Leg length change in total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe type IV developmental hip dysplasia.
ABSTRACT Primary total hip arthroplasties were performed in 70 hips for the treatment of Crowe type IV developmental dysplasia of the hip. The patients were subdivided into 2 groups with or without iliofemoral osteoarthritis. Leg length change was measured radiographically. Preoperative hip motion was reviewed from medical records and defined as either higher or lower motion groups. The leg length change in patients without iliofemoral osteoarthritis was significantly greater than that in patients with iliofemoral osteoarthritis, and the higher hip motion group had greater leg length change in total hip arthroplasty than the lower motion group. The current study identifies several features that might help predict leg length change during the preoperative planning of total hip arthroplasty for Crowe type IV developmental hip dysplasia.
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ABSTRACT: The aim of this study was to determine whether the ratio between the femoral head diameter and pelvic height in a Chinese population is the same as that found in Westerners. Standard pelvic radiography was performed on a group of 187 Chinese adult subjects consisting of 81 males and 106 females with a mean age of 40 years (21-68 years). Femoral head diameter (vertical distance from the femoral head-neck junction to the highest point of the femoral head) and pelvic height (vertical distance from the highest point of the iliac crest to the edge of the ischial tuberosities) were measured. There were significant differences between males and females (p < 0.001), and between persons of high height versus low height (p = 0.011) and medium height (p = 0.039). There were no significant differences between persons of different age (p = 0.244), body mass index (p = 0.091), or between persons of low- and medium-height groups (p = 0.69). The overall mean ratio between the femoral head diameter and pelvic height was 0.215 (0.173-0.249) with a 95 % CI = 0.214-0.217. The mean ratios in males and females were 0.221 (0.194-0.249) and 0.211 (0.173-0.238), respectively. The mean ratio in Chinese population was similar to the reported ratio in a western population (about 1:5). We suggest that Chinese surgeons may be able to use the Crowe classification to classify patients with hip dysplasia.European Journal of Orthopaedic Surgery & Traumatology 08/2013; · 0.18 Impact Factor
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ABSTRACT: Limb-length discrepancy (LLD) arising from hip subluxation or dislocation and accompanied by insufficiency of hip abductor in patients with developmental dysplasia of the hip (DDH) can be corrected partially or completely with total hip arthroplasty (THA). However, information about post-THA changes in abductor strength related to preoperative LLD in patients with DDH is lacking. We aimed to explore the post-THA recovery course of abductor muscle strength and its related factors in patients with DDH. A cohort of 45 patients with unilateral DDH was divided into two groups according to their Crowe classification: patients with class I or II DDH formed Group M, and patients in class III and IV DDH formed Group S. The following parameters were measured on standardized antero-posterior hip radiographs taken in the supine position pre- and post-THA: abductor muscle length, abductor lever arm, LLD, and femoral offset (FO). Abductor strength was evaluated quantitatively with the Isomed 2000 isokinetic test system (1 week before the operation and 1, 3, 6, and 12 months after the operation). The contralateral normal hip joint served as a within-patient control. The affected side:healthy side ratios of the parameters above were calculated. Abductor strength ratio evaluated at the five follow-up time points was larger in Group M than that in Group S (p < 0.001). The average abductor strength ratio reached 78.5, 85.4, and 89.2 % at the 3, 6, and 12 months postoperative exams, respectively, in Group M, and reached 50.3, 63.2, and 72.9 % in Group S. The abductor muscle length ratio, the abductor muscle level arm ratio, and the FO ratio were significantly increased postoperatively, relative to preoperative assessment, in the two groups. LLD was reduced significantly postoperatively, relative to preoperative values, in both groups. Both preoperative LLD (r = -0.791, p < 0.001) and the change in abductor muscle length ratio (r = -0.659, p < 0.001) correlated with abductor strength recovery. Patients showed the greatest improvement in abductor strength within the first 6 months after THA, especially during the first 3 months. Abductor strength was consistently greater in patients with mild dysplasia than in patients with severe dysplasia. The extent of preoperative LLD and the increase in abductor length were related with post-THA abductor strength recovery in patients with DDH.Archives of Orthopaedic and Trauma Surgery 12/2013; · 1.36 Impact Factor
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ABSTRACT: PURPOSE: The study was designed to evaluate the efficacy and safety of lesser trochanteric osteotomy for femoral shortening in total hip arthroplasty in treatment of 28 cases of CROWE IV developmental dysplasia of the hip (DDH). METHODS: Patients underwent progressive femoral shortening at the level of lesser trochanteric to make reduction possible into the anatomical acetabulum in all hips. The results were collected and evaluated clinically and radiographically. RESULTS: The mean follow-up period was 55.3 months. The average postoperative leg length discrepancy was eight millimetres for unilateral THA patients. A modified Merle d'Aubigné scale was improved from 9.3 preoperatively to 15.9 postoperatively. Sciatic nerve palsy was confirmed in two hips which resolved completely in six months. The Trendelenburg sign was positive in two hips at the final follow-up. No revision surgery was required by the final follow-up. CONCLUSION: Lesser trochanteric osteotomy proved to be safe and effective in femoral shortening for treatment of CROWE IV DDH without the problem of nonunion at the site of osteotomy.International Orthopaedics 01/2013; · 2.32 Impact Factor