Shanaa Jean, Bernstein Ethan, Shanaa Natalie, Bahador Maani, Di Pauli von Treuheim Theodor, Marwin Scott
California Northstate University College of Medicine, Elk Grove, California.
Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
JBJS Rev. 2025 Jul 18;13(7). doi: e25.00091. eCollection 2025 Jul 1.
As interest in hip resurfacing arthroplasty (HRA) expands to complex pathologies, developmental dysplasia of the hip (DDH) has emerged as a challenging but increasingly considered indication. Although severe DDH often precludes resurfacing because of distorted anatomy, mild cases (Crowe I and II) may provide favorable conditions. This review evaluates outcomes of HRA in mild DDH, compares them with outcomes of total hip arthroplasty (THA) in DDH and HRA in primary osteoarthritis (OA) and assesses the potential of HRA to improve long-term function in this population.
A systematic search of PubMed, Embase, and Scopus identified studies reporting outcomes of HRA in DDH. Titles and abstracts were screened, followed by full-text review. Data on demographics, outcomes, and radiographic findings were extracted. Pooled complication and survivorship rates were calculated. A random-effects meta-analysis compared revision risk in HRA-treated patients with DDH vs. OA, and in patients with DDH treated with HRA vs. THA. Statistical significance was defined as a 95% confidence interval (CI) excluding 1. A separate meta-analysis compared mean postoperative flexion in patients with DDH treated with HRA vs. THA, with significance defined as a 95% CI excluding 0.
From 65 screened articles, 11 met inclusion criteria, totaling 895 patients and 1,006 hips with DDH. The mean age was 45.26 years, with an average follow-up of 7.06 years. The pooled survivorship was 93%, and the complication rate was 13%. No significant difference in revision risk was found between DDH and OA HRA cohorts, or between HRA and THA in DDH, although both trends favored OA and THA. Patients with HRA-treated DDH had significantly greater postoperative flexion (standardized mean difference -1.21, 95% CI -1.54 to -0.87).
Despite anatomical challenges and a potential for higher revision or complication rates in patients with DDH, mid-term outcomes, including patient-reported outcome, were comparable with those in primary osteoarthritis and THA cohorts. This review supports the selective use of HRA in patients with Crowe I and II DDH, particularly when modern surgical techniques and DDH-specific implants are used.
Level III, systematic review of Level I, III, and IV studies. See Instructions for Authors for a complete description of levels of evidence.
随着对髋关节表面置换术（HRA）的兴趣扩展到复杂病变，髋关节发育不良（DDH）已成为一个具有挑战性但越来越受关注的适应证。尽管严重的DDH常因解剖结构异常而无法进行表面置换，但轻度病例（Crowe I和II型）可能提供有利条件。本综述评估了轻度DDH患者行HRA的结果，将其与DDH患者行全髋关节置换术（THA）以及原发性骨关节炎（OA）患者行HRA的结果进行比较，并评估HRA改善该人群长期功能的潜力。
对PubMed、Embase和Scopus进行系统检索，以确定报告DDH患者行HRA结果的研究。先筛选标题和摘要，然后进行全文审查。提取有关人口统计学、结果和影像学表现的数据。计算合并的并发症和生存率。采用随机效应荟萃分析比较HRA治疗的DDH患者与OA患者的翻修风险，以及DDH患者行HRA与行THA的翻修风险。统计学显著性定义为95%置信区间（CI）不包括1。另一项荟萃分析比较了DDH患者行HRA与行THA术后的平均屈曲度，显著性定义为95%CI不包括0。
在筛选的65篇文章中，11篇符合纳入标准，共895例患者、1006髋DDH。平均年龄45.26岁，平均随访7.06年。合并生存率为93%，并发症发生率为13%。DDH和OA的HRA队列之间，以及DDH患者行HRA与行THA之间，翻修风险均无显著差异，尽管两种趋势均有利于OA和THA。HRA治疗的DDH患者术后屈曲度显著更大（标准化均数差-1.21，95%CI -1.54至-0.87）。
尽管DDH患者存在解剖学挑战且翻修或并发症发生率可能更高，但中期结果，包括患者报告的结果，与原发性骨关节炎和THA队列相当。本综述支持在Crowe I和II型DDH患者中选择性使用HRA，尤其是在采用现代手术技术和特定于DDH的植入物时。
III级，对I、III和IV级研究的系统评价。有关证据水平的完整描述，请参阅作者指南。
