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Clinical evaluation of direct anterior approach total hip arthroplasty for severe developmental dysplasia of the hip
It is challenging to treat developmental dysplasia of the hip (DDH) classified Crowe III-IV using direct anterior approach (DAA) total hip arthroplasty (THA), and very little is known on its outcome. This study aimed to investigate the clinical result in this defined disorder with DAA versus postero...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Nature Publishing Group UK
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046760/ https://www.ncbi.nlm.nih.gov/pubmed/33854151 http://dx.doi.org/10.1038/s41598-021-87543-x |
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author | Liu, Zaiyang Bell, Courtney D. Ong, Alvin C. Zhang, Jun Li, Jie Zhang, Yuan |
author_facet | Liu, Zaiyang Bell, Courtney D. Ong, Alvin C. Zhang, Jun Li, Jie Zhang, Yuan |
author_sort | Liu, Zaiyang |
collection | PubMed |
description | It is challenging to treat developmental dysplasia of the hip (DDH) classified Crowe III-IV using direct anterior approach (DAA) total hip arthroplasty (THA), and very little is known on its outcome. This study aimed to investigate the clinical result in this defined disorder with DAA versus posterolateral approach. Twenty-three consecutive hips with Crowe III-IV DDH who underwent DAA were retrospectively evaluated from 2016 through 2018. Outcomes were primarily assessed by HHS, WOMAC, and SF-12 physical scales. The second evaluations included leg length discrepancy, hip muscle strength, radiographic review, complications, and limp recovery. Results were compared to a control cohort of 50 hips underwent posterolateral THA concurrently within the observational period. At last follow-up (DAA 28.5 months; PLA 39.0 months), the mean increase of the HHS for DAA was 48.2 and 30.3 for PLA (p = 0.003). The improvement in WOMAC score in DAA cohort was 15.89 higher that of the PLA cohort after adjusting preoperative difference [R2 = 0.532, P = 0.000, 95% CI (10.037, 21.735)]. DAA had more rapid recovery of hip abductor strength at 1-month (p = 0.03) and hip flexor strength at 3 months (p = 0.007) compared to PLA. No significant differences were found in the radiographic analysis with the exception of increased acetabular anteversion in the DAA cohort (p = 0.036). Satisfactory improvement in limp, indicated by the percentage of limp graded as none and mild to the total, was much higher in DAA cohort (97.6%), compared to that of PLA cohort (90.0%, p = 0.032). DAA for high-dislocated dysplasia demonstrate a significant improvement in clinical result comparable to posterolateral approach. Improved clinical outcome in terms of increased HHS and WOMAC scores, rapid recovery of hip abductor and flexor strength, and enhanced limp recovery without an increased risk in complications, could be acquired when the surgeons were specialized in this approach. |
format | Online Article Text |
id | pubmed-8046760 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
spelling | pubmed-80467602021-04-15 Clinical evaluation of direct anterior approach total hip arthroplasty for severe developmental dysplasia of the hip Liu, Zaiyang Bell, Courtney D. Ong, Alvin C. Zhang, Jun Li, Jie Zhang, Yuan Sci Rep Article It is challenging to treat developmental dysplasia of the hip (DDH) classified Crowe III-IV using direct anterior approach (DAA) total hip arthroplasty (THA), and very little is known on its outcome. This study aimed to investigate the clinical result in this defined disorder with DAA versus posterolateral approach. Twenty-three consecutive hips with Crowe III-IV DDH who underwent DAA were retrospectively evaluated from 2016 through 2018. Outcomes were primarily assessed by HHS, WOMAC, and SF-12 physical scales. The second evaluations included leg length discrepancy, hip muscle strength, radiographic review, complications, and limp recovery. Results were compared to a control cohort of 50 hips underwent posterolateral THA concurrently within the observational period. At last follow-up (DAA 28.5 months; PLA 39.0 months), the mean increase of the HHS for DAA was 48.2 and 30.3 for PLA (p = 0.003). The improvement in WOMAC score in DAA cohort was 15.89 higher that of the PLA cohort after adjusting preoperative difference [R2 = 0.532, P = 0.000, 95% CI (10.037, 21.735)]. DAA had more rapid recovery of hip abductor strength at 1-month (p = 0.03) and hip flexor strength at 3 months (p = 0.007) compared to PLA. No significant differences were found in the radiographic analysis with the exception of increased acetabular anteversion in the DAA cohort (p = 0.036). Satisfactory improvement in limp, indicated by the percentage of limp graded as none and mild to the total, was much higher in DAA cohort (97.6%), compared to that of PLA cohort (90.0%, p = 0.032). DAA for high-dislocated dysplasia demonstrate a significant improvement in clinical result comparable to posterolateral approach. Improved clinical outcome in terms of increased HHS and WOMAC scores, rapid recovery of hip abductor and flexor strength, and enhanced limp recovery without an increased risk in complications, could be acquired when the surgeons were specialized in this approach. Nature Publishing Group UK 2021-04-14 /pmc/articles/PMC8046760/ /pubmed/33854151 http://dx.doi.org/10.1038/s41598-021-87543-x Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Article Liu, Zaiyang Bell, Courtney D. Ong, Alvin C. Zhang, Jun Li, Jie Zhang, Yuan Clinical evaluation of direct anterior approach total hip arthroplasty for severe developmental dysplasia of the hip |
title | Clinical evaluation of direct anterior approach total hip arthroplasty for severe developmental dysplasia of the hip |
title_full | Clinical evaluation of direct anterior approach total hip arthroplasty for severe developmental dysplasia of the hip |
title_fullStr | Clinical evaluation of direct anterior approach total hip arthroplasty for severe developmental dysplasia of the hip |
title_full_unstemmed | Clinical evaluation of direct anterior approach total hip arthroplasty for severe developmental dysplasia of the hip |
title_short | Clinical evaluation of direct anterior approach total hip arthroplasty for severe developmental dysplasia of the hip |
title_sort | clinical evaluation of direct anterior approach total hip arthroplasty for severe developmental dysplasia of the hip |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046760/ https://www.ncbi.nlm.nih.gov/pubmed/33854151 http://dx.doi.org/10.1038/s41598-021-87543-x |
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