Department of Orthopedics, Joint Disease and Sport Medicine Center, Xinqiao Hospital, Army Medical University, 183# Xinqiao Street, Shapingba District, Chongqing, 400037, China.
Rothman Orthopaedic Institute, Building 1300, 2500 English Creek Ave,, Egg Harbor Township, NJ, 08234, USA.
Sci Rep. 2021 Apr 14;11(1):8105. doi: 10.1038/s41598-021-87543-x.
It is challenging to treat developmental dysplasia of the hip (DDH) classified Crowe III-IV using direct anterior approach (DAA) total hip arthroplasty (THA), and very little is known on its outcome. This study aimed to investigate the clinical result in this defined disorder with DAA versus posterolateral approach. Twenty-three consecutive hips with Crowe III-IV DDH who underwent DAA were retrospectively evaluated from 2016 through 2018. Outcomes were primarily assessed by HHS, WOMAC, and SF-12 physical scales. The second evaluations included leg length discrepancy, hip muscle strength, radiographic review, complications, and limp recovery. Results were compared to a control cohort of 50 hips underwent posterolateral THA concurrently within the observational period. At last follow-up (DAA 28.5 months; PLA 39.0 months), the mean increase of the HHS for DAA was 48.2 and 30.3 for PLA (p = 0.003). The improvement in WOMAC score in DAA cohort was 15.89 higher that of the PLA cohort after adjusting preoperative difference [R2 = 0.532, P = 0.000, 95% CI (10.037, 21.735)]. DAA had more rapid recovery of hip abductor strength at 1-month (p = 0.03) and hip flexor strength at 3 months (p = 0.007) compared to PLA. No significant differences were found in the radiographic analysis with the exception of increased acetabular anteversion in the DAA cohort (p = 0.036). Satisfactory improvement in limp, indicated by the percentage of limp graded as none and mild to the total, was much higher in DAA cohort (97.6%), compared to that of PLA cohort (90.0%, p = 0.032). DAA for high-dislocated dysplasia demonstrate a significant improvement in clinical result comparable to posterolateral approach. Improved clinical outcome in terms of increased HHS and WOMAC scores, rapid recovery of hip abductor and flexor strength, and enhanced limp recovery without an increased risk in complications, could be acquired when the surgeons were specialized in this approach.
采用直接前侧入路（DAA）全髋关节置换术（THA）治疗 Crowe III-IV 型发育性髋关节发育不良（DDH）具有挑战性，目前对于该术式的临床结果知之甚少。本研究旨在比较 DAA 与后外侧入路治疗这种明确疾病的临床结果。2016 年至 2018 年，回顾性分析了 23 例连续接受 DAA 治疗的 Crowe III-IV DDH 患者。主要通过 HHS、WOMAC 和 SF-12 身体量表评估结果。第二次评估包括下肢长度差异、髋关节肌肉力量、影像学检查、并发症和跛行恢复情况。结果与同期在观察期内接受后外侧 THA 的 50 髋对照组进行比较。末次随访时（DAA 28.5 个月；PLA 39.0 个月），DAA 的 HHS 平均增加 48.2，PLA 为 30.3（p=0.003）。调整术前差异后，DAA 组 WOMAC 评分的改善比 PLA 组高 15.89[R2=0.532，P=0.000，95%CI（10.037，21.735）]。与 PLA 相比，DAA 在术后 1 个月时髋关节外展肌力量恢复更快（p=0.03），术后 3 个月时髋关节屈肌力量恢复更快（p=0.007）。除 DAA 组髋臼前倾角增加外（p=0.036），影像学分析无显著差异。DAA 组跛行改善更明显（无跛行和轻度跛行的百分比），为 97.6%，明显高于 PLA 组（90.0%，p=0.032）。对于高位发育不良，DAA 显示出与后外侧入路相当的临床显著改善。采用该入路时，当外科医生具备专业技能时，可获得临床结果的改善，包括 HHS 和 WOMAC 评分的提高、髋关节外展和屈肌力量的快速恢复以及跛行的改善，而并发症的风险并未增加。
