Direct anterior approach proximal femoral reconstruction total hip arthroplasty for adult Crowe type IV hip dysplasia

Abstract

Abstract Objective To evaluate the early clinical results of total hip arthroplasty (THA) with proximal femoral reconstruction via the direct anterior approach for Crowe IV developmental dysplasia of the hip (DDH). Methods From January 2023 to May 2023, 20 patients with Crowe type IV developmental dysplasia of the hip underwent total hip arthroplasty with proximal femoral reconstruction via the direct anterior approach. The operation time, intraoperative blood loss volume and perioperative complications were recorded. The Harris hip score, VAS score, Berg score, Tinetti score, leg length discrepancy, femoral osteotomy block size, loosening and displacement of the prosthesis were evaluated before the operation and at the last follow-up visit. Results The mean operation time was 143.7±28.8 min (range, 90-200 min). Four patients received blood transfusions. All incisions healed with Grade Ⅰ/A, and no surgical site infection or deep vein thrombosis occurred. At the last follow-up visit, the Harris hip score, Berg score and Tinetti score were significantly higher than those before the operation (P < 0.001), and the VAS pain score was significantly lower than that before the operation (P < 0.001). The difference between the pre and postoperative length of the lower limbs was within 1.5 cm, which was significant. There was no wire fracture, femoral osteotomy block, or loosening or displacement of the acetabular prosthesis during the follow-up exam. ConclusionTotal hip arthroplasty with proximal femoral reconstruction via the direct anterior approach for Crowe IV developmental dysplasia of the hip not only reconstructs the abnormal anatomical structure of the proximal femur but also has a low perioperative complication rate and a satisfactory early clinical effect; thus, this approach is an effective method for treating Crowe IV developmental dysplasia of the hip.