Clinical Outcomes of Total Hip Arthroplasty in Unilateral Crowe Type IV Hip Dysplasia

Objective: To investigate the functional outcomes of femoral shortening osteotomy concomitant with cementless total hip arthroplasty (THA) in unilateral Crowe type IV hip dysplasia. Methods: A total of 57 patients that underwent THA with femoral shortening osteotomy having the diagnosis of Crowe type IV developmental dysplasia of the hip between January 2005 and March 2016 were retrospectively reviewed. The Harris hip score and Western Ontario and McMaster Universities Osteoarthritis index were used to evaluate functional results. Abductor function was evaluated with the Trendelenburg sign before and after surgery. Major complications were assessed. The pre-operative and post-operative leg height inequality was also measured for all patients. Results: The mean follow-up period of patients with a follow-up of at least 2 years was 47.8 months. The Trendelenburg sign, which was positive in all patients before surgery, was positive in three patients (5.2%) during the last follow-up. The mean pre-operative leg inequality was 6.9±2.4 cm, and decreased to 1.3±0.3 cm postoperatively. During the last follow-up, five patients (8.7%) had a complaint of leg length discrepancy due to a longer leg on the THA side. Functional scores of patients during the last follow-up were statistically significant higher compared to the pre-operative period. Conclusion: Applying cementless THA in patients with unilateral Crowe type IV has satisfactory clinical results. To relieve pain and improve functional scores and quality of life, THA is the best treatment option. The rate of complications is high; however, patient can be managed with a secondary intervention or only observation.