Total hip arthroplasty results in the osteoarthritis secondary to developmental dysplasia

Abstract

Together with standard total hip arthroplasty (THA), total hip arthroplasty in hip dysplasia and hip dislocation cases has also increased in our country. In this study short and long term evaluation of total hip arthroplasty cases secondary to osteoarthritis following Crowe type III and IV developmental dysplasia of the hip (DDH) has been evaluated. In Ondokuz Mayis University Medical Faculty Department of Orthopaedics and Traumatology we have retrospectively evaluated 78 THA patients presenting with high dislocation between May 2000 and May 2008. Out of 65 patients seventy-eight hips were assessed in the study. One of the patients was male and remaining 64 patients were females. Thirty-four (43.6%) patients were operated from their right hips, while 44 (56.4%) patients were operated from their left hips. Mean follow up time was 49.5 months (10–105 months). Seventy-eight hips were operated using posterolateral approach. Patients were postop¬eratively evaluated in 1st, 5th, 3rd, 5th, 6th and 12th months and once for the subsequent year. Clinical Harris scale and radiological Callaghan and Engh criteria were used to evaluate the results. Results were evaluated both clinically and radiologically. Twenty-two (28.2%) of the 78 hips were determined to be Crowe type III and 56 (71.8%) of them were type IV. Mean value of limb length deficiency before operation was 3.29 cm (distribution 0–7.5 cm, ± 2.06), in the final control it was determined to be 0.84 cm (distribution 0–2 cm, ±0.89). Trochanteric osteotomy was performed for 41 (52.5%) hips and sub trochanteric osteotomy was performed for 21 (%26.9) hips. In these osteotomized hips acetabulum was moved to its plausible location. Shortening was not performed in 16 (20.5%) patients. Mean value for distance of greater trochanter–minor trochanter was 49.20 mm. (31–65mm, ± 6.5). In 21 (26.9%) of the patients autograft taken from femoral head was put on to superolateral of acetabulum. Acetabular covering was 20-35%, and the median value was 30 (20-35) %. In 10 (12.8%) of the 62 osteotomized hips non-union was detected. In 7 patients (8.9%) there was late dislocation (except one). Preoperative mean Harris score was 41.9 (± 8.9) while postoperative mean Harris score was 88.9 (± 9.5). According to these results, 69 (69.7%) of the cases were excellent, 22 (22.2%) were very good, 6 (6.1%) were good and 2 (2%) were average. Results of total hip arthroplasties following developmental dysplasia or dislocation of hip are quite good. When examining the complaints leading to losses in PO Harris score, it has been found out that holding the handrails while climbing up the stairs as well as wearing shoes and socks have been detected to be the factors resulting in most decreases in the score. On the other hand, it has apparently been showed that in all the criteria including pain, walking, activity, deformity and latitude of motion which are the general basis of Harris evaluation schedule, point increase that is recovery has been determined in PO period. 

Keywords

• Developmental hip dysplasia
• Arthroplasty
• Osteoarthritis
• Femoral shortening osteotomy
• Trochanteric osteotomy

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