DeNovio Anthony C-J, Bedard Nicholas A, Trousdale Robert T, Abdel Matthew P, Hannon Charles P, Berry Daniel J
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2025 Oct;40(10):2679-2684. doi: 10.1016/j.arth.2025.04.081. Epub 2025 May 7.
Cementless total hip arthroplasty (THA) with subtrochanteric shortening osteotomy (SSO) is a well-established treatment for Crowe IV developmental dysplasia of the hip (DDH). However, series to date are limited by mid-term follow-up. The purpose of this study was to evaluate the long-term (mean 18 years) implant survivorship, radiographic results, and clinical outcomes of our previously published series.
We retrospectively reviewed 28 hips (24 patients) that underwent cementless THA with SSO for Crowe IV DDH between 1992 and 2005 using our institutional total joint registry. The mean age at the time of THA was 48 years, 83% were women, and the mean body mass index was 27. Since the original study, five patients died, including a patient who had bilateral THAs; five hips were revised; two withdrew from the study; and one was lost to follow-up. As such, 14 hips were available for follow-up at a mean of 18 years (range, 12 to 28). Kaplan-Meier survivorship curves were calculated, radiographs were reviewed, and clinical outcomes were evaluated via the Harris Hip Score.
The 20-year survivorship free of any revision was 79%. There were five revisions, including two for aseptic loosening of the femoral stem at 10 months and 2 years, one for stem fracture at 2 years, one for aseptic loosening of the acetabular component at one year, and one for polyethylene liner dissociation at 6 years. There were no new revisions or reoperations after 6 years. All unrevised hips were radiographically well-fixed at the most recent follow-up. The mean Harris Hip Score was 81 at a mean of 15 years.
Cementless THA with SSO for Crowe IV DDH provides good implant survivorship with durable fixation and reliable clinical outcomes at long-term (mean 18 years) follow-up. In this series, femoral aseptic loosening was rare.
Therapeutic Level IV.
采用转子下缩短截骨术（SSO）的非骨水泥型全髋关节置换术（THA）是治疗Crowe IV型发育性髋关节发育不良（DDH）的一种成熟方法。然而，迄今为止的系列研究受中期随访的限制。本研究的目的是评估我们先前发表系列的长期（平均18年）植入物生存率、影像学结果和临床结局。
我们使用机构全关节登记系统回顾性分析了1992年至2005年间因Crowe IV型DDH接受非骨水泥型THA联合SSO的28例髋关节（24例患者）。THA时的平均年龄为48岁，83%为女性，平均体重指数为27。自最初的研究以来，5例患者死亡，包括1例接受双侧THA的患者；5例髋关节进行了翻修；2例退出研究；1例失访。因此，14例髋关节可进行平均18年（范围12至28年）的随访。计算Kaplan-Meier生存曲线，复查X线片，并通过Harris髋关节评分评估临床结局。
无任何翻修的20年生存率为79%。有5例翻修，包括2例分别在10个月和2年时因股骨柄无菌性松动、1例在2年时因柄骨折、1例在1年时因髋臼组件无菌性松动以及1例在6年时因聚乙烯衬垫分离。6年后无新的翻修或再次手术。所有未翻修的髋关节在最近一次随访时X线片显示固定良好。平均15年时的平均Harris髋关节评分为81分。
对于Crowe IV型DDH，采用SSO的非骨水泥型THA在长期（平均18年）随访中提供了良好的植入物生存率、持久的固定和可靠的临床结局。在本系列中，股骨无菌性松动罕见。
治疗性IV级。
