Evaluation of long term outcomes of patients with developmental dysplasia of hip after hip arthroplasty with femoral shortening

Developmental hip dysplasia (DDH) is an important disease that causes hip pain and secondary osteoarthritis in adults if not treated appropriately in childhood. Especially the treatment of patients with high hip dislocation poses difficulties in adulthood. In this study, we aimed to compare the pre-operative and post-operative clinical and radiological results and examine variables that may affect this results of patients who were diagnosed with Crowe 4 high hip dislocation and underwent total hip arthroplasty (THA) with subtrochanteric femoral shortening osteotomy (SFSO) in the Department of Orthopedics and Traumatology, Hacettepe University Faculty of Medicine. 77 hips of 62 patients who underwent THA with SFSO with the diagnosis of DDH sequelae between 1995 and 2018 were included in our study. Demographic and clinical findings, surgical complications, Harris hip score (HHS) and forgotten joint scores (FJS) of the patients were evaluated retrospectively. Radiologically, pelvis, hip and extremity length x-rays of the patients taken in the pre-operative and post- operative periods were examined. With these radiographs, the staging of the patients, rotation center change and limb length difference were calculated. Complications during the follow-up period were noted. Statistical analysis of the obtained data was performed using IBM® SPSS version 25 software. The mean age at surgery was 45.39±9.96 years, and the median follow-up period was 190.6 months (60.2-297.5 months). The difference between the preoperative and postoperative disruption levels was found to be significant, with the patients' preoperative HHS increasing from 32.55 (25.3-73.8) to 94 (70.55-99.85) at the last follow-up. (p<0.001) The median FJS was found to be 91.66 (58.3-100) at the last follow-up and a strong positive correlation was observed between FJS and final follow-up HHS. (r=0.632, p<0.001) The overall survival rate was %86.4 (%95 CI: 69.4-103.4). In our study, THA surgery with oblique SFSO was performed using proximal 1/3 hydroxyapatite-coated stems and plate fixation, was evaluated as a successful surgery with high survival that greatly increased the clinical and functional scores of the patients. Key Words: Developmental hip dysplasia, subtrochanteric osteotomy, hip arthroplasty