The outcome of total hip arthroplasty without subtrochanteric shortening osteotomy and in severe developmental dysplasia of the hip

Abstract

Abstract Background: Total hip arthroplasty (THA) is a surgical technique to correct Developmental dysplasia of the hip (DDH). Various THA-based techniques have been described for the management of end-stage osteoarthritis in patients with DDH Crowe type III or IV. In this study we evaluate the Harris Hip Score (HHS) before and after THA without subtrochanteric shortening osteotomy (STO) in patients with DDH Crowe type III or IV who were candidates for THA, as well as the complications and the need for revision operation.Methods: This quasi-experimental study was conducted retrospectively on patients with DDH crown type III and IV, who were candidate for THA with Watson Jones technique without shortening STO. HHS was calculated and recorded in their medical files before the operation. Patients with missed or uncompleted medical files, without written informed consent, neurovascular diseases, use of immunosuppressive drugs, congenital bone and articular anomalies, low back pain with spread to the lower extremities, existence of simultaneous fractures, positive history of lower extremities fractures or articular infection were excluded. HHS was recalculated in the outpatient follow-up. Neurovascular defects and the need for reoperation were also evaluated. All data were recorded and then analyzed.Results: Thirty-two patients were enrolled with mean ± SD age of 50.34 ± 15.45 years, and most of them were women (75%). The patients were followed range 2 to 5 years. The nerve defect after the operation was seen in only 1 (3.1%) patient. Also hip reoperation was performed in 1 (3.1%) patient. The mean ± SD of HHS before the operation was 50.10 ± 12.48, which was raised to 77.99 ± 15.60 after the operation, significantly (P < 0.001). Moreover, HHS before and after the intervention were evaluated in both gender, separately, that in each gender, HHS raised significantly.Conclusion: THA without shortening osteotomy could improve HHS in patients with DDH Crowe III and IV and deliver satisfactory outcomes in these patients. On the other hand, complications such as neurological defects and the need for reoperation are negligible in this method.