Poursalehian Mohammad, Hassanzadeh Ali, Shafiei Seyyed Hossein, Mortazavi S M Javad
Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Orthopedic Surgery Research Centre, Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran.
J Arthroplasty. 2025 Feb;40(2):530-539. doi: 10.1016/j.arth.2024.08.026. Epub 2024 Aug 23.
Severe forms of developmental dysplasia of the hip (DDH) in adulthood often lead to total hip arthroplasty (THA). This study aimed to evaluate the mid-term to long-term outcomes of THA in Crowe type IV DDH cases, which represent a technically challenging and complex patient group.
PubMed, EMBASE, Web of Science, and Scopus were searched for observational studies and case series with over 100 months of mean follow-up on adult patients who had Crowe type IV DDH treated with THA. A total of 3,710 records were initially identified, leading to the inclusion of 24 studies in the final analysis. These studies were subjected to quality assessment using the National Institutes of Health Quality Assessment tool. Various outcomes including revision rates, leg-length discrepancy, Harris Hip Score, and complications like periprosthetic joint infections, dislocations, and nerve injuries were analyzed. A random effects model was employed for statistical analysis, with sensitivity analysis and metaregression applied in cases of high heterogeneity.
The included studies assessed 1,024 hips with a mean follow-up of 11 years, revealing improvements in Harris Hip Score and reductions in leg length discrepancy post-THA. However, notable challenges were noted, including a 10.7% rate of intraoperative fractures, a 1.8% periprosthetic joint infection rate, and a 5.8% dislocation rate. Osteolysis and aseptic loosening revisions were observed in 9.1 and 8% of cases, respectively. Heterotopic ossification occurred in 11.1% of patients. Nerve injury was reported in 4.2% of cases. With the use of metaregression, some factors for observed heterogeneity were identified.
Total hip arthroplasty (THA) in Crowe type IV DDH patients presents notable challenges, but can lead to substantial long-term improvements in patient-reported outcomes.
IV.
成年期严重的发育性髋关节发育不良（DDH）常导致全髋关节置换术（THA）。本研究旨在评估Crowe IV型DDH病例行THA的中长期疗效，这类病例在技术上具有挑战性且病情复杂。
检索PubMed、EMBASE、Web of Science和Scopus数据库，查找对接受THA治疗的成年Crowe IV型DDH患者进行平均随访超过100个月的观察性研究和病例系列。初步共识别出3710条记录，最终纳入24项研究进行分析。使用美国国立卫生研究院质量评估工具对这些研究进行质量评估。分析了包括翻修率、肢体长度差异、Harris髋关节评分以及假体周围关节感染、脱位和神经损伤等并发症在内的各种结局。采用随机效应模型进行统计分析，在异质性较高的情况下应用敏感性分析和Meta回归分析。
纳入的研究评估了1024例髋关节，平均随访11年，结果显示THA术后Harris髋关节评分有所改善，肢体长度差异减小。然而，也发现了一些显著挑战，包括术中骨折发生率为10.7%、假体周围关节感染率为1.8%、脱位率为5.8%。分别有9.1%和8%的病例出现骨溶解和无菌性松动翻修。11.1%的患者发生异位骨化。4.2%的病例报告有神经损伤。通过Meta回归分析，确定了一些观察到的异质性因素。
Crowe IV型DDH患者行全髋关节置换术（THA）存在显著挑战，但可使患者报告的结局在长期内得到实质性改善。
IV级。
