Direct Anterior Approach Combined With Proximal Femoral Osteotomy for Crowe Type IV Developmental Dysplasia in Total Hip Arthroplasty.

Abstract

Crowe type IV developmental dysplasia of the hip (DDH) presents unique challenges in total hip arthroplasty. This study compares the clinical outcomes and efficiency of the direct anterior approach (DAA) in the lateral decubitus position combined with proximal femoral osteotomy versus the posterolateral approach (PLA). A retrospective analysis of 73 hips from 64 patients who had Crowe type IV DDH was conducted. Patients underwent total hip arthroplasty via DAA or PLA. Clinical and radiological outcomes, including postoperative complications, radiological evaluations (implant alignment and osteotomy healing included), Harris Hip Score, limb length discrepancy, Visual Analog Scale pain scores, operative time, and intraoperative bleeding, were evaluated. In addition, the operation time and the learning curve of the DAA group were also evaluated. There was no significant difference in postoperative complications and radiological evaluations between the two groups. The DAA group achieved superior functional recovery, postoperative pain relief, and lower intraoperative bleeding than the PLA group. The DAA group had longer initial operative times, but showed significant reductions with experience. The lateral decubitus DAA combined with proximal femoral osteotomy offers superior functional recovery, pain relief, and reduced bleeding compared to PLA, with comparable implant stability. These findings support DAA as an effective option for Crowe type IV DDH. Further studies are warranted to confirm these results. Level III.