Total hip arthroplasty with modular stem for Crowe I and II developmental dysplasia of the hip

Abstract

BackgroundThe variation of femoral anteversion is not completely consistent with the grade of developmental dysplasia of the hip (DDH), which poses challenges to hip replacement with the non-modular tapered stem. Currently, whether the modular stem should be used in Crowe I and II DDH is still controversial. The aim of this study is to compare the clinical efficacy of the modular stem and the non-modular tapered stem in Crowe I and II DDH patients.MethodsWe retrospective analyzed the clinical data of 196 patients with unilateral Crowe I and II DDH from January 2015 to January 2017. One hundred patients were operated by an experienced surgeon with the modular stems; the remaining 96 patient was operated by another equivalent surgeon with the non-modular tapered stems. The preoperative basic information, operating time, intraoperative and postoperative complications, postoperative leg length discrepancy (LLD) and offset, Harris hip score (HHS), and forgotten joint score (FJS) in postoperative 2 years were collected and analyzed.ResultsPostoperative LLD (P = 0.010) and FJS (P = 0.001) had significant difference between two groups. Concurrent acceptable LLD and offset were achieved in 87% of patients with the modular stem and in 68% of patients with the non-modular stem (P = 0.001). There was no significant difference in the operating time (P = 0.086), intraoperative complication (P = 0.096), postoperative dislocation rate (P = 0.056), postoperative offset difference (P = 0.108), and Harris score (P = 0.877) between two groups.ConclusionsCompared with the non-modular tapered stem, the modular stem was more likely to provide accurate reconstruction and forgotten artificial hip for Crowe I and II DDH patients. We recommend the modular stem as routine choice for these patients.

Controlled fracture of the medial wall versus structural autograft with bulk femoral head to increase cup coverage by host bone for total hip arthroplasty in osteoarthritis secondary to developmental dysplasia of the hip: a retrospective cohort study

“…The study from Bobyn et al demonstrated that the wear particle was not significant enough to cause osteolysis and loosening [ 44 ]. Also, Seufert and McGrory [ 43 ] and Kong et al [ 45 ] have reported modular stem can successfully accommodate the distorted anatomy of the proximal femur and achieved optimal stem version as well as excellent clinical outcomes. So, modular stem can be recommended as an alternative choice to reconstruct the femora in THA for patients diagnosed with DDH.…”

Controlled fracture of medial wall versus structural autograft with bulk femoral head to increase cup coverage by host bone for total hip arthroplasty in osteoarthritis secondary to developmental dysplasia of hip: a retrospective cohort study

“…However, there are concerns associated with modular stem including junction failure and corrosion due to the slippage and micromotion occurred at the stem-sleeve interface [40,45,46]. The study from Bobyn et al demonstrated that the wear particle was not signi cant enough to cause osteolysis and loosening [47]. Also, Seufert et al [46] and Kong et al [48] have reported modular stem can successfully accommodate the distorted anatomy of the proximal femur and achieved optimal stem version as well as excellent clinical outcomes.…”

Titanium modular stems in total hip arthroplasty due to developmental dysplasia: a registry comparison with single-taper implants

“…1 However, the outcomes of modularity in DDH are described in single-centre retrospective case series, mainly without a control group. [5][6][7][8][9][10][11][12][13][14][15][16][17] Thus, an arthroplasty registry study was designed to compare the outcomes of DT and ST implants in THAs undertaken for osteoarthritis after DDH. Only DT implants with proximal titanium-on-titanium modularity were admitted.…”