Intraoperative two-stage evaluation of muscle contractures in Crowe type IV hips in total hip arthroplasty (a new surgical technique)

Background: It is important to maintain soft-tissue balance and prevent muscle contractures after hip reduction during total hip arthroplasty (THA) in patients with Crowe type IV developmental dysplasia of the hip (DDH). To make such hips functional and durable, the techniques to achieve soft-tissue...

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Bibliographic Details
Published in:Hip international 2022-05, Vol.32 (3), p.391-400
Main Authors: Bilgen, Ömer F, Yaray, Osman, Mutlu, Müren, Aksakal, Ahmet M
Format: Article
Language:English
Subjects:
Arthroplasty, Replacement, Hip - adverse effects
Arthroplasty, Replacement, Hip - methods
Contracture - etiology
Contracture - surgery
Femur - surgery
Follow-Up Studies
Hip Dislocation, Congenital - complications
Hip Dislocation, Congenital - diagnostic imaging
Hip Dislocation, Congenital - surgery
Humans
Muscles - surgery
Retrospective Studies
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Summary:Background: It is important to maintain soft-tissue balance and prevent muscle contractures after hip reduction during total hip arthroplasty (THA) in patients with Crowe type IV developmental dysplasia of the hip (DDH). To make such hips functional and durable, the techniques to achieve soft-tissue balance were studied to create an algorithm for intraoperative 2-stage evaluation of muscle contractures, specifying the optimal order for contracture release. Methods: Between February 2011 and March 2015, we evaluated 64 patients (75 hips) with DDH for muscle contractures as they underwent THA. Following acetabular implantation, femoral osteotomy was applied of various lengths according to limb-length discrepancy. First, the distal part of the femur was prepared by broaching, and the hip was then reduced. The tensor fascia lata, rectus femoris, sartorius, hamstrings, and adductor muscles were evaluated, and any contractures were released. A trial conjoining of the distal and proximal parts of the femur was made, and the hip was reduced again. Finally, the iliopsoas and abductor muscles were evaluated, and contractures were released. Results: The mean follow-up duration was 4.6 years. Preoperative and postoperative Harris Hip Scores were 52 and 87, respectively. Limb-length discrepancy was mean 4.2 cm preoperatively, and
ISSN:1120-7000
1724-6067
DOI:10.1177/1120700020959784