Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.
Clinic Research Management Department, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.
Orthop Surg. 2020 Apr;12(2):589-600. doi: 10.1111/os.12665. Epub 2020 Mar 29.
To investigate whether the risk of dislocation after total hip arthroplasty (THA) in patients with Crowe type IV developmental dysplasia of the hip (DDH) is high and to further identify the risk factors for postoperative dislocation in these patients.
This retrospective cohort study reviewed Crowe type IV DDH patients undergoing THA between January 2009 and December 2017 in our institution. Each Crowe type IV DDH patient was matched with three Crowe type I, II, or III DDH patients according to gender, side and date of operation. The primary outcome of this study was postoperative dislocation after THA. Occurrence, rate, classification, treatment and outcome of dislocation were documented in detail for all patients. The dislocation rates were compared between Crowe type IV DDH patients and Crowe type I, II, or III DDH patients. Demographic data, implant factors, and surgical factors were compared between the dislocation and no dislocation groups. Multiple logistic regression analysis was used to determine the independent risk factors for dislocation in Crowe type IV hips.
A total of 131 Crowe type IV hips were followed up for a mean of 76.5 ± 28.1 months. Three hundred and ninety-three Crowe type I, II and III hips, including 261 type I hips, 94 type II hips, and 38 type III hips, were identified as controls and followed up for a mean of 76.4 ± 28.2 months. No significant difference was observed in follow-up time between two groups (P = 0.804). One or more dislocations occurred in 22 of the 524 dysplasia hips (4.20%). Of the 22 dislocated hips, 20 hips (90.9%) were successfully managed with non-operative treatment. Two patients (9.1%, one Crowe type I and one Crowe type IV) experienced recurrent dislocation and required revision surgery. Crowe type IV hips had a significantly higher postoperative dislocation rate than type I, II, and III hips (11.45% vs 1.78%, P < 0.001). The use of a 22-mm femoral head (odds ratio [OR] = 23.55, 95% confidence interval [CI] = 1.901-291.788, P = 0.014), older age (OR = 1.128, 95% CI = 1.037-1.275, P = 0.031), and absence of false acetabulum (OR = 12.425, 95% CI = 1.982-77.879, P = 0.007) were identified as independent risk factors for dislocation in Crowe type IV hips.
Crowe type IV DDH patients were at a high risk of dislocation after THA, and using large femoral heads and improving abductor muscle strength may help decrease the rate of postoperative dislocation in such patients.
探讨髋关节发育不良（DDH）克罗伊Ⅳ型患者行全髋关节置换术（THA）后脱位的风险是否较高，并进一步明确此类患者术后脱位的危险因素。
本回顾性队列研究纳入了 2009 年 1 月至 2017 年 12 月在我院行 THA 的克罗伊Ⅳ型 DDH 患者。根据性别、手术侧和手术日期，每位克罗伊Ⅳ型 DDH 患者均与 3 例克罗伊Ⅰ型、Ⅱ型或Ⅲ型 DDH 患者相匹配。本研究的主要结局为 THA 后术后脱位。详细记录所有患者的脱位发生、发生率、分类、治疗和结果。比较克罗伊Ⅳ型 DDH 患者与克罗伊Ⅰ型、Ⅱ型或Ⅲ型 DDH 患者的脱位率。比较脱位组和无脱位组的人口统计学数据、植入物因素和手术因素。采用多因素 logistic 回归分析确定克罗伊Ⅳ型髋关节脱位的独立危险因素。
共随访 131 例克罗伊Ⅳ型髋关节，平均随访时间为 76.5±28.1 个月。共纳入 393 例克罗伊Ⅰ型、Ⅱ型和Ⅲ型髋关节，包括 261 例Ⅰ型髋关节、94 例Ⅱ型髋关节和 38 例Ⅲ型髋关节，作为对照组，平均随访时间为 76.4±28.2 个月。两组随访时间无显著差异（P=0.804）。在 524 例发育不良髋关节中，1 或更多髋关节发生脱位的患者有 22 例（4.20%）。在 22 例脱位的髋关节中，20 例（90.9%）通过非手术治疗成功处理。2 例（9.1%，1 例克罗伊Ⅰ型，1 例克罗伊Ⅳ型）发生复发性脱位，需要行翻修手术。克罗伊Ⅳ型髋关节术后脱位率明显高于Ⅰ型、Ⅱ型和Ⅲ型（11.45%比 1.78%，P<0.001）。使用 22mm 股骨头（比值比[OR] =23.55，95%置信区间[CI] =1.901-291.788，P=0.014）、年龄较大（OR =1.128，95%CI =1.037-1.275，P=0.031）和无假臼（OR =12.425，95%CI =1.982-77.879，P=0.007）被确定为克罗伊Ⅳ型髋关节脱位的独立危险因素。
克罗伊Ⅳ型 DDH 患者行 THA 后脱位风险较高，使用大股骨头和增强外展肌力量可能有助于降低此类患者术后脱位的发生率。
