Initial stability of integrated prosthesis or combined prosthesis in the treatment of Crowe III-IV developmental dysplasia of the hip

doi:10.12307/2022.691

Abstract

Abstract: BACKGROUND: In total hip replacement surgery for high dislocation developmental dysplasia of the hip, the advantages and disadvantages of using integrated Wagner cone prosthesis and combined S-ROM prosthesis after low femoral neck osteotomy are currently unclear.
OBJECTIVE: To explore the advantages and disadvantages of low femoral neck osteotomy combined with integrated prosthesis or combined prosthesis in the treatment of Crowe type III-IV developmental dysplasia of the hip patients.
METHODS: The clinical data of 36 patients with Crowe type III-IV developmental dysplasia of the hip in Affiliated Hospital of Southwest Medical University from September 2015 to August 2019 were analyzed retrospectively, including 5 males and 31 females, aged from 27 to 64 years. There were 19 cases on the left and 17 cases on the right. All underwent total hip replacement treatment. Among them, 18 patients were treated with Wanger cone prosthesis and 18 patients with S-ROM prosthesis. During follow-up, Harris score and visual analog score of hip joint function were compared between the two groups. Through imaging examination, differences in the prosthesis loosening, subsidence, length of the lower limbs, heterotopic ossification and osteolysis, and stress shielding of the proximal femur were observed in both groups.
RESULTS AND CONCLUSION: (1) All patients were followed up for 15 months and above in both groups. All incisions healed by first intention after surgery, and there was no dislocation of the prosthesis, aseptic loosening, infection around the prosthesis, osteolysis or heterotopic ossification. (2) There were 15 cases of I degree stress shielding effect in the proximal femur and 3 cases of II degree in the S-ROM group; 12 cases of I degree stress shielding effect and 6 cases of II degree in the proximal femur in the Wagner cone group; no significant difference was found between the two groups (P > 0.05). One patient in the S-ROM group with a shortened limb of 6.7 cm developed symptoms of femoral nerve palsy, and one patient in the Wagner cone group developed peroneal vein thrombosis after surgery; there was no significant difference in the length of the shortened limb between the two groups (P > 0.05). (3) There was no significant difference in the Harris score and visual analog score of hip joint function between the two groups at 15 months after operation (P > 0.05). (4) It is concluded that for patients with Crowe type III-IV developmental dysplasia of the hip, low femoral neck osteotomy combined with S-ROM prosthesis or integrated Wagner cone prosthesis can achieve satisfactory short-term results, but attention should be paid to the initial stability of the proximal cuff of S-ROM prosthesis.

Key words: developmental dysplasia of the hip, joint replacement, prosthesis , hip, femoral stem, S-ROM, Wanger cone

CLC Number:

Li Yang, Lyu Hui, Huang Denghua, Zou Longfei, Zhang Zhongjie, Tan Meiyun. Initial stability of integrated prosthesis or combined prosthesis in the treatment of Crowe III-IV developmental dysplasia of the hip[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(18): 2839-2843.

