Clinical Analysis Of Total Hip Arthroplasty In The Treatment Of Adult Hip Dysplasia

Objective:To explore the surgical approach and clinical efficacy of Total hip arthroplasty(THA)in the treatment of adult developmental dysplasia of the hip(DDH).Methods: Clinical data of 64 cases of adult hip dysplasia treated in our hospital from January 2013 to December 2017 were collected.A retrospective analysis was performed on 64 DDH patients(78 hips)who underwent total hip replacement in the department of orthopaedics of our hospital,including 10males(10 hips)and 54 females(68 hips),50 unilateral and 14 bilateral patients,ranging in age from 22 to 73 years old,with an average age of(54.6±11.2)years.According to the preoperative positive pelvic radiographs of the patients,all patients eligible for the study were divided into four types according to Crowe classification,including Crowe I type 9 hip,Crowe II type 37 hip,Crowe III type 25 hip,and Crowe IV type 7 hip.The surgical focus was acetabular reconstruction on the true acetabulum,proximal femur and medullary cavity management,and correction of excessive anteversion.When necessary,the acetabular defect was repaired by structural bone grafting with the femoral head.All patients received biological prostheses implanted at the level of the true acetabulum.The postoperative efficacy was statistically analyzed according to the changes in Harris scoring system,visual pain simulation score(VAS)andimaging examination indexes to evaluate the clinical efficacy.Result: All patients underwent surgery successfully under general anesthesia,with a blood loss of 100-1425 ml and an average blood loss of(508.8±325.8)ml.The operative time was 51-274 min,with an average(116.4 ±51.4)min.Postoperative wound healing was achieved after fat liquefaction debridement and suture in 1 patient,and the wounds of the remaining patients were all healed in one stage,with an average hospitalization time of(15.2± 6.9)days.Limbs on the affected side were lengthened to varying degrees,with limb lengthening range of 0.5-4.0cm,with an average lengthening of(1.4 ±0.8)cm.No vascular and nerve injury occurred after limb lengthening,and no complications such as infection,pulmonary embolism and anemia occurred during hospitalization.Host bone and graft were observed by imaging examination,and trabecular reconstruction and missing contact surface were observed.During the follow-up,no dislocation of the hip joint occurred,no prosthesis loosening revision,graft absorbency loosening and fracture around the prosthesis occurred.The follow-up time was 10-64 months,with an average of(30.7 ± 15.3)months.Preoperative Harris score was(48.6 ± 5.2),and postoperative Harris score was(85.7 ± 3.4),the efficacy of all cases was evaluated according to the scoring system,with excellent hip(12),good hip(63)and adjustable hip(3),and the postoperative excellent and good rate reached96.2%.Preoperative visual pain simulation score(VAS)(5.4 ± 0.9),postoperative VAS(1.5±0.7),and preoperative and postoperative comparison t=30.2(P<0.05).The preoperative mean CE Angle was(18.7 ± 2.3),and the postoperative mean was(48.1 ± 6.7),t=-36.3(P<0.05).Preoperative acetabular coverage(AHI)average was(0.592 ±0.059),postoperative AHI average was(0.851±0.036),t=-36.4(P<0.05),the difference was statistically significant afterstatistical analysis.After surgery,the femoral eccentricity of prosthesis was(34.3± 5.1)in the unilateral patients,and(33.8 ± 5.2)in the healthy side of the unilateral patients,and the difference was not statistically significant(t=-0.96,P > 0.05).All patients had improved hip function,significant pain relief,and partial functional recovery.Conclusions:Total hip arthroplasty is an effective treatment for adult DDH and the only effective treatment for patients with advanced DDH.Postoperative hip pain and hip function were improved,and the mid-term efficacy was satisfactory.However,since surgery is more difficult than conventional hip replacement,corresponding measures should be taken according to the primary lesions and secondary pathological changes of hip dysplasia,and different surgical schemes should be developed to restore the normal physiological and anatomical structure and stress of the hip joint as much as possible,which is the key for patients to achieve good long-term results.