Kanda Akio, Obayashi Osamu, Mogami Atsuhiko, Morohashi Itaru, Ishijima Muneaki
Department of Orthopaedic Surgery, Juntendo Shizuoka Hospital, Nagaoka 1129, Izunokuni-country, 410-2295 Shizuoka, Japan.
Department of Orthopaedic Surgery, Juntendo University, Hongou 3-1-3, Bunkyou ward, 113-8431 Tokyo, Japan.
SICOT J. 2024;10:34. doi: 10.1051/sicotj/2024032. Epub 2024 Sep 6.
Treatment of patients with Crowe type III and IV dislocated hips is challenging because of the hip deformity in these patients. In addition to the usual total hip replacement, shortening and reduction of the femur are often required. We herein report on our surgical technique using a monoblock cylindrical cementless stem and a direct lateral approach.
This study included patients with a diagnosis of severe developmental dysplasia of the hip (Crowe types III and IV) who underwent primary total hip arthroplasty at our hospital from August 2019 to January 2022. Eleven hips of seven patients were treated. All patients underwent horizontal osteotomy using a monoblock cylindrical cementless stem and a direct lateral approach. Complications such as dislocation, infection, and implant dropout were evaluated. In addition, the clinical assessment included the hip range of motion at the last observation and hip function based on the Japanese Orthopaedic Association (JOA) hip score and the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ).
The average operation time was 224 min (range, 194-296 min), and the average bleeding amount was 396.1 g (range, 20-1010 g). The main complications were acetabular implant dislocation, postoperative dislocation, intraoperative arterial injury, intraoperative proximal femoral fracture, subsidence of femoral implant. and postoperative pulmonary infarction, which occurred in one patient each.
Total hip arthroplasty for Crowe type III and IV hips is associated with various surgical technical difficulties because of its anatomical characteristics. While patients with severe osteoporosis are contraindicated, the use of a cylindrical monoblock cementless stem and the direct lateral approach makes it possible to simplify the procedure for shortening the femur and increase the indications for surgery.
Therapeutic Level Ⅳ.
由于Crowe III型和IV型髋关节脱位患者存在髋关节畸形，其治疗具有挑战性。除了常规的全髋关节置换术外，通常还需要缩短和复位股骨。我们在此报告使用一体式圆柱形非骨水泥柄和直接外侧入路的手术技术。
本研究纳入了2019年8月至2022年1月在我院接受初次全髋关节置换术的重度发育性髋关节发育不良（Crowe III型和IV型）患者。治疗了7例患者的11个髋关节。所有患者均采用一体式圆柱形非骨水泥柄和直接外侧入路进行水平截骨术。评估了脱位、感染和植入物松动等并发症。此外，临床评估包括末次观察时的髋关节活动范围以及基于日本骨科协会（JOA）髋关节评分和日本骨科协会髋关节疾病评估问卷（JHEQ）的髋关节功能。
平均手术时间为224分钟（范围194 - 296分钟），平均出血量为396.1克（范围20 - 1010克）。主要并发症为髋臼植入物脱位、术后脱位、术中动脉损伤、术中股骨近端骨折、股骨植入物下沉和术后肺梗死，各发生1例。
由于其解剖学特征，Crowe III型和IV型髋关节的全髋关节置换术存在各种手术技术难题。虽然重度骨质疏松患者为禁忌，但使用圆柱形一体式非骨水泥柄和直接外侧入路可以简化股骨缩短手术过程并增加手术适应症。
治疗性IV级。
