Abstract:

Objective

To analyze the clinical effect of eccentric rotary acetabular osteotomy （ERAO）in the treatment of developmental dysplasia of the hip （DDH）.

Methods

From March 2010 to February 2022， patients with DDH and treated by ERAO in the First Affiliated Hospital of Sun Yat-sen University were collected. The patients who were evaluated as under stage III of Tönnis hip osteoarthritis staging and aged from 15 to 60 years were enrolled， while the patients with hip surgery history or requiring femoral osteotomy were excluded. A total of 78 patients with 92 hip joints were included in this study. There were 28 males and 50 females. According to Tönnis grades of hip osteoarthritis， there were 15 hips in stage zero， 67 hips in stage Ⅰ，and 10 hips in stage Ⅱ. According to the Crowe classification of hip dysplasia， all the patients were type I. The Harris score was used as the standard for clinical evaluation. Imaging evaluation was conducted by photographing the anterior and posterior positions of the pelvis before and after surgery and the anterior and lateral positions of the affected hip to observe the acetabular head index （AHI）， lateral center-edge angle （LCEA） and Sharp angle，as well as to observe whether there were complications such as infection and neurovascular injury .Comparing preoperative and postoperative differences for statistical significance through t test.

Results

The patients were（45±16） years old on average， and the follow-up time was 12 to 138 months， （68±32） months on average. In the shortterm and six months follow-up after surgery， except for two cases of wound infection， there was no other complication such as neurovascular injury. During more than five years follow-up， five patients with five hips underwent total hip replacements. Harris score elevated from （73.5±9.4） to （89.8±6.2） after ERAO surgery， and the difference was statistically significant （t=-7.8， P ＜ 0.001）. The sharp angle was （52.2±3.8）° before surgery， and was improved to（42.4±3.2）° after surgery （t=3.1， P ＜ 0.05）. The LCEA increased from （10.7±2.6）° before surgery to （35.8±6.5）°. The AHI increased from preoperative （48.9±6.5） % to postoperative （88.0±10.7） %， The horizontal distance from teardrop decreased from preoperative （41.2±9.4） mm to postoperative （37.3±8.6） mm， and the vertical distance from teardrop decreased from preoperative （20.8±10.5） mm to postoperative （17.2±10.1） mm.

Conclusions

ERAO can obviously correct the deformity of acetabulum in patients with DDH， improve the stress mode of the abnormal hip joint， and delay the progression of secondary lesions such as osteoarthritis of hip. The short mid-term clinical effect is the definite results. ERAO is an effective surgical method for the treatment of DDH， andbeing worthto promote and apply.

Key words: Hip dislocation, congenital, Osteotomy, Osteoarthritis, hip, Acetabulum, Adult