Total hip arthroplasty with modular stem for Crowe I and II developmental dysplasia of the hip
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(2019) 14:362
RESEARCH ARTICLE
Open Access
Total hip arthroplasty with modular stem for Crowe I and II developmental dysplasia of the hip Xiangpeng Kong1, Yunming Sun2, Minzhi Yang1,3, Yonggang Zhou1, Jiying Chen1, Wei Chai1* and Yan Wang1*
Abstract Background: The variation of femoral anteversion is not completely consistent with the grade of developmental dysplasia of the hip (DDH), which poses challenges to hip replacement with the non-modular tapered stem. Currently, whether the modular stem should be used in Crowe I and II DDH is still controversial. The aim of this study is to compare the clinical efficacy of the modular stem and the non-modular tapered stem in Crowe I and II DDH patients. Methods: We retrospective analyzed the clinical data of 196 patients with unilateral Crowe I and II DDH from January 2015 to January 2017. One hundred patients were operated by an experienced surgeon with the modular stems; the remaining 96 patient was operated by another equivalent surgeon with the non-modular tapered stems. The preoperative basic information, operating time, intraoperative and postoperative complications, postoperative leg length discrepancy (LLD) and offset, Harris hip score (HHS), and forgotten joint score (FJS) in postoperative 2 years were collected and analyzed. Results: Postoperative LLD (P = 0.010) and FJS (P = 0.001) had significant difference between two groups. Concurrent acceptable LLD and offset were achieved in 87% of patients with the modular stem and in 68% of patients with the non-modular stem (P = 0.001). There was no significant difference in the operating time (P = 0.086), intraoperative complication (P = 0.096), postoperative dislocation rate (P = 0.056), postoperative offset difference (P = 0.108), and Harris score (P = 0.877) between two groups. Conclusions: Compared with the non-modular tapered stem, the modular stem was more likely to provide accurate reconstruction and forgotten artificial hip for Crowe I and II DDH patients. We recommend the modular stem as routine choice for these patients. Keywords: Hip dislocation, congenital, Arthroplasty, replacement, hip, Modular prosthesis, Leg length discrepancy, Offset, Forgotten joint score
Background Total hip arthroplasty (THA) has been one of the most mature orthopedic surgery in recent years [1, 2]. Its clinical outcome is encouraging, but not perfect. Leg length discrepancy (LLD), altered hip biomechanics, dysfunctional gait, lower back pain, instability, and dislocation followed by THA are recognized as imperfections or complications [3, 4]. In America, postoperative * Correspondence: [email protected]; [email protected] 1 Department of Orthopaedics, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, China Full list of author information is available at the end of the article
LLD has been the leading factor in patient dissatisfaction and litigation [5]. Besides the surgical technique, the design of prosthesis also plays an important role in the restoration of the normal biomechanics [6]. The femor
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