title: Cementless total hip arthroplasty for patients with Crowe type III or IV developmental dysplasia of the hip: two-stage total hip arthroplasty following skeletal traction after soft tissue release for irreducible hips.
abstract: BACKGROUND
  Total hip arthroplasty (THA) for severe developmental dysplasia of the hip (DDH) is a technically demanding procedure for arthroplasty surgeons, and it is often difficult to reduce the hip joint without soft tissue release due to severe flexion contracture. We performed two-stage THAs in irreducible hips with expected lengthening of the affected limb after THA of over 2.5 cm or with flexion contractures of greater than 30 degrees in order to place the acetabular cup in the true acetabulum and to prevent neurologic deficits associated with acute elongation of the limb. The purpose of this study is to evaluate the outcomes of cementless THA in patients with severe DDH with a special focus on the results of two-stage THA.
  
  
  METHODS
  Retrospective clinical and radiological evaluations were done on 17 patients with Crowe type III or IV developmental DDH treated by THA. There were 14 women and 3 men with a mean age of 52.3 years. Follow-ups averaged 52 months. Six cases were treated with two-stage THA followed by surgical hip liberalization and skeletal traction for 2 weeks.
  
  
  RESULTS
  The mean Harris hip score improved from 40.9 to 89.1, and mean leg length discrepancy (LLD) in 13 unilateral cases was reduced from 2.95 to 0.8 cm. In the patients who underwent two-stage surgery, no nerve palsy was observed, and the single one-stage patient with incomplete peroneal nerve palsy recovered fully 4 weeks postoperatively.
  
  
  CONCLUSIONS
  The short-term clinical and radiographic outcomes of primary cementless THA for patients with Crowe type III or IV DDH were encouraging. Two-stage THA followed by skeletal traction after soft tissue release could provide alternative solutions to the minimization of limb shortenings or LLD without neurologic deficits in highly selected patients.
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Boramae Hospital, Seoul, Korea.
authors.forename: Pil Whan
authors.initials: PW
authors.lastname: Yoon
authors.forename: Jung Il
authors.initials: JI
authors.lastname: Kim
authors.forename: Dong Ok
authors.initials: DO
authors.lastname: Kim
authors.forename: Cheol Hwan
authors.initials: CH
authors.lastname: Yu
authors.forename: Jeong Joon
authors.initials: JJ
authors.lastname: Yoo
authors.forename: Hee Joong
authors.initials: HJ
authors.lastname: Kim
authors.forename: Kang Sup
authors.initials: KS
authors.lastname: Yoon
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery; D006615:Hip / Q000000981:diagnostic imaging / Q000601:surgery; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D007085:Ilium / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D011859:Radiography; D012189:Retrospective Studies; D014143:Traction
keywords: Congenital hip dysplasia; Total hip arthroplasty