Total Hip Arthroplasty in Patients with Crowe Grades II, III, and IV Developmental Dysplasia of the Hip: Evaluation of Different Acetabular Reconstruction Techniques. Clinical and Functional Outcomes and Radiographic Analysis
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Published:
Oct 17, 2024
Keywords:
Developmental dysplasia of the hip, Crowe classification, total hip arthroplasty
Main Article Content
Abstract
Introduction: Developmental dysplasia of the hip (DDH) is one of the leading causes of hip osteoarthritis, particularly in young patients. Total hip arthroplasty (THA) is an effective treatment to alleviate pain and improve function in these patients. However, anatomical deformities and the variability in the presentation of DDH make these surgeries challenging.
Objectives: To evaluate the clinical and functional outcomes of THA in patients with Crowe grades II, III, and IV DDH and to analyze the acetabular reconstruction techniques used.
Methods: This retrospective study included patients who underwent THA between 2008 and 2023. Patients were assessed using the Harris Hip Score and radiographic imaging. Statistical analyses were performed to compare outcomes and evaluate the relationship between age and postoperative progress.
Results: The sample included 50 patients with Crowe grades II, III, and IV DDH. Of the patients, 78% were female, with a mean age of 47.24 years. Crowe grade II DDH was found in 49.12% of the patients. The most common acetabular reconstruction technique was medialization (58%). There was no significant relationship between age and clinical outcomes. Postoperative complication rates were similar across age groups.
Conclusions: This study suggests that age does not significantly influence THA outcomes in patients with Crowe grades II, III, and IV DDH. The choice of acetabular reconstruction technique should be individualized for each case.
Objectives: To evaluate the clinical and functional outcomes of THA in patients with Crowe grades II, III, and IV DDH and to analyze the acetabular reconstruction techniques used.
Methods: This retrospective study included patients who underwent THA between 2008 and 2023. Patients were assessed using the Harris Hip Score and radiographic imaging. Statistical analyses were performed to compare outcomes and evaluate the relationship between age and postoperative progress.
Results: The sample included 50 patients with Crowe grades II, III, and IV DDH. Of the patients, 78% were female, with a mean age of 47.24 years. Crowe grade II DDH was found in 49.12% of the patients. The most common acetabular reconstruction technique was medialization (58%). There was no significant relationship between age and clinical outcomes. Postoperative complication rates were similar across age groups.
Conclusions: This study suggests that age does not significantly influence THA outcomes in patients with Crowe grades II, III, and IV DDH. The choice of acetabular reconstruction technique should be individualized for each case.
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How to Cite
Rivera Bacile, V., Paz, M. L., Rabello, N., Mishima, R. S., Pioli, I. J., Gómez, J. M., Iglesias , S. L., & Allende, B. L. (2024). Total Hip Arthroplasty in Patients with Crowe Grades II, III, and IV Developmental Dysplasia of the Hip: Evaluation of Different Acetabular Reconstruction Techniques. Clinical and Functional Outcomes and Radiographic Analysis. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(5), 443-449. https://doi.org/10.15417/issn.1852-7434.2024.89.5.1966
Section
Clinical Research
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References
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IV developmental dysplasia of the hip: Ten years results. Int J Surg 2017;42:17-21. https://doi.org/10.1016/j.ijsu.2017.04.029
2. Grappiolo G, La Camera F, Della Rocca A, Mazziotta G, Santoro G, Loppini M. Total hip arthroplasty with a
monoblock conical stem and subtrochanteric transverse shortening osteotomy in Crowe type IV dysplastic hips. Int Orthop 2018;43(1):77-83. https://doi.org/10.1007/s00264-018-4122-5
3. Krych AJ, Howard JL, Trousdale RT, Cabanela ME, Berry DJ. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-IV developmental dysplasia. J Bone Joint Surg Am 2010;92(Suppl 1 Pt 2):176-87. https://doi.org/10.2106/JBJS.J.00061
4. Greber E, Pelt CE, Gililland J, Anderson MB, Erickson J, Peters CL, Challenges in total hip arthroplasty in the
setting of developmental dysplasia of the hip. J Arthroplasty 2017;32(9S):S38-S44. https://doi.org/10.1016/j.arth.2017.02.024
5. Hartofilakidis G, Karachalios T, Stamos KG. Epidemiology, demographics, and natural history of congenital hip
disease in adults. Orthopedics 2000;23(8):823-7. https://doi.org/10.3928/0147-7447-20000801-16
6. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone
Joint Surg Am 1979;61(1):15-23. PMID: 365863
7. Jasty M, Harris WH. Total hip replacement in the congenitally dysplastic hip. Op Tech Orthop 1995;5(4):336-40.
https://doi.org/10.1016/S1048-6666(95)80034-4
8. O’Neill CL, Creedon SB, Brennan SA, O’Mahony FJ, Lynham RS, Guerin S, et al. Acetabular revision using
trabecular metal augments for Paprosky type 3 defects. J Arthroplasty 2018;33(3):823-8.
https://doi.org/10.1016/j.arth.2017.10.031
9. Park MS, Kim KH, Jeong WC, Han SH. Cementless total hip arthroplasty with subtrochanteric transverse
shortening osteotomy in Crowe type IV hip dysplasia. J Arthroplasty 2007;22(7):1031-6.
