Palumbo Brian T, Salomon Kevin, Sullivan Alex, Simon Peter, Lyons Steven, Bernasek Thomas L
Florida Orthopaedic Institute, Temple Terrace, FL, USA.
University of South Florida, Tampa, FL, USA.
Arthroplast Today. 2022 Aug 22;17:101-106. doi: 10.1016/j.artd.2022.07.004. eCollection 2022 Oct.
Total hip arthroplasty (THA) for developmental hip dysplasia (DDH) often requires a subtrochanteric shortening derotational osteotomy (SDO) to limit leg lengthening, mitigate risk of peripheral nerve palsy, and reduce excessive femoral anteversion. Few studies exist detailing long-term clinical outcomes and survivorship. The aim of this study is to analyze the long-term outcomes and survivorship of an SDO-THA cohort.
We retrospectively reviewed all patients who underwent cementless THA with femoral osteotomy due to Crowe I-IV DDH between 1991 and 2001. Primary outcome measures included revision surgery for any reason and functional outcome measures using modified Harris Hip scores. Secondary outcome measures included mode of implant failure and radiographic assessment for osteotomy union, polyethylene wear, osteolysis, and implant loosening.
Our review resulted in 24 SDO-THA cases in 20 patients with a mean follow-up of 19 years (range, 8-27 years). Overall survivorship was 67%. All 8 failures were treated with acetabular revision at a mean time to revision of 11 years (range, 1-25 years). Of the failures, there were 5 cases due to polyethylene wear (62.5%), 2 cases due to acetabular loosening (25%), and 1 case due to recurrent instability (12.5%). The mean postoperative modified Harris Hip score was 76 (range, 52-91) with long-term improvement of 43 points maintained ( < .001).
THA with SDO can produce durable long-term outcomes for the patient with DDH. It is important to consider some common reasons for revision, namely polyethylene wear and osteolysis, acetabular loosening, and recurrent acetabular dislocations.
发育性髋关节发育不良（DDH）的全髋关节置换术（THA）通常需要进行转子下缩短旋转截骨术（SDO），以限制肢体延长、降低周围神经麻痹风险并减少股骨过度前倾。很少有研究详细描述其长期临床结果和生存率。本研究的目的是分析SDO-THA队列的长期结果和生存率。
我们回顾性分析了1991年至2001年间因Crowe I-IV型DDH接受非骨水泥型THA并股骨截骨术的所有患者。主要结局指标包括因任何原因进行的翻修手术以及使用改良Harris髋关节评分的功能结局指标。次要结局指标包括植入物失败模式以及截骨愈合、聚乙烯磨损、骨溶解和植入物松动的影像学评估。
我们的回顾纳入了20例患者的24例SDO-THA病例，平均随访19年（范围8-27年）。总体生存率为67%。所有8例失败病例均接受了髋臼翻修，平均翻修时间为11年（范围1-25年）。在这些失败病例中，5例（62.5%）是由于聚乙烯磨损，2例（25%）是由于髋臼松动，1例（12.5%）是由于反复不稳定。术后改良Harris髋关节评分的平均值为76分（范围52-91分），长期改善维持在43分（P <.001）。
SDO-THA可为DDH患者带来持久的长期效果。重要的是要考虑一些常见的翻修原因，即聚乙烯磨损和骨溶解、髋臼松动以及髋臼反复脱位。
