High Hip Center Technique in Total Hip Arthroplasty for Crowe Type II-III Developmental Dysplasia: Results of Midterm Follow-up

Abstract

Background: High hip center technique is still controversial about the survivorship of prothesis and postoperative complications. We aimed to show the utility of high hip center technique used in patients with Crowe II-III developmental dysplasia of the hip at the midterm follow-up and evaluated the clinical and radiographic results between different heights of hip center.Methods: We retrospectively evaluated 69 patients (85 hips) with Crowe II-III dysplasia who underwent a high hip center cementless total hip arthroplasty at a mean follow up of 8.9 years (range, 6.0-14.1years). The patients were divided into two groups according to the height of hip center, respectively group A (≥22mm and <28mm) and group B (≥28mm). Radiographic, functional and survivorship outcomes were evaluated.Results: The mean location of the hip center from the inter-teardrop was 25.1mm vertically and 30.0mm horizontally in the group A, and 33.1mm vertically and 31.4mm horizontally in the group B. There were no statistically significant differences between two groups in postoperative femoral offset, abductor lever arm, leg length discrepancy and cup inclination. At the final follow up, the mean WOMAC and Harris hip score were significantly improved in both groups. Of the 85 hips, 7 hips (8.2%) showed a positive Trendelenburg sign. Additionally, 6 patients (8.7%) presented with a limp. No significant differences were shown regarding the Harris hip score, WOMAC score, Trendelenburg sign and limp between two groups. The Kaplan-Meier implants survivorship rates at the final follow-up for all-causes revisions in the group A and group B were similar (96.7% [95% confidence interval, 90.5%-100%] and 96.2% [95% confidence interval, 89.0%-100%], respectively).Conclusions: The high hip center technique is a valuable alternative to achieve excellent midterm results for Crowe II-III developmental dysplasia of the hip. Further, we reported good results and could not demonstrate any significant differences in outcomes or survivorship between the groups with differing degrees of HHC in our study, however the relatively small sample size must be considered and larger comparative studies are required to confirm the value of high hip center technique.

Integrated acetabular prosthesis versus bone grafting in total hip arthroplasty for Crowe type II and III hip dysplasia: a retrospective case–control study

“…To restore the rotational center of the hip joint and establish normal biomechanics, the reconstruction of the acetabulum in the true acetabulum position uses autologous bone grafting (BG) technique to provide structural support for the acetabular cup, bringing its position closer to the normal anatomical location, and at the same time providing su cient bone mass for future revision (9). However, complications such as absorption and collapse of the bone grafts can easily lead to instability of the acetabular component (10). In recent years, with the increasing application of 3D technology in preoperative planning and intraoperative guidance, many di culties in traditional orthopedic surgery have been solved (11,12).…”