JOURNAL ARTICLE

[Morphological changes of proximal femur in patients with Crowe II/III developmental dysplasia of hip and their implication to total hip arthroplasty]

Ruiyu Liu, Chunsheng Wang, Kunzheng Wang
Chinese Journal of Reparative and Reconstructive Surgery 2007, 21 (10): 1050-3
17990767

OBJECTIVE: To investigate the morphological changes of the proximal femur and their implication to the total hip arthroplasty in patients with Crowe II/III developmental dysplasia of the hip (DDH).

METHODS: The experimental group was composed of 15 hips in 14 patients (Crowe II, 9 hips; Crowe III, 6 hips ) with osteoarthritis secondary to Crowe II/III DDH (2 males, 12 females; age, 35-61 years). None of the patients had accepted any osteotomy treatment. The control group was composed of 15 normal hips in 15 patients with unilateral DDH (3 males, 12 females; age, 35-57 years). Twelve hips came from the experimental group and the other 3 came from the patients with unilateral Crowe I DDH. The femurs were examined with the CT scanning. The following parameters were measured: the height of the center of the femoral head (HCFH), the isthmus position (IP), the neck-shaft angle(NS), the anteversion angle, the canal flare index, and the canal width. Then, the analysis of the data was conducted.

RESULTS: HCFH and IP in the experimental group and the control group were 50.1 +/- 6.7 mm, 50.1 +/- 7.4 mm, and 107.4 +/- 21.5 mm, 108.7 +/- 18.1 mm, respectively, which had no significant difference between the two groups (P > 0.05). In the experimental group and the control group, the NS were 138.3 +/- 10.0 degrees and 126.7 +/- 5.7 degrees, the anteversion angles were 36.5 +/- 15.9 degrees and 18.8 +/- 5.4 degrees, and the canal flare indexes were 4.47 +/- 0.40 and 5.01 +/- 0.43. There was a significant difference between the two groups in the above 3 parameters (P < 0.05). As for the canal width of the femur, there was a significant difference in the interior/exterior widths and the anterior/posterior widths at the level of 2 cm above the lesser trochanter and 4 cm below the lesser trochanter between the two groups (P < 0.05); however, there was no significant difference in the canal width of the femur at the isthmus between the two groups (P > 0.05).

CONCLUSION: It is necessary to evaluate the morphology of the proximal femur before the total hip arthroplasty performed in patients with Crowe II /III DDH. The straight and smaller femoral prosthesis should be chosen and implanted in the proper anteversion position during operation.

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