| ObjectiveTo investigate the value of cementless total hip arthroplasty(THA)operation for the treatment in Crowe type III developmental dysplasia of the hip(DDH)with oesteoarthritis in adults.MethodsFrom September 2012 to May 2016,Kunming Medical University First Affiliated Hospital orthopedic treatment 31 cases(33 hips)Crowe III type DDH secondary severe osteoarthritis patients.Case inclusion criteria:Crowe III type DDH secondary severe osteoarthritis,hip pain seriously affects the patient’s normal life or work.Exclusion criteria:suffering from hip infection history,fracture history,surgical history,lower limb sensory disturbances.There were 6 males(6 hips)and 25females(27hips),with the average age of 39(ranging from 19 yrs to 60 yrs)years.Unilateral DDH ocured in 29patients with 19 in left side and right side of 10,otherwise,bilateral DDH occured in 2 patients.Almost every patients had the symptom of DDH such as limp walking and pain feeling in the hips.Before being hospitalized since presenting the clinic signs,the patients suffered from the symptoms of DDH during 10-47 months(average 26 months).The sign of "4" number test,Trendenleburg sign were positive.Preoperative application of pelvic plain film,CT and other tests to assess the acetabular morphology and proximal femur.20 cases(20 hips)with autologous femoral head structural bone grafting the remaining use of bone filling bone graft,femur side are close to small rotor osteotomy.All patients were treated with a biologic hip prosthesis,with a cup diameter of 44-56 mm.The Harris score and SF-36 score were compared between the patients before and after operation.The Ranawat triang method was used to determine the rotation center of the hip joint in the ipsilateral hip anatomical rotation center and unilateral patients.The vertical distance and horizontal distance of the anatomical rotation center were measured.The eccentricity of the contralateral femur and the length of the limb were measured.The distance between the vertical and horizontal distance of the rotation center of the prosthesis,the eccentricity of the femur,the abduction angle of the acetabulum and the length of the limb were measured again.SPSS 22.0 statistical software package to deal with data,measurement data using t test to P<0.05 for the difference was statistically significant.ResultsAll the incisions healed by first intention after operation.Only 2 patients(2 hips)had complications of femoral nerve palsy,meanwhile leg swelling occurred in 7 patients(7 hips),the symptoms recoverd after supportive treatment.All the patients were followed up for 6-18 months,average time is 10 months.The sign of limp walking were improved after surgery,the pain feeling in the hips were totally relieved in 27 patients(28hips)and only 4 patients(5 hips)still had a mild pain feeling.The X-ray films showed bony healing between the grafted bone and the ilium in 3-6 months(average 5 months)since post-operation.The horizontal,vertical and femoral offset distances of the hip center were(44.35±5.09)mm,(35.89±5.16)mm and(26.98±5.98)mm.The three digital value compared with preoperative were(44.47±4.72)mm,(35.81±5.10)mm and(26.96±5.96)mm.The differences didn’t have significant statistically(P>0.05)。Harris score was increased from(40.52±6.06)to(91.16± 2.95)after surgery,there is significant statistically(t =-42.69,P<0.05).The difference of SF-36 scores also has significant statistically(P<0.05).The accuracy of the postoperative oblique angle was(42.5 ± 3.5)。compared with the guidance range(40 degrees to 45 degrees),the coincidence was 96.8%.The preoperative length of the limb was(82.30± 6.71),the postoperative length of the limb was(84.40±6.39),that means the prolong of the limb was(2.32 ± 1.50).ConclusionsThe cementless THA by the structural femoralhead autograft for patients with femoral side close to small rotor osteotomy is an effective method to treat Crowe type III DDH. |
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