Total hip arthroplasty for Crowe type IV developmental dysplasia of the hip combined with intertrochanteric fracture: a case report and literature review

Abstract

Background Total hip arthroplasty for Crowe type IV developmental dysplasia of the hip (DDH) is a complex procedure. Crowe type IV DDH combined with intertrochanteric frature is very rare. Case presentation A 75-year-old patient suffering from left hip pain after a fall was sent to our hospital. Plain radiographs and computed tomography scans were used to diagnose this patient with DDH combined with an intertrochanteric fracture. We conducted a total hip arthroplasty using an S-rom prosthesis following subtrochanteric shortening osteotomy in this patient, after which steel wires were used to fix the intertrochanteric fracture. The patient did not suffer any significant intraoperative or postoperative complications, and treatment was sufficient to overcome lower leg abnormalities. The patient was encouraged to resume walking with support at 3 days post-surgery, and at 6-month postoperatively he had regained the majority of his original range of motion. At 10-month postoperatively, the intertrochanteric fracture and subtrochanteric osteotomy of left femur had healed effectively,and the patient’s VAS and mHSS scores had improved significantly. Conclusions Total hip arthroplasty is an effective approach to treat patients suffering from Crowe type IV DDH combined with an intertrochanteric fracture, and can achieve satisfactory clinical outcomes.

Complications and outcomes of total hip arthroplasty in dogs with luxoid hip dysplasia: 18 cases (2010–2022)

“…In Crowe Type IV hip dysplasia, the most severe category, there is complete superior dislocation without trauma, and thus this may be analogous to LH in dogs 36 . Total hip arthroplasty for Crowe Type IV hip dysplasia is highly challenging and typically requires extensive modifications to the standard surgical technique 37–39 . One frequently employed strategy is the use of femoral shortening osteotomy to minimize tension to the surrounding soft tissues, decrease postoperative limb lengthening, maintain anatomic offset, and in particular, protect the neurovascular structures 37–39 .…”

“…36 Total hip arthroplasty for Crowe Type IV hip dysplasia is highly challenging and typically requires extensive modifications to the standard surgical technique. [37][38][39] One frequently employed strategy is the use of femoral shortening osteotomy to minimize tension to the surrounding soft tissues, decrease postoperative limb lengthening, maintain anatomic offset, and in particular, protect the neurovascular structures. [37][38][39] As noted above, severe muscular and periarticular soft tissue tension due to the marked distal translation of the femur following reduction may be an important predisposing risk factor for major complications in dogs with LH.…”

“…[37][38][39] One frequently employed strategy is the use of femoral shortening osteotomy to minimize tension to the surrounding soft tissues, decrease postoperative limb lengthening, maintain anatomic offset, and in particular, protect the neurovascular structures. [37][38][39] As noted above, severe muscular and periarticular soft tissue tension due to the marked distal translation of the femur following reduction may be an important predisposing risk factor for major complications in dogs with LH. In humans, functional lengthening-i.e., distally displacing the femur greater than 4 cm-is avoided to decrease the risk of neurovascular injury and postoperative discomfort.…”