Abstract
BackgroundDevelopmental dysplasia of the hip (DDH) can lead to pain and premature secondary osteoarthritis at an early stage. Joint-preserving osteotomy is an established solution to this problem. In contrast, a conservative approach would result in pain persistence, ultimately raising the patients question for a possible date of expected prosthesis implantation.The aim of the study was to identify the relationship between the dysplastic hip anatomy and the time of prosthesis implantation in order to enable prognostic predictions in younger patients with symptomatic DDH.Materials and methodsData from 129 hips who received THA due to secondary DDH osteoarthritis were evaluated. The preoperative hip anatomy was evaluated for AI and LCE angle. Multiple linear regression analyses were then used to correlate the influence of these parameters with the patient’s age at the time of surgery. In addition, a graphical relationship was derived by the method of power least squares curve fitting with second-degree polynomials.ResultsThe mean age for THA was 54.3 ± 11 years. The time of surgery correlated significantly with LCE (0.37) and AI (− 0.3) (p < 0.001). The mean age of patients with LCE angle ≤ 10° was 41.9 ± 14.0 years, for LCE 11–20° 52.7 ± 9.5 years, and for LCE 21–30° 57.0 ± 10.3 years. The following formula could then be determined for the calculation of the potential patient age at the time of THA as a function of LCE angle: age pTHA = 40.2 + 0.8 × LCE angle − 0.01 × (LCE angle)2.ConclusionA significant correlation between the extent of dysplasia and the time of prosthesis implantation was identified. In particular, the LCE and the AI correlated strongly with the time of implantation. The more dysplastic the angles were, the sooner the THA was necessary. Using the calculations presented in this study, the probable age of prosthesis implantation can be prognosticated and included in a counseling session about treatment options for DDH.
Highlights
Developmental dysplasia of the hip (DDH) can lead to pain and premature secondary osteoarthritis at an early stage
Using the calculations presented in this study, the probable age of prosthesis implantation can be prognosticated and included in a counseling session about treatment options for DDH
A series of X-ray images showing the course of osteoarthritis had to be available for each patient so that the radiological measurements could be performed on nearly healthy hips without osteoarthritis-related changes ensuring correct angle measurements
Summary
Developmental dysplasia of the hip (DDH) can lead to pain and premature secondary osteoarthritis at an early stage. The relevant anatomical characteristic of DDH is a deficient acetabular development, leading to an acetabular under coverage of the femoral head [5, 6]. The sequelae of this morbid anatomy include axial overloading with decreased contact area, increased contact stress on the cartilage matrix with failure of the acetabular labrum, hypertrophy of the labral cartilage, maximum loading at the acetabular rim, and progressive instability, all of which accelerating joint degeneration [1, 2, 7]. The Bernese periacetabular osteotomy (PAO) has been proven to be an effective technique to substantially delay or ideally prevent total hip arthroplasty (THA) in critically selected patients with closed triradiate cartilage and symptomatic dysplasia of the acetabulum [4, 12,13,14]
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