Direct anterior approach for Crowe grade III developmental dysplasia in total hip arthroplasty

Abstract

Inrtroduction: THA for high dislocation due to severe acetabular dysplasia of the hip (DDH) often requires bone grafting due to bone loss on the acetabular side, have proximal femur deformity and leg length difference, making treatment difficult. Purpose: In this study, we examined the clinical and radiological outcome of 5 THAs using Direct anterior approach (DAA) for patients with DDH. Result: The cup inclination angle was 37.2° and the anteversion angle was 18.8°. The leg length discrepancy improved from 28.8mm preoperatively to 7.95mm. The HHS significantly improved from 37.8 ​± ​7.78 preoperatively to 88 ​± ​2.35 (p ​< ​0.001) at latest follow-up. The JHEQ score also improved from 19.8 ​± ​15.1 before surgery to 64.5 ​± ​9.88 at the final survey (p ​= ​0.003). The patients were able to walk with a cane and discharged from hospital in 27 days. No postoperative complications such as dislocation or neurological disorders were observed. The limp improved in all patients 6 months after surgery, and they were able to walk without a cane. Radiologically, the autologous bone grafted on the acetabular side had healed and no stem subsidence of more than 3 mm was observed at the final observation. There was no revision case for any reason. The limp improved in all patients 6 months after surgery, and they were able to walk without a cane. There was no revision case for any reason. Conclusion: DAA improved early postoperative recovery due to muscle preservation and significantly improved clinical outcomes, and it also improved leg length and prevented dislocation.

Keywords

• Total hip arthroplasty
• Direct anterior approach
• Developmental dysplasia