Figures/Tables 6

References

[1] CROWE J, MANI V, RANAWAT C. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am. 1979;61(1):15-23.
[2] GREBER E, PELT C, GILILLAND J, et al. Challenges in Total Hip Arthroplasty in the Setting of Developmental Dysplasia of the Hip. J Arthroplasty. 2017;32:S38-S44.
[3] CAYLAK R, ORS C, TOGRUL E. Minimum 10-Year Results of Cementless Ceramic-On-Ceramic Total Hip Arthroplasty Performed With Transverse Subtrochanteric Osteotomy in Crowe Type IV Hips. J Arthroplasty. 2021;36(10):3519-3526.
[4] ZENG W, LIU J, WANG F, et al. Total hip arthroplasty for patients with Crowe type IV developmental dysplasia of the hip: Ten years results. Int J Surg. 2017;42:17-21.
[5] WANG D, LI L, WANG H, et al. Long-Term Results of Cementless Total Hip Arthroplasty With Subtrochanteric Shortening Osteotomy in Crowe Type IV Developmental Dysplasia. J Arthroplasty. 2017;32(4):1211-1219.
[6] SUN C, ZHANG Y, LI L, et al. Long-Term Outcomes of Total Hip Arthroplasty With Transverse Subtrochanteric Shortening Osteotomy and Modular Stem in Crowe IV Developmental Dysplasia. J Arthroplasty. 2021;36(2):630-635.
[7] KARAISMAILOGLU B, KARAISMAILOGLU T. Comparison of Trochanteric Slide and Subtrochanteric Shortening Osteotomy in the Treatment of Severe Hip Dysplasia: Mid-Term Clinical Outcomes of Cementless Total Hip Arthroplasty. J Arthroplasty. 2020;35(9): 2529-2536.
[8] NAGOYA S, KAYA M, SASAKI M, et al. Cementless total hip replacement with subtrochanteric femoral shortening for severe developmental dysplasia of the hip. J Bone Joint Surg Br. 2009;91(9):1142-1147.
[9] WU X, LI S, LOU L, et al. The techniques of soft tissue release and true socket reconstruction in total hip arthroplasty for patients with severe developmental dysplasia of the hip. Int Orthop, 2012;36(9):1795-801.
[10] LI H, YUAN Y, XU J, et al. Direct Leverage for Reducing the Femoral Head in Total Hip Arthroplasty Without Femoral Shortening Osteotomy for Crowe Type 3 to 4 Dysplasia of the Hip. J Arthroplasty. 2018;33(3):794-799.
[11] 郭江,张忠杰,夏波,等.紧贴小转子截骨结合Wagner coneg股骨假体治疗成人Crowe Ⅳ型先天性髋关节发育不良[J].中国修复重建外科杂志,2015,29(4):435-448.
[12] 李慧武,朱振安,毛远青,等.非截骨全髋关节置换术治疗单侧CroweⅣ型髋关节发育不良[J].中华骨科杂志,2014,34(12):1205-1211.
[13] HARRIS W. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51(4):737-755.
[14] BROOKER AF, BOWERMAN JW, ROBINSON RA, et al. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973;55(8):1629-1632.
[15] GRUEN TA, MCNEICE GM, AMSTUTZ HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979; (141):17-27.
[16] KUSANO T, SEKI T, HIGUCHI Y, et al. Preoperative Canal Bone Ratio is Related to High-Degree Stress Shielding: A Minimum 5-Year Follow-Up Study of a Proximally Hydroxyapatite-Coated Straight Tapered Titanium Femoral Component. J Arthroplasty. 2018;33(6):1764-1769.
[17] BAO N, MENG J, ZHOU L, et al. Lesser trochanteric osteotomy in total hip arthroplasty for treating CROWE type IV developmental dysplasia of hip. Int Orthop. 2013;37(3):385-390.
[18] MU W, YANG D, XU B, et al. Midterm Outcome of Cementless Total Hip Arthroplasty in Crowe IV-Hartofilakidis Type III Developmental Dysplasia of the Hip. J Arthroplasty. 2016;31(3):668-675.
[19] OLLIVIER M, ABDEL M, KRYCH A, et al. Long-Term Results of Total Hip Arthroplasty With Shortening Subtrochanteric Osteotomy in Crowe IV Developmental Dysplasia. J Arthroplasty. 2016;31(8):1756-1760.
[20] SOFU H, KOCKARA N, GURSU S, et al. Transverse Subtrochanteric Shortening Osteotomy During Cementless Total Hip Arthroplasty in Crowe Type-III or IV Developmental Dysplasia. J Arthroplasty. 2015;30(6):1019-1023.
[21] YAN F, CHEN G, YANG L, et al. A reduction technique of arthroplasty without subtrochanteric femoral shortening osteotomy for the treatment of developmental high dislocation of hip: a case series of 28 hips. J Arthroplasty. 2014;29(12):2289-2293.
[22] LAI K, SHEN W, HUANG L, et al. Cementless total hip arthroplasty and limb-length equalization in patients with unilateral Crowe type-IV hip dislocation. J Bone Joint Surg Am. 2005;87(2):339-345.
[23] LI H, XU J, QU X, et al. Comparison of Total Hip Arthroplasty With and Without Femoral Shortening Osteotomy for Unilateral Mild to Moderate High Hip Dislocation. J Arthroplasty. 2017;32(3):849-856.