The Use Of Combined Anteversion In Total Hip Arthroplasty For Patients With Crowe â…£ Dysplasia Of The Hip

Objective:The combined anteversion technique has been proposed recently and proved to be an applicable technique in general THA. However, complications of dislocation rate was higher in adult Crowe IV degree of developmental dysplasia of the hip with osteoarthritis after total hip arthroplasty, but the combined anteversion technique is not applied in these patients.The purpose of this retrospective study was to demonstrate the clinical outcome of using combined anteversion (CA) technique to prevent dislocation in cementless total hip arthroplasty(THA) with patients who had Osteoarthritis secondary to Crowe Group-IV developmental dysplasia of the hip((DDH).Materials and Methods:This paper retrospectively selected 16 patients,12 female,14 hips and 2 male,2 hips with Crowe Ⅳ degree of DDH from August 2007 to August 2013. Patients’　average age was 53.13±5.43 years (36 to58), average follow-up was 45±24.20 months (12-96). The arthroplasty was performed in combination with a subtrochanteric shortening osteotomy,with placement of the acetabular component at the level of the anatomic hip center and with CA technique, which fixing acetabular component and adjusting femoral anteversion Anteversion angle of cetabulum and femoral prosthesis and CA were measured postoperatively. Clinical evaluation was assessed by investigating preoperative and postoperative Harris score system and presence of dislocation.During follow-up,radiographic evaluation was assessed by both sides of the pelvis and the affected side lateral X-ray taken preoperatively and postoperatively.Result:All patients were followed up. Harris hip score increased significantly by comparing The average preoperative with postoperative Harris hip score, from 43.31 ±2.57(38-47) to 88.06±3.33(78-92). Postoperative the mean three-dimensional CT measurement of acetabular anteversion angle was 31.19±2.50°(26.30°-35.15°),femoral anteversion average was 17.94±2.88° (15.36°-26.20°), the mean CA was 49.25±2.62 °(43.44-54.45°). Preoperative Trendelenburg syndrome were positive, and were negative at 12 month follow-up.At last follow-up,1 cases of mild claudication was found at last follow-up. No dislocation, prosthesis loosening, infection, femoral osteotomy and acetabular overhead bone nonunion and other complications were found at last follow-up, nor were sciatic nerve and femoral nerve palsy.2 cases of heterotopic ossification(HO) asymptomatic were found During follow-up.Conclusion The incidence of postoperative dislocation can be effectively prevented with the technique of placement of the acetabular componen in the true acetabulum, subtrochanteric shortening transverse Osteotomy, CA technology of fixing acetabular component,adjusting femoral anteversion in cementless total hip arthroplasty (THA) in the treatment of adult Crowe Ⅳ of developmental dysplasia of the hip, good function can be also obtained.