In Patients With Hip Dysplasia, Mid-Term Lower Extremities and Spine After Hip Arthroplasty Natural Course

Study Overview
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Brief Summary
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Patients with developmental hip dysplasia often present to the outpatient clinic in adulthood with hip pain due to progressive hip osteoarthritis. However, they may have complaints such as limping, lumbar lordosis, lower back pain, and leg length difference. Today, the best treatment option for these patients is hip arthroplasty. Hip arthroplasty causes a high rate of functional improvement and pain relief. According to the hip arthroplasty technique applied, improvement in lameness, leg length difference and spinal curvatures is expected. The aim of our study is to show the change in postoperative spine and lower extremity curvatures after hip arthroplasty in patients with advanced developmental hip dislocation.

Detailed Description
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Developmental hip dysplasia (DDH) describes the spectrum of anatomical changes in the acetabulum and proximal femur; these can cause limping, lower back pain, lumbar lordosis, and leg length variation. DDH is the main cause of degenerative arthritis of the hip and valgus deformity of the knee. The best treatment option for DDH is total hip arthroplasty (THA). During THA, the distorted anatomy of the acetabulum and proximal femur poses great difficulties. Additionally, the soft tissue can be released and the femur can be shortened while correcting the placement of the acetabulum to prevent neurological damage (sciatic nerve paralysis). Postoperative evaluations focused on assessing joint function and alleviating preoperative clinical symptoms. Some studies have examined changes in lower extremity and knee alignment after THA in patients with DDH. In patients with DDH, THA may cause genu valgus deformity due to increased lower extremity length and Q angle immediately after the operation. THA extends the lower extremity, affecting the patellofemoral joint and anterior knee pain. However, the long-term effects of THA on the alignment of the lower extremity are unclear, especially in patients with Crowe type III and IV DDH, which involves femoral shortening osteotomy. There are few studies examining changes in the knee and lower extremities as a result of THA in patients with DDH. The aim of this study is to evaluate the mid- and long-term alignment of the spine and lower extremity after THA with or without femoral shortening osteotomy in patients with unilateral DDH (Crowe type III-IV).

Official Title
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In Patients With Crowe Type III and Crowe Type IV Hip Dysplasia, Mid-Term Lower Extremities and Spine After Total Hip Arthroplasty Natural Course

Conditions
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Total Hip Arthroplasty

Intervention / Treatment
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* Procedure: total hip arthroplasty


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with unilateral Crowe type 3 hip dysplasia Patients with unilateral Crowe type 4 hip dysplasia Exclusion Criteria: Patients with unilateral Crowe type 1 hip dysplasia Patients with unilateral Crowe type 2 hip dysplasia History of previous surgery on the hip for which surgery is planned
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Patients with Crowe type 3 or Crowe type 4 hip dysplasia who underwent total hip replacement<br> | Procedure: total hip arthroplasty<br>* Patients with Crowe type 3 or Crowe type 4 hip dysplasia who underwent hip replacement<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mechanical axis deviation (MAD) | the lower limb was defined as the distance from the center of the knee to the mechanical axis of the lower limb | From enrollment to the end of treatment at 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| tibiofemoral angle (TFA) | the angle formed by the line from the center of the femoral canal to the center of the knee joint and the line from the center of the knee joint to the center of the ankle joint. | From enrollment to the end of treatment at 2 years | 
| The femoral offset (FO) | the vertical distances from the center of the femoral head to the center of the femoral canal | From enrollment to the end of treatment at 2 years | 
| The hip-knee-ankle angle (HKA) | the angle formed by the mechanical axis of the femur and the mechanical axis of the tibia | From enrollment to the end of treatment at 2 years | 
| The lateral distal femoral angle (LDFA) | the angle formed by the anatomic axis of the femur and the distal femoral joint orientation line | From enrollment to the end of treatment at 2 years | 
| The medial proximal tibial angle (MPTA) | the angle formed by the anatomic axis of the tibia and the proximal tibial joint orientation line | From enrollment to the end of treatment at 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hip, Total hip arthroplasty, developmental hip dysplasia