Patient-specific total hip arthroplasty is superior to conventional methods for Crowe III and IV adult developmental hip dysplasia: a randomized controlled trial

Abstract

Background: Restoration of the acetabulum during total hip arthroplasty in adults with developmental dysplasia of the hip (DDH-THA) and resumption of hip function remain major challenges. Herein, a new patient-specific instrument (PSI) was developed that uses the superolateral rim of the acetabulum as a positioning marker to assist surgeons in adult DDH-THA.Methods: From January 2017 to October 2018, 104 adult DDH patients were randomized to either the PSI group or conventional operation (CO) group, and further divided into eight subgroups by stratified random sampling using Crowe's classification. Complications, Harris hip scores (HHS), and X-ray results were recorded at 3 and 12 months after surgery.Results: With the exception of anteversion in CO-Crowe II group patients, there was no difference in the accuracy of cup placement and orientation between the PSI and CO groups in Crowe I and II DDH patients.With the exception of percentage of acetabular cup coverage (PACC) and the qualification rate of Crowe IV PACC patients, among all Crowe III and IV DDH groups, all postoperative indexes of cup orientation and positioning exhibited significant differences between the PSI and CO groups; however, no significant differences were observed in Crowe I and II DDH patients.Conclusions: Compared with conventional methods, the new PSI-assisted surgical method improved the accuracy of placement and orientation of the acetabulum and cup prosthesis, optimized the surgical process, reduced complications, and contributed to quicker recovery of hip function after surgery in adults with Crowe III and IV DDH-THA, but little difference was noted for those with Crowe I and II DDH.

A Novel Technique for Autograft Preparation Using Patient-Specific Instrumentation (PSI) Assistance in Total Hip Arthroplasty in Developmental Dysplasia of Hip (DDH)

“…However, the outcomes of PSI in patients with DDH Crowe I was not yet determined. There was no significant difference in the accuracy of PSI for patients with DDH Crowe I [ 40 ]. The indication of accuracy included cup placement and orientation.…”

“…In another study in 2021, the operation time in patients with DDH Crowe III and IV is less in the PSI group than conventional surgery group, but the operation time in patients with DDH Crowe I was longer in the PSI group than that in the conventional group. The reasons might be that the anatomical structure in patients with DDH Crowe I is relatively simple, and extra procedures are needed when performing PSI on patients with DDH Crowe I [ 40 ]. However, with the successful experiences of PSI-assisted THA on patients with DDH Crowe I in this study, there is a higher chance to achieve shorter operation time for DDH Crowe I patients and to reduce related risks.…”