Outcomes and Complications of Total Hip Arthroplasty for Crowe Type-IV Dysplasia of the Hip: An International Multicenter Study.

Abstract

Crowe type-IV developmental dysplasia of the hip (DDH) represents the most severe form of hip dislocation and poses major technical challenges for total hip arthroplasty (THA). This study aimed to evaluate outcomes and complications of THA in Crowe IV hips across multiple international centers, highlighting outcomes that may be relevant across practices in technique and implant selection. A retrospective review of 37 patients (49 hips) who had Crowe type-IV DDH who underwent THA between 2013 and 2022 at four centers in three countries was conducted. Clinical and radiographic data included Harris Hip Score (HHS), Oxford Hip Score (OHS), leg-length discrepancy (LLD), component positioning, and complications. Subtrochanteric osteotomy, surgical approach, and implant type were documented. The mean follow-up was 7.8 years (range, three to 12). The LLD improved from 4.10 ± 1.20 cm preoperatively to 0.70 ± 0.42 cm postoperatively (P < 0.001). The HHS improved from 36.7 to 80.1 (P < 0.001) and OHS from 14.0 to 40.2 (P < 0.001). Abductor lurch decreased from 100 to 29.7%. Return to independent mobility was achieved in 81% of patients. Shortening osteotomy was performed in 64.9% of cases. Complications occurred in 21% of patients (16% of hips); the most common was periprosthetic fracture (n = five, 10%), and osteotomy nonunion occurred in two cases (4.1%), one of which was associated with overlengthening and required revision with a shortening osteotomy. There were no dislocations or infections reported. Kaplan-Meier analysis of 37 patients showed 97.3% implant survival at a mean 7.6-year follow-up, with only one early revision. Outcomes between unilateral and bilateral DDH were similar. A THA for Crowe type-IV DDH can provide good outcomes with careful planning, restoration of the hip center, and leg-length adjustment. However, variable functional recovery and a relatively high complication rate, particularly with tapered stems, warrant caution, and surgeons should set realistic expectations, as not all patients achieve optimal results.