THA (Total hip arthroplasty) is being increasingly performed via the HAA (Hueter anterior approach). It has proven advantages with non-dysplastic hips. However, little has been published on its outcomes with dysplastic hips, where it can yield superior acetabular exposure.

For Crowe Type-IV Dysplasia, the study evaluating THA depicted that THA via the HAA on a traction table for hips with Crowe type-IV dysplasia yielded satisfactory mid-term outcomes. Both FHA (femoral head autografts) and SSO (subtrochanteric shortening osteotomies) can be suitably performed via the HAA to help restore the hip center of rotation to the true acetabulum.

This retrospective study aimed to describe the technique for THA via the HAA in hips with Crowe type-IV developmental dysplasia. It also reported the mid-term findings of cases that were performed over 5 consecutive years.

A continuous series of 8 hips (6 patients) with Crowe type-IV dysplasia were evaluated. The patient's age ranged from 44 ± 20 years at the index THA. All the participants received uncemented implants via the HAA on a traction table to restore the hip center of rotation to the true acetabulum. FHAs were utilized to increase acetabular coverage in 6 hips, and SSOs were performed in 5 hips. At a minimum follow-up of 2 years, the patients were assessed clinically and radiographically.

No revisions, deaths, dislocations, or infections were reported. Intraoperative complications were witnessed in only 2 hips (25%). The postoperative complication that required reoperation without implant removal was witnessed in 1 hip (13%) as shown in the following table:

All the hips were clinically and radiographically examined at 4 ± 1 year. The mHHS (modified Harris hip score) improved from 33 ± 7 to 90 ± 7, and the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) improved from 53 ± 14 to 89 ± 6. 

The postoperative leg-length discrepancy was found to be 3.2 mm. None of the hips were found to have osteolysis or radiolucent lines of >2 mm.

For Crowe Type-IV Dysplasia, THA via the HAA is a valuable technique.