Clinical Results Of Proximal Femur Reconstruction For Crowe Type-Ⅳ Developmental Dysplasia Of The Hip

Objective Proximal femoral reconstruction techniques use a more concise and effective osteotomy to correct the anatomy of proximal femoral deformities.To investigate the early clinical effects and complications of proximal femoral reconstruction and total hip replacement for high congenital hip dysplasia with proximal femoral deformity.Methods From May 2015 to March 2018,29 cases(33 hips)with congenital hip dysplasia combined with proximal femoral deformity were treated with total hip arthroplasty with proximal femoral reconstruction technology.Among them,there were6 males(7 hips)and 23 females(26 hips),with an average age of 44.9 ±12.3years(range,24-74years).Preoperative X-ay and CT showed serious anatomical abnormalities,including the dislocation of the the hips with the greater trochanters moved up significantly,abnormal femoral neck development,abnormal rake angle and neck stem anglel and abnormal development of the medullary cavity.All the Trendelenburg signs preoperatively were positive.Perioperative clinical indicators,hip function score,difference in length of lower extremity,gait,complications,and radiographic data were also evaluated.Results All cases were followed up for 19-53 months,with an average of 33.0±11.0months.All the surgicalincisions were primary healing without infection or deep vein thrombosis,and all the osteotomy fragments healed at the follow-up of half a year.The Harris score of the hip increased from 44.0±12.0 points preoperatively to 89.8±2.8 at the last follow-up,showing a statistically significant difference(t=-22.917,P<0.01).Thedifference in the length of lower limbs was recovered from 3.8±1.6cm before the operation to 0.6± 0.4cm after the operation,and the difference was statistically significant(t=11.958,P<0.01).Among them,the difference in the length of lower limbs in 2 patients was greater than 1cm,but less than 2cm,and that in other patients was less than 1cm.The X-ray showed that the osteotomy area was union with obvious callus formation and blurred osteotomy line at 3-6 months after surgery.At the last follow-up,no displacement loosening was observed in the acetabular prosthesis,and no wire fracture was observed in the proximal femoral osteotomy.Local osteolysis was observed in Gruen 1 and 7 areas around the femoral prosthesis in 2 patients.The femoral and acetabular components showed no obvious loosening and sinking.,both acetabular prosthesis and femoral prosthesis achieved good bone growth.Conclusion Used the proximal femoral reconstruction with total hip replacement for Crowe type Ⅳ congenital hip dysplasia,curative effect is satisfied with early postoperative clinical follow-up results.Proximal femoral reconstruction technique can effectively restore nearly normal proximal femoral anatomical structure,which is one of the effective methods for the treatment of patients with high congenital hip dysplasia with proximal femoral deformity.