High Hip Center Technique in Total Hip Arthroplasty for Crowe Type II–III Developmental Dysplasia: Results of Midterm Follow‐up

Abstract

Objectives We aimed to show the utility of high hip center technique used in patients with Crowe II–III developmental dysplasia of the hip at the midterm follow‐up and evaluated the clinical and radiographic results between different heights of hip center. Methods From December 2003 to November 2013, we retrospectively evaluated 69 patients (85 hips) with Crowe II–III dysplasia who underwent a high hip center cementless total hip arthroplasty. The patients were divided into two groups according to the height of hip center, respectively group A (≥ 22 mm and < 28 mm) and group B (≥28 mm). The survivorship outcomes and radiographic and clinical results, including the vertical and horizontal distances of hip center, femoral offset, abductor lever arm, cup inclination, leg length discrepancy, Trendelenburg sign, and limp were evaluated. Results The mean follow‐up time was 8.9 ± 1.8 years. The mean location of the hip center from the inter‐teardrop was 25.1 ± 1.6 mm vertically and 30.0 ± 3.8 mm horizontally in group A, and 33.1 ± 4.8 mm vertically and 31.4 ± 6.1 mm horizontally in group B. Eleven hips of group B showed a lateralization over 10 mm, and the same was shown in one hip in group A (P = 0.012). There were no statistically significant differences between two groups in postoperative femoral offset, abductor lever arm, leg length discrepancy and cup inclination. At the final follow up, the mean WOMAC and Harris hip score were significantly improved in both groups. Of the 85 hips, four hips in group A and three hips in group B showed a positive Trendelenburg sign. Additionally, four patients in group A and two patients in group B presented with a limp. No significant differences were shown regarding the Harris hip score, WOMAC score, Trendelenburg sign, and limp between two groups. One hip of group A was revised by reason of dislocation at 8.3 years after surgery. One hip of group B was diagnosed with osteolysis and underwent a revision at 8.1 years after surgery. The Kaplan–Meier implants survivorship rates at the final follow‐up for all‐causes revisions in group A and group B were similar (96.7% [95% confidence interval, 90.5%–100%] and 96.2% [95% confidence interval, 89.0%–100%], respectively). Conclusions The high hip center technique is a valuable alternative to achieve excellent midterm results for Crowe II–III developmental dysplasia of the hip. Further, between the groups with differing degrees of HHC, there were no significant differences in outcomes or survivorship in our study.

Jumbo cup in hip joint renovation may cause the center of rotation to increase

“…Although Nwankwo et al [ 11 ] and others found that the average rotational center rose 11 mm in their study, the rise in the average rotational center was only 7.5 mm in our study. These values represent excellent outcomes in numerous research reports regarding the placement of jumbo cups with high rotational centers in treating lateral acetabular defects[ 12 - 15 ]. Kelley[ 16 ]’s study of 23 jumbo cups placed with a high rotational center did not show loosening at an average of 35 mo of follow-up.…”

Functional and radiographical results of asymmetrically reconstructed total hip arthroplasty in patients with bilateral dysplastic arthritic hips with one hip Crowe II–III and the other Crowe IV: a retrospective cohort study

“…High hip center technique has become a prevalent method to address the problem of segmental deficiency in Crowe II–III DDH hips. The midterm results of this technique have been encouraging in recent reports [ 7 , 8 , 10 ]. However, for patients with bilateral dysplasia who have asymmetrical reconstruction of two hips, the outcomes are still unknown.…”

“…In a retrospective study of 85 HHC hips, Shen et al. [ 8 ] observed 12 acetabular cups with lateral placement greater than 10 mm compared with the anatomical center; however, no complications such as loosening and liner wear occurred with excessive lateralization. In this study, we also did not find any radiographic loosening or significant wear.…”

“…On account of the advantages of shortening surgical time and simplifying the procedure, HHC was accepted as a valuable and effective alternative. In recent years, for patients with unilateral DDH, many encouraging mid- to long-term results have been reported in the literature [ 7 , 8 ]. Nawabi et al.…”

“…Shen et al. [ 8 ] evaluated 16 patients (32 hips) treated with bilateral HHC and for whom no revision occurred at the last follow-up. However, for patients with bilateral dysplasia who had asymmetrical reconstruction of two hips, the result remains uncertain.…”