Clinical evaluation of direct anterior approach total hip arthroplasty for severe developmental dysplasia of the hip

Abstract 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 versu...

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Autores principales:	Zaiyang Liu, Courtney D. Bell, Alvin C. Ong, Jun Zhang, Jie Li, Yuan Zhang
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/a413fc9350db46d0a66ab940e15cdc77
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spelling	oai:doaj.org-article:a413fc9350db46d0a66ab940e15cdc772021-12-02T18:03:07ZClinical evaluation of direct anterior approach total hip arthroplasty for severe developmental dysplasia of the hip10.1038/s41598-021-87543-x2045-2322https://doaj.org/article/a413fc9350db46d0a66ab940e15cdc772021-04-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-87543-xhttps://doaj.org/toc/2045-2322Abstract 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.Zaiyang LiuCourtney D. BellAlvin C. OngJun ZhangJie LiYuan ZhangNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Zaiyang Liu Courtney D. Bell Alvin C. Ong Jun Zhang Jie Li Yuan Zhang Clinical evaluation of direct anterior approach total hip arthroplasty for severe developmental dysplasia of the hip
description	Abstract 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	article
author	Zaiyang Liu Courtney D. Bell Alvin C. Ong Jun Zhang Jie Li Yuan Zhang
author_facet	Zaiyang Liu Courtney D. Bell Alvin C. Ong Jun Zhang Jie Li Yuan Zhang
author_sort	Zaiyang Liu
title	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_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_sort	clinical evaluation of direct anterior approach total hip arthroplasty for severe developmental dysplasia of the hip
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/a413fc9350db46d0a66ab940e15cdc77
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Clinical evaluation of direct anterior approach total hip arthroplasty for severe developmental dysplasia of the hip

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