Clinical Effect Of Treatment For Congenital Dysplasia Of The Hip With Total Hip Replacement

Background:A number of patients with congenital Dysplasia of the Hip(CDH)are unaware of their condition before seeking medical care.Almost all patients seek medical treatment at the end of the disease when soreness and even rest occur after hip activity.Pain,joint stiffness and limited mobility,severely troubled the quality of life and work ability.When the pain could not been inhibited by non-surgical treatment such as non-steroidal and other analgesic drugs,Total Hip Replacement will be a new treatment for the patient.Purpose:To analyse retrospectively the clinical efficacy of treatment of total hip replacement in the treatment of osteoarthritis resulted from congenital dysplasia of the hip.Methods:From August 2015 to November 2017,20 cases with osteoarthritis resulted from congenital dysplasia of the hip had been treated with total hip replacement(THR)in qilu hospital.Finally,24 hips accepted total hip replacement because bilateral total hip replacement was performed in 4 patients.The age of the patients ranged from 42～65 years,the main age was(55.3±0.3)years old.In this study,according the X ray,hips were divided into four types before operation by Crowe typing method:type Ⅰ11 hips;type Ⅱ6 hips;type Ⅲ 3 hips;type Ⅳ 4 hips.As we all known,it is key points in surgery to reconstruct acetabulum in or nearby the original one as well as autograft with femoral head in acetabulum defect area and well prepared graft bed.Moreover,soft tissue should be relaxed,including total excision of the joint capsule and scarring of tissue near the acetabulum.In order to evaluate the effect of surgery,the clinical outcomes were graded into excellent,good,fair and poor according to the Harris score system.Results:The operations in each type had been performed successfully,and the incision had healed well in I stage.All patients walked independently without crutches,took care of themselves and returned to their pre-operative work within 3 months after surgery.The pre-operation functional scores of hips averaged 47.1±7.8,while the post-operation functional scores were 91.2±6.7.The postoperative functional scores and preoperative functional scores were statistically significant(t =17.7236,P<0.05).According to the Harris score system,hip function of 24 hips were displayed as below:excellent in 22 hip,good in 2 hip,fair in 2 hip.And the rate of excellent and good hip function was 91.67%.Moreover,no dislocation of hip happened afther operation,and no others complications in the series.In this study,the average follow-up time was(22.9 ± 0.3)months,ranging from 6 to 24 months,and the position of the component in each patient were radiographic satisfactory,tested by X ray and CT.Conclusions:Total hip replacement is an effective method for treating osteoarthritis secondary to congenital hip dysplasia in adults.There were four special problems encountered in the surgical procedure should be considered,such as the position of the acetabular component,the implantation of the femoral stem,the reconstruction of the abductor force,and the correction of the leg length difference.This is a challenging job for orthopedic surgeons,and careful preoperative planning is recommended.