[A COMPARATIVE STUDY ON TWO OSTEOTOMIES IN TOTAL HIP ARTHROPLASTY FOR CROWE TYPE IV DEVELOPMENTAL DYSPLASIA OF THE HIP].

OBJECTIVE: To assess the effectiveness of two osteotomy methods in total hip arthroplasty (THA) for treating Crowe type IV adult developmental dysplasia of the hip (DDH), trochanteric osteotomy and subtrochanteric osteotomy.

METHODS: A retrospective analysis was made on the clinical data of 36 patients (43 hips) with Crowe type IV DDH undergoing THA between June 2007 and December 2013. In THA, 19 patients (23 hips) underwent trochanteric osteotomy (group A) and 17 patients (20 hips) underwent subtrochanteric osteotomy (group B). There was no significant difference in age, gender, body mass index, side, preoperative Harris score, and limb length difference between 2 groups (P>0.05). The operation duration, bleeding volume, hospitalization duration, intraoperative and postoperative complications were compared between 2 groups.

RESULTS: There was no significant difference in operation duration, bleeding volume, and hospitalization days between 2 groups (P>0.05). The rate of intraoperative complication was 21.7% (5/23) in group A and 5.0% (1/20) in group B, showing no significant difference between 2 groups (P>0.05). The rate of postoperative complications was 10.5% (2/19) in group A and 22.2% (4/18) in group B, showing no significant difference between 2 groups (P>0.05). Thirty-one patients (37 hips) were followed up 1-7 years (mean, 3 years), including 16 cases (19 hips) in group A and 15 cases (18 hips) in group B. X-ray films showed good position of the prostheses. The Harris score at last follow-up was significantly increased when compared with preoperative score in 2 groups (P<0.05), but there was no significant difference between 2 groups (P>0.05). The postoperative discrepancy of bilateral lower limbs had no significant difference (t = -1.343, P=0.188).

CONCLUSION: THA with trochanteric osteotomy or subtrochanteric osteotomy both can effectively treat Crowe type IV DDH. THA with subtrochanteric osteotomy has an advantage in correcting lower limb discrepancy.