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      Risk of Dislocation After Total Hip Arthroplasty in Patients with Crowe Type IV Developmental Dysplasia of the Hip

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          To investigate whether the risk of dislocation after total hip arthroplasty (THA) in patients with Crowe type IV developmental dysplasia of the hip (DDH) is high and to further identify the risk factors for postoperative dislocation in these patients.


          This retrospective cohort study reviewed Crowe type IV DDH patients undergoing THA between January 2009 and December 2017 in our institution. Each Crowe type IV DDH patient was matched with three Crowe type I, II, or III DDH patients according to gender, side and date of operation. The primary outcome of this study was postoperative dislocation after THA. Occurrence, rate, classification, treatment and outcome of dislocation were documented in detail for all patients. The dislocation rates were compared between Crowe type IV DDH patients and Crowe type I, II, or III DDH patients. Demographic data, implant factors, and surgical factors were compared between the dislocation and no dislocation groups. Multiple logistic regression analysis was used to determine the independent risk factors for dislocation in Crowe type IV hips.


          A total of 131 Crowe type IV hips were followed up for a mean of 76.5 ± 28.1 months. Three hundred and ninety‐three Crowe type I, II and III hips, including 261 type I hips, 94 type II hips, and 38 type III hips, were identified as controls and followed up for a mean of 76.4 ± 28.2 months. No significant difference was observed in follow‐up time between two groups ( P = 0.804). One or more dislocations occurred in 22 of the 524 dysplasia hips (4.20%). Of the 22 dislocated hips, 20 hips (90.9%) were successfully managed with non‐operative treatment. Two patients (9.1%, one Crowe type I and one Crowe type IV) experienced recurrent dislocation and required revision surgery. Crowe type IV hips had a significantly higher postoperative dislocation rate than type I, II, and III hips (11.45% vs 1.78%, P < 0.001). The use of a 22‐mm femoral head (odds ratio [ OR] = 23.55, 95% confidence interval [ CI] = 1.901–291.788, P = 0.014), older age ( OR = 1.128, 95% CI = 1.037–1.275, P = 0.031), and absence of false acetabulum ( OR = 12.425, 95% CI = 1.982–77.879, P = 0.007) were identified as independent risk factors for dislocation in Crowe type IV hips.


          Crowe type IV DDH patients were at a high risk of dislocation after THA, and using large femoral heads and improving abductor muscle strength may help decrease the rate of postoperative dislocation in such patients.

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          Most cited references 43

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          Dislocations after total hip-replacement arthroplasties.

          In a series of 300 total hip replacements, nine (3 per cent) dislocated. Precise measurements of the orientation of the acetabular cup were made and it was found that anterior dislocations were associated with increased acetabular-component anteversion. There was no significant correlation between cup-orientation angle and posterior dislocation. The dislocation rate for cup orientation with anteversion of 15 +/- 10 degrees and lateral opening of 40 +/- 10 degrees was 1.5 per cent, while outside this "safe" range the dislocation rate was 6.1 per cent. Other factors that were documented include time after surgery (with the greatest risk in the first thirty days) and surgical history (with a greater risk in hips that have had prior surgery).
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            The definition and measurement of acetabular orientation.

            The orientation of an acetabulum or an acetabular prosthesis may be described by its inclination and anteversion. Orientation can be assessed anatomically, radiographically, and by direct observation at operation. The angles of inclination and anteversion determined by these three methods differ because they have different spatial arrangements. There are therefore three distinct definitions of inclination and anteversion. This paper analyses the differences between the definitions and provides nomograms to convert from one to another. It is recommended that the operative definitions be used to describe the orientation of prostheses and that the anatomical definitions be used for dysplastic acetabula.
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              Total hip replacement in congenital dislocation and dysplasia of the hip.

              The results of thirty-one total hip replacements in twenty-four patients with either severe congenital dysplasia or dislocation, after an average follow-up of four years, were excellent in eleven, good in sixteen, fair in one, and poor in one. The operative technique included superolateral bone grafts to increase the acetabular coverage in six hips. Twenty-seven hips required smaller and straighter femoral components than normal. The incidence of major complications was 19 per cent.

                Author and article information

                Orthop Surg
                Orthop Surg
                Orthopaedic Surgery
                John Wiley & Sons Australia, Ltd (Melbourne )
                29 March 2020
                April 2020
                : 12
                : 2 ( doiID: 10.1111/os.v12.2 )
                : 589-600
                [ 1 ] Department of Orthopaedics West China Hospital/West China School of Medicine, Sichuan University Chengdu China
                [ 2 ] Clinic Research Management Department West China Hospital/West China School of Medicine, Sichuan University Chengdu China
                Author notes
                [* ] Address for correspondence Zong‐ke Zhou, MD, Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu 610041, China Tel: (86)18980601028; Fax: (86)028‐85422428; Email: zhouzongke@

                Zi‐chuan Ding and Wei‐nan Zeng contributed equally to this work.

                © 2020 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

                This is an open access article under the terms of the License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 4, Tables: 3, Pages: 12, Words: 7946
                Clinical Article
                Clinical Articles
                Custom metadata
                April 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.1 mode:remove_FC converted:29.04.2020


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