Mid-Term to Long-Term Outcomes and Complications of Total Hip Arthroplasty in Patients Who Have Crowe IV Developmental Dysplasia of the Hip: A Systematic Review and Meta-Analysis.

ABSTRACT

BACKGROUND: Severe forms of developmental dysplasia of the hip (DDH) in adulthood often lead to total hip arthroplasty (THA). This study aimed to evaluate the mid-term to long-term outcomes of THA in Crowe type IV DDH cases, which represent a technically challenging and complex patient group. METHODS: PubMed, EMBASE, Web of Science, and Scopus were searched for observational studies and case series with over 100 months of mean follow-up on adult patients who had Crowe type IV DDH treated with THA. A total of 3,710 records were initially identified, leading to the inclusion of 24 studies in the final analysis. These studies were subjected to quality assessment using the National Institutes of Health Quality Assessment tool. Various outcomes including revision rates, leg-length discrepancy, Harris Hip Score, and complications like periprosthetic joint infections, dislocations, and nerve injuries were analyzed. A random effects model was employed for statistical analysis, with sensitivity analysis and metaregression applied in cases of high heterogeneity. RESULTS: The included studies assessed 1,024 hips with a mean follow-up of 11 years, revealing improvements in Harris Hip Score and reductions in leg length discrepancy post-THA. However, notable challenges were noted, including a 10.7% rate of intraoperative fractures, a 1.8% periprosthetic joint infection rate, and a 5.8% dislocation rate. Osteolysis and aseptic loosening revisions were observed in 9.1 and 8% of cases, respectively. Heterotopic ossification occurred in 11.1% of patients. Nerve injury was reported in 4.2% of cases. With the use of metaregression, some factors for observed heterogeneity were identified. CONCLUSIONS: Total hip arthroplasty (THA) in Crowe type IV DDH patients presents notable challenges, but can lead to substantial long-term improvements in patient-reported outcomes. LEVEL OF EVIDENCE IV.