Cementless Total Hip Arthroplasty for Patients with Crowe Type III or IV Developmental Dysplasia of the Hip: Two-Stage Total Hip Arthroplasty Following Skeletal Traction after Soft Tissue Release for Irreducible Hips

Abstract

BackgroundTotal hip arthroplasty (THA) for severe developmental dysplasia of the hip (DDH) is a technically demanding procedure for arthroplasty surgeons, and it is often difficult to reduce the hip joint without soft tissue release due to severe flexion contracture. We performed two-stage THAs in irreducible hips with expected lengthening of the affected limb after THA of over 2.5 cm or with flexion contractures of greater than 30 degrees in order to place the acetabular cup in the true acetabulum and to prevent neurologic deficits associated with acute elongation of the limb. The purpose of this study is to evaluate the outcomes of cementless THA in patients with severe DDH with a special focus on the results of two-stage THA.MethodsRetrospective clinical and radiological evaluations were done on 17 patients with Crowe type III or IV developmental DDH treated by THA. There were 14 women and 3 men with a mean age of 52.3 years. Follow-ups averaged 52 months. Six cases were treated with two-stage THA followed by surgical hip liberalization and skeletal traction for 2 weeks.ResultsThe mean Harris hip score improved from 40.9 to 89.1, and mean leg length discrepancy (LLD) in 13 unilateral cases was reduced from 2.95 to 0.8 cm. In the patients who underwent two-stage surgery, no nerve palsy was observed, and the single one-stage patient with incomplete peroneal nerve palsy recovered fully 4 weeks postoperatively.ConclusionsThe short-term clinical and radiographic outcomes of primary cementless THA for patients with Crowe type III or IV DDH were encouraging. Two-stage THA followed by skeletal traction after soft tissue release could provide alternative solutions to the minimization of limb shortenings or LLD without neurologic deficits in highly selected patients.

Two-stage total hip arthroplasty for primary advanced septic arthritis of the hip in adults: comparison of debridement versus femoral head resection with spacer implantation

“…Subsequent study has revealed that two-stage THA using interval spacer can improve the Harris Hip Score [22]. In addition, Yoon et al [23] have reported that two-stage THA could reduce the mean leg length discrepancy from 2.95 to 0.8 cm. Furthermore, two-stage THA using debridement or antiloaded spacer implantation can treat effectively for patients with advanced active tuberculosis of the hip and there were no significant differences between the two procedures [9].…”

Minimum 10-Year Outcome of One-Stage Total Hip Arthroplasty Without Subtrochanteric Osteotomy Using a Cementless Custom Stem for Crowe III and IV Hip Dislocation

“…A potential increased risk of infection remains, owing to the use of an external fixator, and the hospital stay was increased by 2 weeks, corresponding to the time needed for lengthening before the second stage. Yoon et al [22] described a 2-stage operation planned in 6 irreducible hips when expected lengthening of the affected limb after THA was superior to 2.5 cm or when flexion contracture was superior to 30 0 . Surgical hip release with abductor slide, tensor fascia lata, sartorius muscle, iliopsoas tendon, and rectus femoris release was performed through 2 skin incisions during the first stage.…”

“…Thirteen hips (50%) had a previous surgery on the considered hip, including 6 shelf arthroplasties, 5 intertrochanteric osteotomies, 1 open reduction, and 1 Chiari pelvic osteotomy. The mean follow-up was 16 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) years.…”

“…Several authors have reported long-term results of THA for high DDH performed using shortening osteotomy [16e21]. To avoid the complications related to osteotomy, recent reports documented 2-stage progressive femoral lowering followed by a cementless THA (Yoon et al [22], Binazzi [23]). However, only few papers have documented the long-term results of isolated cementless THA in such etiology (Crowe III and IV) [24,25] and none using isolated custom stems.…”

Endoprothese bei Dysplasiecoxarthrose

“…Die Anlage des Fixateurs kann mit und ohne einen gleichzeitigen Weichteilrelease bzw. eine Kopfresektion erfolgen und auch die Kombination mit einer späteren Verkürzungsos-teotomie ist möglich [33,45,76]. Sogar die primäre Endoprothesenimplantation (in luxierter Position und Kombination mit einem Weichteilrelease sowie Anlage eines Fixateurs externe) mit anschließender Distraktionsbehandlung und final geschlossener Reposition nach erreichtem Längenausgleich ist beschrieben [46].…”