secondary osteoarthritis and underwent total hip replacement, from January 2012 to December 2016 in Nantong University Affiliated JianHu Orthopaedic Hospital. Inclusion criteria: Crowe Ⅱ/Ⅲ adult DDH secondary end stage osteoarthritis, hip pain affects normal walking function; exclusion criteria: history of infection, fracture and operation, and other diseases of the affected limb. Harris hip score (HHS) was used for evaluation before and after the operation, The vertical and horizontal distances of hip rotation center before and after the operation were measured and compared. HHS score, the horizontal distance and the vertical distance of the hip rotation center before and after the operation were compared by paired sample t test. Results None of the patient had blood vessel or nerve injury, infection, nor prosthesis loosening. The preoperative limb shortening was (2.6±0.7) cm on average, postoperative lower limb lengthening was (2.5±0.4) cm on average. The preoperative HHS score was (37±8) (25~55), and it was (93±4) (89~100)at the end of the follow-up; the postoperative HHS score was significantly higher than the preoperative one (t =39.45, P<0.05); the fine rate was 100%. The anteroposterior pelvis X-ray of hip joint rotation center before and after the operation showed: preoperative hip rotation center vertical distance was (36.7±6.1) mm, postoperative one was (13±4) mm, the difference was statistically significant (t=4.28, P<0.05). Hip rotation center horizontal distance was (41±7) mm preoperatively, and it was (23±5) mm postoperatively, the difference was statistically significant (t=4.13, P<0.05). Conclusion Good results can be obtained by anatomical reconstruction of the acetabulum and bone graft at the bone defect above the acetabulum when treating adult DDH of Crowe type Ⅱ/Ⅲ by total hip arthroplasty. Key words: Hip dislocation; Osteoarthritis; Hip; Arthroplasty