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Factors Associated With Complications in 176 Crowe IV Hips Treated With Total Hip Arthroplasty
Cheng-Qi Jia1,2, Yu-Jie Wu3
1Department of Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
Insights
This study identified height and preoperative left knee valgus as key predictors of complications in Crowe IV total hip arthroplasty (THA). Taller patients with preoperative left knee valgus experienced fewer complications, aiding surgical decision-making.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Clinical Outcomes Research
Background:
- Total hip arthroplasty (THA) for Crowe IV hip deformities presents surgical challenges and potential complications.
- Existing evaluations often rely on indirect, operator-dependent measures like surgical techniques and radiographs.
- Objective factors influencing THA outcomes in Crowe IV hips require further investigation.
Purpose of the Study:
- To identify objective factors that predict complications following total hip arthroplasty (THA) in patients with Crowe IV hip deformities.
- To develop a predictive model for surgical decision-making in this challenging patient group.
Main Methods:
- Retrospective review of 136 Crowe IV patients (176 hips) undergoing THA between July 2010 and December 2019.
- Collection of demographic and surgical parameters, including height, preoperative knee valgus, and surgical history.
- Analysis using univariable and multivariable logistic regression to identify complication predictors.
Main Results:
- Complications occurred in 45% of Crowe IV hips.
- Independent significant predictors for complications were height (OR: 0.00) and preoperative left knee valgus (OR: 0.37).
- Taller patients with preoperative left knee valgus demonstrated a lower complication rate.
Conclusions:
- A predictive model incorporating objective factors can guide THA decision-making for Crowe IV hips.
- Height and preoperative left knee valgus are crucial objective factors for predicting complications.
- Surgeons can utilize these findings to optimize patient selection and surgical planning for improved outcomes.
Objective:
Total hip arthroplasty (THA) in Crowe IV hip was a challenge for surgeons, along with some complications. Currently, most evaluations focused on the surgical techniques and radiographs, which were indirectly measured parameters and easily affected by the operators. Objective factors were not considered. This study aimed to investigate objective factors to predict the complications.
Methods:
We retrospectively reviewed a series of Crowe IV patients who received THA between July 2010 and December 2019 in our hospital. Demographics and surgical parameters were collected: gender, age, height, weight, sides of preoperative knee valgus, limb length discrepancy, hip surgical history, osteotomy length, acetabular prosthesis position, acetabular prosthesis sizes, femoral prosthesis, femoral head sizes, femoral prosthesis distal sizes, and acetabular liner. The complications periprosthetic fractures, periprosthetic infection, polyethylene lining wear, postoperative dislocation, limited flexion, limp, knee valgus, knee pain, thigh pain (distal femoral prosthesis), and hip abnormal noise were recorded. Univariable and multivariable logistic regression analyses were used to identify the predictors of complications.
Results:
A total of 136 Crowe IV patients (176 hips) were included in this study. The mean follow-up time was 8.87 ± 2.60 (5-14) years. The mean limb length discrepancy was 2.73 ± 2.05 cm. Thirty-two hips had a surgical history. One hundred and three hips underwent intraoperative osteotomy, and the mean osteotomy length was 3.42 ± 1.22 (1-7) cm. Complications occurred in 45% (79/176) Crowe IV hips. The height (odds ratio [OR]: 0.00; 95% confidence interval [CI]: 0.00-0.26), and preoperative left knee valgus (OR: 0.37; 95% CI: 0.16-0.88) were identified as independent significant factors for complications in Crowe IV hips. A residual limp was observed in 34.09%, knee valgus was 23.3%, hip abnormal noise was 7.39%, knee pain was 1.7%, thigh pain (distal femoral prosthesis) was 1.14%, and limited flexion was 0.57%. The incidence of polyethylene lining wear was 6.3%, periprosthetic fractures was 1.7%, postoperative dislocation was 1.14%, and periprosthetic infection was 0.57%.
Conclusion:
Our model provided a framework to guide decision-making in Crowe IV hips for surgeons. A tall Crowe IV patient with preoperative left knee valgus was found to have a lower rate of complications.
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