Mehmet MADEN, Mahmut TUNÇEZ, Süleyman SOFULU, Cemal KAZİMOGLU

Crowe Evre 3 ve Evre 4 Gelişimsel Kalça Displazili Hastalarda Çimentosuz Total Kalça Artroplastisi Uygulaması Sonrası Fonksiyonel Sonuçlar Elde Etmek Mümkün Mü?

Amaç: Gelişimsel kalça displazisi toplumda genç erişkin yaş grubunda total kalça artroplastisi uygulanmasının en önemli nedenlerinden birisidir. Bu hastalarda artroplasti uygulaması teknik anlamda ortopedik cerrahlar açısından son derece zorlu ve karmaşıktır. Çalışmanın amacı, Crowe evre 3 ve 4 gelişimsel kalça displazili hastalarda total kalça artroplastisinin orta dönem fonksiyonel sonuçlarının değerlendirilmesidir. Gereç ve Yöntem: 2017-2020 yılları arasında gelişimsel kalça displazisi nedeniyle total kalça artroplastisi uygulanan 10 hasta çalışmamıza dahil edildi. Ortalama yaş 52 olarak saptandı. Üç hasta Crowe evre 3, yedi hasta ise Crowe evre 4’tü. Hastalar retrospektif olarak incelendi. Değerlendirmede Harris Kalça Skorları, fizik muayene ve radyografik analiz parametreleri kullanıldı. Bulgular: Ortalama takip süresi 18 aydı ve hastalarda hesaplanan minimum Harris Kalça Skoru 88, maksimum 95 puan olmak üzere ortalama Harris Kalça Skoru 93 (88-95) olarak bulundu. Osteotomi yapılan hiçbir hastada kaynamama izlenmedi. Postoperatif dönemde ortalama her iki bacak arası uzunluk farkı 0 cm saptandı. Hiçbir hastada siyatik sinir hasarı ve enfeksiyon görülmedi. Sonuç: Evre 3-4 gelişimsel kalça displazili olgularda uygulanan total kalça artroplastisi ile iyi fonksiyonel sonuçlar elde etmek mümkündür. Bu hastalarda total kalça artroplastisi sonrası normale yakın bir bacak restorasyonu ve hastalar için fizyolojik bir kalça oluşturulması sağlanabilir.

Anahtar Kelimeler:

Gelişimsel kalça displazisi, Total kalça artroplastisi, Kısaltma osteotomisi

Is It Possible to Obtain Functional Results after Cementless Total Hip Arthroplasty in Patients with Crowe Stage 3 and Stage 4 Developmental Hip Dysplasia?

Objective: Developmental hip dysplasia is one of the most important causes of the application of total hip arthroplasty in young adults. In these patients ,arthroplasty is technically very difficult and complex for orthopedic surgeons. The purpose of this study is to evaluate the mid-term functional results of total hip arthroplasty in patients with Crowe stage 3 and 4 developmental hip dysplasia. Materials and Method: 10 patients who underwent total hip arthroplasty due to developmental hip dysplasia were included in our study between 2017 and 2020. The average age was 52. Three patients were Crowe stage 3, and seven were Crowe stage 4. Patients were analyzed retrospectively. The evaluation was performed through Harris Hip Scores, physical examination, and radiographic analysis. Results: The average follow-up period was 18 months and the Harris Hip Scores varied from a minimum 88 to a maximum 95 points with an average score of 93 (88-95). Nonunion was not observed in any patient who underwent osteotomy. In the postoperative period, the average difference in length between both legs was 0 cm. No patients had sciatic nerve damage and infection. Conclusion: It is possible to achieve good functional results with total hip arthroplasty in cases with stage 3-4 developmental hip dysplasia. In these patients, a near-normal leg restoration and a physiological hip can be obtained after total hip arthroplasty.

Keywords:

Developmental hip dysplasia, Total hip arthroplasty, Shortening osteotomy,

PDF

___

Mu W, Yang D, Xu B, Mamtimin A, Guo W, Cao L. Midterm Outcome of Cementless Total Hip Arthroplasty in Crowe IV-Hartofilakidis Type III Developmental Dysplasia of the Hip. J Arthroplasty. 2016 Mar 1;31(3):668–75.
Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congential dislocation and dysplasia of the hip. J Bone Jt Surg - Ser A. 1979;
Sofu H, Şahin V, Gürsu S, Yildirim T, Issin A, Koçkara N. Cementless total hip arthroplasty in patients with crowe type-4 developmental dysplasia. HIP Int. 2013;23(5):472–7.
Harris WH. Traumatic Arthritis of the Hip after Dislocation and Acetabular Fractures. J Bone Jt Surg. 1969;
Karachalios T, Hartofilakidis G. Congenital hip disease in adults: Terminology, classification, pre-operative planning and management. Journal of Bone and Joint Surgery - Series B. 2010.
Arych AJ, Howard JL, Trousdale RT, Cabanela ME, Berry DJ. Total Hip Arthroplasty with Shortening Subtrochanteric Osteotomy in Crowe Type-IV Developmental Dysplasia. J Bone Jt Surgery-American Vol [Internet]. 2009 Sep 1 [cited 2020 Mar 26];91(9):2213–21. Available from: http://journals.lww.com/00004623-200909000-00019
Nilsdotter A, Bremander A. Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (A. Arthritis Care Res. 2011;
Wang S, Zhou Y, Ma H, Du Y, Piao S, Wu W. Mid-term results of total hip replacement with subtrochanteric osteotomy, modular stem, and ceramic surface in Crowe IV hip dysplasia. Arthroplast Today. 2018;
Rasi AM, Kazemian G, Khak M, Zarei R. Shortening subtrochanteric osteotomy and cup placement at true acetabulum in total hip arthroplasty of Crowe III–IV developmental dysplasia: results of midterm follow-up. Eur J Orthop Surg Traumatol. 2018;
Bhave A, Paley D, Herzenberg JE. Improvement in gait parameters after lengthening for the treatment of limb-length discrepancy. J Bone Jt Surg - Ser A. 1999;81(4):529–34.
Gross RH. Leg length discrepancy: How much is too much? Orthopedics. 1978 Jul 1;1(4):307–10.
Wang D, Li DH, Li Q, Wang HY, Luo ZY, Yang Y, et al. Subtrochanteric shortening osteotomy during cementless total hip arthroplasty in young patients with severe developmental dysplasia of the hip. BMC Musculoskelet Disord. 2017 Nov 25;18(1):1–13.
Bicanic G, Delimar D, Delimar M, Pecina M. Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop. 2009 Apr 18;33(2):397–402.
Togrul E, Özkan C, Kalaci A, Gülşen M. A new technique of subtrochanteric shortening in total hip replacement for crowe type 3 to 4 dysplasia of the hip. J Arthroplasty. 2010 Apr 1;25(3):465–70.
Howie CR, Ohly NE, Miller B. Cemented total hip arthroplasty with subtrochanteric osteotomy in dysplastic hips. In: Clinical Orthopaedics and Related Research. Springer New York LLC; 2010. p. 3240–7.
Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res. 1987 May 1;No. 218(218):136–41.