| Objective:The medium-term efficacy of S-ROM stem used in total hip arthroplasty(THA)for the treatment of adult Crowe Ⅳ development dysplasia of the hip(DDH)was retrospectively analyzed to provide theoretical and practical guidance for clinical treatment.Methods:The Clinical data of patients who received THA treatment due to Crowe Ⅳ DDH in our department from January 2016 to January 2021 were collected.The follow-up time was 24-84 months,mean 47 months.Sixty-two patients(76 hips)were included in this study.There were 56 females and 6 males;48 patients were unilateral and 14 were bilateral.The age range is 22-73 with an average age of 47.Preoperative and postoperative Harris hip score(HHS),Visual analogue scale(VAS),Leg length discrepancy(LLD)and related X-ray observation indexes were recorded,respectively.The intraoperative situation,postoperative complications and subjective satisfaction of patients were summarized.To evaluate the operative effect.Results:1.Intraoperative time was 73-205(125±28)min,blood loss was 400-1300(739±207)ml;all patients were treated with biologic acetabular cup and S-ROM femoral stem.Subtrochanteric oblique osteotomy was performed on 9 hips,subtrochanteric transverse osteotomy was performed on 42 hips,with the osteotomy length ranging from 15 mm to 45 mm,mean 30 mm.Femoral split fracture occurred in 3hips(3.9%).2.Postoperative joint dislocation occurred in 5 hips(6.6%),periprosthesis fracture occurred in 1 hip(1.3%),periprosthesis infection occurred in 2 hips(2.6%),nerve paralysis occurred in 4 hips(5.3%),secondary osteotomy due to hyperextension of the affected limb occurred in 1 hip(1.3%),there were no other complications occurred.3.At the final follow-up,the Harris hip score was(88.97±3.44)improved compared to preoperatively(44.87±5.18),and the difference was statistically significant(t=115.966,P<0.05);the VAS score was(1.96±0.81)decreased compared to preoperatively(7.18±0.71),and the difference was statistically significant(t=-56.227,P<0.05);the patients’ self-rated satisfaction: 34 hips were very satisfied,29 hips were fairly satisfied,7 hips were average,3 hips were less satisfied,and 3 hips were very dissatisfied.4.At the final follow-up,the leg length discrepancy was(7.80±6.56)mm lower compared to preoperatively(35.20±20.15)mm,and the difference was statistically significant(t=-10.383,P<0.05);the extension of the affected limb was 4.96 mm to57.53 mm,mean 28.41 mm.5.At the final follow-up,the abduction angle of the cup was 32.50-58.00(42.01±5.24)°,with a median of 41.35°;the anteversion angle of the cup was 3.01-31.75(16.09±4.76)°,with a median of 15.88°.In patients with unilateral DDH,postoperatively;the femoral offset(FO)was 30.22(27.65,32.75)mm,which was statistically significant compared with 32.50(30.03,34.74)mm on the healthy side(Z=-3.912,P<0.05);the vertical distance between the acetabulum rotation center and tear drop line was 16.21(13.89,18.78)mm,which was statistically significant compared with 18.52(16.21,20.81)mm on the healthy side(Z=-3.022,P<0.05);the horizontal distance between the center of acetabulum rotation and the edge of tear drop was 26.76(24.44,28.00)mm,which was statistically significant compared with 28.65(27.63,30.25)mm on the healthy side(Z=-4.647,P<0.05).6.At the final follow-up,radiographs showed that all acetabular prostheses were well pressed with no loosening,liner wear,or osteolysis.The proximal microporous coating part of all femoral stem prostheses obtained stable bone growth,and the distal intramedullary compression was well fixed without loosening and subsidence.Conclusion:Total hip arthroplasty with S-ROM stem is a safe and effective way for the treatment of adult Crowe Ⅳ DDH,satisfactory medium-term efficacy can be achieved,which including significant improvement of hip function,significant relief of pain,reduction of leg length discrepancy,low complication rate,and high patient satisfaction. |
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