The outcome of total hip arthroplasty in patients with developmental dysplasia of the hip

Retrospective Review of Outcomes of Total Hip Arthroplasty in Developmental Dysplasia of the Hip in Adults

BACKGROUND

Developmental dysplasia of the hip (DDH) is a major cause of hip arthritis in young adults. Total hip arthroplasty (THA) is an effective treatment for DDH, but few studies have examined mid- (5 to 10 years) to long-term (> 10 years) outcomes. This study reports the long-term survivorship, clinical, and radiographic outcomes of THA in DDH patients.

METHODS

A total of 255 patients were included from our retrospective review of THAs from January 2004 to January 2022. Among these cases, 214 (83.9%) were women; the mean age at the time of surgery was 46 years (range, 18 to 87), and the mean follow-up was 8.3 (range, 0.05 to 21.1) years. Kaplan-Meier survivorship analysis was conducted with failure defined as revision surgery for any reason.

RESULTS

Kaplan-Meier survivorship for patients who underwent THA to treat DDH due to all-cause failure was 93.4% (95% confidence interval (CI): 90.3 to 96.5) at 5 years, 92.5% (95% CI: 89.0 to 95.6) at 10 years, and 90.9% (95% CI: 86.2 to 94.0) at 15 years. The overall rate of revision of the index surgery was 18 of 255 (7.1%). These complications included pain (seven), dislocation (four), aseptic loosening of the cup (three), periprosthetic fracture (two), complete foot drop (one), and infection (one). Kaplan-Meier all-cause survivorship for Hartofilakidis A, B, and C was also conducted and showed no significant differences. The mean femoral offset improved from a preoperative value of 12.2 cm (SD 1.4) to a postoperative value of 11.7 cm (SD 1.1) (P < 0.001). The rate of femoral nerve palsy was 0.78%.

CONCLUSIONS

Our study suggests THA for DDH is a viable treatment, providing excellent mid-term to long-term survivorship, clinical, and radiographic outcomes with a low complication rate. Future research should evaluate patient-reported outcomes and long-term follow-up in larger cohorts.

Robotically Assisted vs. Manual Total Hip Arthroplasty in Developmental Hip Dysplasia: A Comparative Analysis of Radiological and Functional Outcomes

Background/Objectives: Developmental dysplasia of the hip (DDH), defined by the malalignment of the femoral head and acetabulum, is a major precursor to coxarthrosis, posing substantial challenges during total hip arthroplasty (THA). Patients with coxarthrosis secondary to DDH often exhibit acetabular bone insufficiency, which makes challenging surgical reconstruction difficult. This study aimed to compare the radiologic and functional outcomes of robotically assisted and conventional manual THA techniques in patients with coxarthrosis secondary to Crowe type III-IV DDH. Methods: This prospective study included 40 patients divided into robotically assisted (n = 20) and conventional manual (n = 20) THA groups. Evaluations encompassed hip pain (Visual Analogue Scale, VAS), function (Harris hip score and University of California, Los Angeles, activity scale), quality of life (Short Form-12), and prosthesis sensation (Forgotten Joint Score-12). Radiologic outcomes included acetabular inclination and anteversion angles. Femoral shortening, operative duration, and follow-up times were also analyzed. Results: Demographic characteristics did not differ between groups (p > 0.05). Robotically assisted THA exhibited a significantly longer operative time (171.40 ± 11.96 vs. 150.30 ± 14.67 min; p = 0.001) but a shorter follow-up (29.3 ± 8.51 vs. 52.95 ± 18.96 months; p = 0.001), without a difference in the amount of femoral shortening (p = 0.947). Despite the extended surgical duration, the two techniques achieved comparable radiologic outcomes, with no significant differences in acetabular inclination or anteversion angles (p > 0.05). Functional assessments, including Harris hip scores (73.85 vs. 73.95; p = 0.978), UCLA activity scores, and VAS, indicated similar efficacy between groups. SF-12 physical and mental quality of life and Forgotten Joint Score-12 prosthesis sensation did not differ between groups (p > 0.05). Conclusions: This study concludes that robotically assisted and conventional manual THA present similar radiologic and functional outcomes in patients with coxarthrosis secondary to Crowe type III-IV DDH, as displayed by comparable acetabular anteversion and inclination alignment, femoral shortening, hip function, pain, quality of life, and prosthesis sensation scores. While robotically assisted THA requires a longer operative time, its precision in implant placement may hold potential advantages for long-term outcomes, demanding further investigation in extended follow-up studies.

Technological rehabilitation versus conventional rehabilitation following hip replacement: A prospective controlled study

BACKGROUND

Among new technological rehabilitation systems, there are proprioceptive platforms. These could be useful to improve static and dynamic balance.

OBJECTIVE

To evaluate technological proprioceptive rehabilitation compared to conventional rehabilitation in patients after total hip arthroplasty (THA).

METHODS

Sixty-four patients after THA were divided in two groups: a conventional group (CG) and a technological group (TG) treated with proprioceptive platforms. Before (T0) and after 20 sessions (T1), we recorded static and dynamic balance. Clinical and disability scales (Modified Harris Hip Score, Barthel Index, Deambulation Index), pain scales (ID-PAIN, DN4, VAS) and QoL scale (SF-36) were administered to patients during T0 and T1. Mann-Whitney U test was used for stabilometric and dynamic assessments to detect differences between groups of patients and healthy subjects. The Wilcoxon signed-rank test was used for the within-group analysis and the ANCOVA test for the analysis between groups of patients.

RESULTS

All scales improved significantly in both groups after treatment (p< 0.05). Static balance improved in both groups, but there were greater improvements in the TG than in the CG. All dynamic balance indexes showed significant improvements only in the TG after treatment.

CONCLUSIONS

Both treatments improved the clinical, disability, pain, and QoL scales, as well as static balance, but only proprioceptive technological rehabilitation improved dynamic balance. Rehabilitation through proprioceptive platforms can indeed improve static and dynamic balance, which are both crucial for the patient's safety and autonomy.

Does THA Affect Sexual Dysfunction in Female Patients With DDH?

BACKGROUND

Sexual health, aside from reproduction, plays an important role in physical, intellectual, emotional and social facets of life. Developmental dysplasia of the hip (DDH) is a chronic orthopedic disease that has negative physical, social, and mental/spiritual effects, and lowers quality of life. However, no studies exist in the literature that focus on sexual function and health in patients with DDH.

METHODS

The preoperative and postoperative 6th month and 1st year sexual functions of women who underwent surgical treatment (total hip arthroplasty) for DDH (Crowe 1-4) (n:50) and their spouses (n:30) were evaluated with Arizona Sexual Experience scale (ASEX) questionnaire which evaluates sexual function in 5 categories such as desire, arousal, erection/lubrication, orgasm, and satisfaction.

RESULTS

The ASEX scores were 22.3 ± 3.5 preoperatively, 17.8 ± 2 at the 6th postoperative month, and 14.8 ± 1.3 at the 1st postoperative year. The decrease in the average score showed that sexual dysfunction existed in the preoperative period and sexual function was positively affected in the postoperative period over time. The ASEX scores of the patients younger than 35 in the postoperative 6th month had higher scores (P = .29). The sexual life of the husbands was not affected by the wives' surgery, even though their spouses had a chronic condition causing functional difficulties.

CONCLUSION

This study showed that the sexual life of women with DDH, who had been treated with total hip arthroplasty, was positively affected, whereas their husbands were unaffected. Further studies focusing on the effect of physiological and emotional factors, in addition to the surgical treatment, on sexual function are needed.