https://doi.org/10.1016/j.arth.2007.05.011
10. Delp SL, Maloney W. Effects of hip center location on the moment-generating capacity of the muscles. J Biomech 1993;26(4-5):485-99. https://doi.org/10.1016/0021-9290(93)90011-3
11. Makita H, Inaba Y, Hirakawa K, Saito T. Cementless total hip arthroplasty for Crowe type IV hip dysplasia: surgical technique and long-term results. J Arthroplasty 2012;27(5):860-6. https://doi.org/10.1016/j.arth.2006.02.157
12. Akbaba YA, Can A, Erdoğan, F. The outcome of total hip arthroplasty in patients with developmental dysplasia of the hip. J Back Musculoskelet Rehabil 2019;32(6):913-9. https://doi.org/10.3233/BMR-181367
13. Eskelinen A, Helenius I, Remes V, Ylinen P, Tallroth K, Paavilainen T. Cementless total hip arthroplasty in patients with high congenital hip dislocation. J Bone Joint Surg Am 2006;88(1):80-91. https://doi.org/10.2106/JBJS.E.00037
14. Smolders JM, Pakvis DF, Hendrickx BW, Verdonschot N, Van Susante JL. Periacetabular bone mineral density
changes after resurfacing Hip arthroplasty versus conventional total hip arthroplasty. a randomized controlled
DEXA study. J Arthroplasty 2013;28(7):1177-84. https://doi.org/10.1016/j.arth.2012.08.025
IV developmental dysplasia of the hip: Ten years results. Int J Surg 2017;42:17-21. https://doi.org/10.1016/j.ijsu.2017.04.029
2. Grappiolo G, La Camera F, Della Rocca A, Mazziotta G, Santoro G, Loppini M. Total hip arthroplasty with a
monoblock conical stem and subtrochanteric transverse shortening osteotomy in Crowe type IV dysplastic hips. Int Orthop 2018;43(1):77-83. https://doi.org/10.1007/s00264-018-4122-5
3. Krych AJ, Howard JL, Trousdale RT, Cabanela ME, Berry DJ. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-IV developmental dysplasia. J Bone Joint Surg Am 2010;92(Suppl 1 Pt 2):176-87. https://doi.org/10.2106/JBJS.J.00061
4. Greber E, Pelt CE, Gililland J, Anderson MB, Erickson J, Peters CL, Challenges in total hip arthroplasty in the
setting of developmental dysplasia of the hip. J Arthroplasty 2017;32(9S):S38-S44. https://doi.org/10.1016/j.arth.2017.02.024
5. Hartofilakidis G, Karachalios T, Stamos KG. Epidemiology, demographics, and natural history of congenital hip
disease in adults. Orthopedics 2000;23(8):823-7. https://doi.org/10.3928/0147-7447-20000801-16
6. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone
Joint Surg Am 1979;61(1):15-23. PMID: 365863
7. Jasty M, Harris WH. Total hip replacement in the congenitally dysplastic hip. Op Tech Orthop 1995;5(4):336-40.
https://doi.org/10.1016/S1048-6666(95)80034-4
8. O’Neill CL, Creedon SB, Brennan SA, O’Mahony FJ, Lynham RS, Guerin S, et al. Acetabular revision using
trabecular metal augments for Paprosky type 3 defects. J Arthroplasty 2018;33(3):823-8.
https://doi.org/10.1016/j.arth.2017.10.031
9. Park MS, Kim KH, Jeong WC, Han SH. Cementless total hip arthroplasty with subtrochanteric transverse
shortening osteotomy in Crowe type IV hip dysplasia. J Arthroplasty 2007;22(7):1031-6.
https://doi.org/10.1016/j.arth.2007.05.011
10. Delp SL, Maloney W. Effects of hip center location on the moment-generating capacity of the muscles. J Biomech 1993;26(4-5):485-99. https://doi.org/10.1016/0021-9290(93)90011-3
11. Makita H, Inaba Y, Hirakawa K, Saito T. Cementless total hip arthroplasty for Crowe type IV hip dysplasia: surgical technique and long-term results. J Arthroplasty 2012;27(5):860-6. https://doi.org/10.1016/j.arth.2006.02.157
12. Akbaba YA, Can A, Erdoğan, F. The outcome of total hip arthroplasty in patients with developmental dysplasia of the hip. J Back Musculoskelet Rehabil 2019;32(6):913-9. https://doi.org/10.3233/BMR-181367
13. Eskelinen A, Helenius I, Remes V, Ylinen P, Tallroth K, Paavilainen T. Cementless total hip arthroplasty in patients with high congenital hip dislocation. J Bone Joint Surg Am 2006;88(1):80-91. https://doi.org/10.2106/JBJS.E.00037
14. Smolders JM, Pakvis DF, Hendrickx BW, Verdonschot N, Van Susante JL. Periacetabular bone mineral density
changes after resurfacing Hip arthroplasty versus conventional total hip arthroplasty. a randomized controlled
DEXA study. J Arthroplasty 2013;28(7):1177-84. https://doi.org/10.1016/j.arth.2012.08.025