Retrospective study: Crowe 3-4 WE performed total hip prosthesis for adult age treatment of developmental hip dysplasia; comparison of patients with and without subtrocanteric shortening osteotomy

Purpose: Comparison of clinical and radiological results of patients with Crowe 3 and 4 with developmental dysplasia of the hip(DDH), who underwent total hip replacement(THR) with and without subtrochanteric shortening osteotomy(STO). Materials and methods: 59 operations of 46 patients over the age of 18 who applied to our clinic with the diagnosis of developmental hip dysplasia and underwent total hip replacement between 2010 and 2020 were evaluated. The patients were divided into two groups(24 with STO, 35 without STO) as patients with and without subtrochanteric shortening osteotomy. These patients had been compared between groups by Harris Hip Score(HHS), Oxford Hip Score(OHS), Visual Analogue Scale(VAS), leg-length discrepancies, sciatalgia, sciatic nerve palsy, Trendelenburg sign, length of hospital stay, the amount of bleeding, the need for erythrocyte suspension, infection, debridement, revision, dislocation, fracture, osteolysis, loosening, nonunion at the osteotomy line, heterotopic ossification, pelvic obliquity. Results: In our study, the reductability of the hip rotation center to the true acetabulum with traction was evaluated under general anesthesia and muscle relaxant, following soft tissue release, and it was decided whether to perform STO or not. The method used in our study was compared with the recommendations of Crowe, Hartofilakidis and Eftekhar classifications, and no statistically significant correlation was found. Femoral stem selections were made according to the preoperative recommendations of the Dorr classification and peroperative femoral implantatinons. The obtained peroperative implantation and our preoperative choices obtained with the Dorr classification were compared, and they were significantly related to each other. We see that pelvic obliquity decreased in both groups. There was no significant difference in the results of VAS and HHS in two groups. In OHS, those without STO were significantly better outcomes. Results of duration of hospitalization, amount of bleeding and need for blood products were evaluated to be significantly more successful in group without STO. We observed that the postoperative results of leg length discrepancy of both groups improved significantly compared to the preoperative period. Sciatic nerve palsy and sciatalgia were reversible, and there was no significant difference between two groups. In the follow-up %98 survival was observed. Conclusion: THR in Crowe 3 and 4 DDH, the height of the dislocated hip of the patient is important in planning the treatment. The tightness of soft tissues and adhesions due to congenital or acquired reasons also affect this planning. Although STO are recommended in the literature due to neurovascular limitations, in our study, we see that near-perfect functional results can be obtained without shortening osteotomies. Keywords: Developmental hip dysplasia, Total hip replacement, Subtrochanteric shortening osteotomy, Harris hip score, Leg length discrepancy.