Total Hip Arthroplasty On Sagittal Spine-Pelvis-Leg Alignment In Adult Patients With Unilateral Crowe Type â…£ Developmental Dysplasia Of The Hip

Part Ⅰ:Study on the sagittal spine-pelvis-leg alignment in adult patients with U-ⅣDDHPurpose:To investigate the sagittal spine-pelvis-leg alignment(SSPLA)in adult patients with unilateral Crowe Ⅳ developmental dysplasia of the hip(U-IV DDH)by comparing the differences in sagittal imaging parameters between adult patients with U-IV DDH,normal people and primary hip osteoarthritis(HOA)patients.Methods:20 normal people(normal control group,NC-G),20 patients with HO A(HO A group,HOA-G)and 21 patients with U-Crowe IV DDH(DDH group,DDH-G)were studied.The full-spinal lateral X-ray images were obtained with the patients placed upright position.The following parameters were measured:(1)spinal sagittal plane parameters:spinal tilt(ST),thoracic kyphosis(TK),lumbar lordosis(LL)and sagittal vertical axis(SVA);(2)pelvic sagittal parameters:pelvic incidence(PI),sacral slope(SS),pelvic tilt(PT),sacrum pubic incidence(SPI),sacrum femoral angle(SFA),pelvic femoral angle(PFA);(3)lower limb sagittal parameter:femoral inclination(FI).The differences in sagittal parameters among the three groups were analyzed by ANOVA test.P<0.05 was considered significant.Results:1.General situation:There were no statistically significant differences in the age and gender distribution among the three groups(P>0.05).2.Imaging parameters:The ST(87.15 ± 3.24°),LL(37.41 ± 1.290)and TK(15.20 ± 3.22°)were significantly smaller,while the SVA(5.28 ± 0.85 cm),PI(55.27 ± 3.23°),SS(54.94 ± 8.42°),SPI(72.93 ± 5.28°),PFA(10.19 ±2.88°)and FI(5.48 ± 3.03°)in DDH-G were significantly higher than those in NC-G and HOA-G(P<0.05);The PT(13.04 ± 2.73°)in DDH-G was just a little higher than those in NC-G and HOA-G,but there was no statistically significant difference between DDH-G and NC-G(P>0.05);The SFA(47.31 ± 7.94°)in DDH-G was smaller than those in NC-G and HOA-G,but there were no statistically significant differences(P>0.05).Conclusions:The adult patients with U-IV DDH had an abnormal sagittal spine-pelvis-leg alignment(ASSPLA).Part Ⅱ:Improvement of THA on ASSPLA in adult patients with U-IV DDHPurpose:To investigate the improvement in SSPLA after THA operation in adult patients with U-IV DDH.Methods:From November 2015 to February 2018,21 patients(21 hips)with U-IV DDH undergoing THA in the department of Bone and Joint of Shandong Provincial Hospital were recruited.There were 20 females and 1 male with an average age of 50.7 ± 6.4 years-old(range,24 to 64 years-old).All these patients were followed up at 3,6 months after operation.The pelvic anteroposterior radiographs and standing position full-spinal anteroposterior and lateral radiographs were obtained before and after THA operation.The following parameters were measured to examine the sagittal alignment of spine-pelvis-leg:spinal sagittal parameters:spine tilt(ST),thoracic kyphosis(TK),lumbar lordosis(LL)and Sagittal vertical axis(SVA);pelvic sagittal parameters:pelvic incidence(PI),sacral slope(SS),pelvic tilt(PT),sacral pelvic angle(SPI),sacral femoral angle(SFA),pelvic femoral angle(PFA);lower limb sagittal parameters:femoral tilt(FI).Self-paired T-tests were used for comparison.P<0.05 was considered significant.Results:1.General situation:dislocation in I case,no postoperative infection,prosthesis loosening,vascular nerve injury,deep venous thrombosis and other complications were found during the follow-up period.2.Imaging parameters:At 6 months after operation,adult patients with U-IV DDH showed significantly larger ST(87.15 ± 3.24° vs 92.94 ± 3.23°),LL(37.41 ±1.29°vs 40.79 ± 2.36°),TK(15.20 ± 3.22° vs 24.35 ± 3.37°),SFA(42.01 ± 3.12°vs 46.23 ± 3.25°)and significantly smaller SVA(5.28 ° 0.85cm vs 2.47 ° 1.32 cm),SS(54.94 ± 8.42°vs 38.68 ± 2.75°),FI(5.48 ± 3.03°vs1.40 ° 0.88°)compared with those measured before operation(P<0.05).However,the PI,PT,PFA and SPI after operation were not significantly different from those measured before operative(P>0.05).Additionally,the parameters at 6 months after surgery were not significantly different from those measured at 3 months after surgery.3.Harris Score of the hip:The score after operation was higher than before operation(90.50±3.93 vs 35.13±4.90)(P<0.05).Conclusions:The ASSPLA in adult patients with U-IV DDH could be restored by THA operation.Moreover,THA is a safe and effective method for the treatment of adult patients with U-V DDH.Part Ⅲ:Improvement of THA on LLD in adult patients with U-Ⅳ DDHPurpose:To investigate the improvement of THA on LLD in adult patients with U-IV DDH.Methods:From November 2015 to February 2018,21 patients(21 hips)with U-IV DDH undergoing THA in the department of Bone and Joint of Shandong Provincial Hospital were recruited.There were 9 females and 1 male with an average age of 50.7 ± 6.4 years-old(range,24 to 64 years-old).All these patients were followed up at 3,6 month after operation.The pelvic AP radiographing and total-length radiographing of both lower limbs were obtained before and after THA operation.The length of the patient’s lower limb after the operation was compared with that measured before operation.The difference in the leg length before and after THA operation was analyzed by ANOVA test.P<0.05 was considered significant.Results:The leg length of adult patients with U-IV DDH was reduced from preoperative(3.69 ± 0.65 cm)(range,2.45 to 4.64 cm)to postoperative(0.94 ± 0.49 cm)(range,0.00 to 1.91 cm),and the difference was statistically significant(P<0.05).Conclusions:THA could effectively improve the leg length equality of adult patients with U-IV DDH,which will help to improve patient’s limp and tilted pelvis,and to restore the normal biomechanical properties of the spine.Part Ⅳ:Improvement of THA on back pain in adult patients with U-IV DDHPurpose:To evaluate the improvement of back pain after THA operation in adult patients with U-IV DDH using visual analog scale(VAS)and Oswestry dysfunction index(OSW).Methods:From No’vember 2015 to February 2018,21 cases of adult patient with U-IV DDH with back pain symptoms in the Department of Bone and Joint of Shandong Provincial Hospital were recruited.The visual analog scale(VAS)and Oswestry dysfunction index(OSW)were used to evaluate patients’ back pain.Data were compared by ANOVA test.P<0.05 was considered significant.Results:The VAS score of adult patients with U-IV DDH was reduced from 8.00 ± 0.81 preoperatively to 1.80 ± 0.78 postoperatively,while the OSW score was reduced from 40.30 ± 5.07 preoperatively to 16.30 ± 4.11 postoperatively.The differences were statistically significant(P<0.05)Conclusion:THA could effectively relieve comorbid back pain symptoms in adult patients with U-IV DDH.