{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:00:43Z","timestamp":1792018843410,"version":"4.4.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T00:00:00Z","timestamp":1618358400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T00:00:00Z","timestamp":1618358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>It is challenging to treat developmental dysplasia of the hip (DDH) classified Crowe III-IV using direct anterior approach (DAA) total hip arthroplasty (THA), and very little is known on its outcome. This study aimed to investigate the clinical result in this defined disorder with DAA versus posterolateral approach. Twenty-three consecutive hips with Crowe III-IV DDH who underwent DAA were retrospectively evaluated from 2016 through 2018. Outcomes were primarily assessed by HHS, WOMAC, and SF-12 physical scales. The second evaluations included leg length discrepancy, hip muscle strength, radiographic review, complications, and limp recovery. Results were compared to a control cohort of 50 hips underwent posterolateral THA concurrently within the observational period. At last follow-up (DAA 28.5\u00a0months; PLA 39.0\u00a0months), the mean increase of the HHS for DAA was 48.2 and 30.3 for PLA (p\u2009=\u20090.003). The improvement in WOMAC score in DAA cohort was 15.89 higher that of the PLA cohort after adjusting preoperative difference [R2\u2009=\u20090.532, P\u2009=\u20090.000, 95% CI (10.037, 21.735)]. DAA had more rapid recovery of hip abductor strength at 1-month (p\u2009=\u20090.03) and hip flexor strength at 3\u00a0months (p\u2009=\u20090.007) compared to PLA. No significant differences were found in the radiographic analysis with the exception of increased acetabular anteversion in the DAA cohort (p\u2009=\u20090.036). Satisfactory improvement in limp, indicated by the percentage of limp graded as none and mild to the total, was much higher in DAA cohort (97.6%), compared to that of PLA cohort (90.0%, p\u2009=\u20090.032). DAA for high-dislocated dysplasia demonstrate a significant improvement in clinical result comparable to posterolateral approach. Improved clinical outcome in terms of increased HHS and WOMAC scores, rapid recovery of hip abductor and flexor strength, and enhanced limp recovery without an increased risk in complications, could be acquired when the surgeons were specialized in this approach.<\/jats:p>","DOI":"10.1038\/s41598-021-87543-x","type":"journal-article","created":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T06:05:44Z","timestamp":1618380344000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Clinical evaluation of direct anterior approach total hip arthroplasty for severe developmental dysplasia of the hip"],"prefix":"10.1038","volume":"11","author":[{"given":"Zaiyang","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney D.","family":"Bell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvin C.","family":"Ong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,14]]},"reference":[{"issue":"9","key":"87543_CR1","doi-asserted-by":"publisher","first-page":"1987","DOI":"10.1016\/j.arth.2019.04.025","volume":"34","author":"NN Patel","year":"2019","unstructured":"Patel, N. N., Shah, J. A. & Erens, G. A. Current trends in clinical practice for the direct anterior approach total hip arthroplasty. J. Arthroplast. 34(9), 1987-1993.e3 (2019).","journal-title":"J. Arthroplast."},{"issue":"9","key":"87543_CR2","doi-asserted-by":"publisher","first-page":"595","DOI":"10.5435\/JAAOS-22-09-595","volume":"22","author":"ZD Post","year":"2014","unstructured":"Post, Z. D. et al. Direct anterior approach for total hip arthroplasty: Indications, technique, and results. J. Am. Acad. Orthop. Surg. 22(9), 595\u2013603 (2014).","journal-title":"J. Am. Acad. Orthop. Surg."},{"issue":"1","key":"87543_CR3","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1007\/s11999-010-1316-6","volume":"469","author":"MU Jawad","year":"2011","unstructured":"Jawad, M. U. & Scully, S. P. In brief: Crowe\u2019s classification: arthroplasty in developmental dysplasia of the hip. Clin. Orthop. Relat. Res. 469(1), 306\u2013308 (2011).","journal-title":"Clin. Orthop. Relat. Res."},{"issue":"4","key":"87543_CR4","doi-asserted-by":"publisher","first-page":"412","DOI":"10.5312\/wjo.v5.i4.412","volume":"5","author":"G Bicanic","year":"2014","unstructured":"Bicanic, G. et al. Current concept in dysplastic hip arthroplasty: Techniques for acetabular and femoral reconstruction. World J. Orthop. 5(4), 412\u2013424 (2014).","journal-title":"World J. Orthop."},{"issue":"9S","key":"87543_CR5","doi-asserted-by":"publisher","first-page":"S38","DOI":"10.1016\/j.arth.2017.02.024","volume":"32","author":"EM Greber","year":"2017","unstructured":"Greber, E. M. et al. Challenges in total hip arthroplasty in the setting of developmental dysplasia of the hip. J. Arthroplast. 32(9S), S38\u2013S44 (2017).","journal-title":"J. Arthroplast."},{"key":"87543_CR6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.otsr.2010.03.007","volume":"1","author":"JL Husson","year":"2010","unstructured":"Husson, J. L. et al. Applications in hip pathology. Orthop. Traumatol. Surg. Res. 1, 1. https:\/\/doi.org\/10.1016\/j.otsr.2010.03.007 (2010).","journal-title":"Orthop. Traumatol. Surg. Res."},{"issue":"3","key":"87543_CR7","doi-asserted-by":"publisher","first-page":"147","DOI":"10.5371\/hp.2018.30.3.147","volume":"30","author":"CW Park","year":"2018","unstructured":"Park, C. W., Lim, S. J. & Park, Y. S. Modular stems: Advantages and current role in primary total hip arthroplasty. Hip Pelvis. 30(3), 147\u2013155 (2018).","journal-title":"Hip Pelvis."},{"issue":"6","key":"87543_CR8","doi-asserted-by":"publisher","first-page":"1052","DOI":"10.1016\/j.arth.2012.11.019","volume":"28","author":"BA Flanagin","year":"2013","unstructured":"Flanagin, B. A. et al. Total hip arthroplasty followed by traction and delayed reduction for Crowe IV developmental dysplasia of the hip. J. Arthroplast. 28(6), 1052\u20131054 (2013).","journal-title":"J. Arthroplast."},{"key":"87543_CR9","first-page":"1","volume":"1","author":"MR Viamont-Guerra","year":"2020","unstructured":"Viamont-Guerra, M. R. et al. The direct anterior approach for total hip arthroplasty for severe dysplasia (Crowe III and IV) provides satisfactory medium to long-term outcomes. J. Arthroplast. 1, 1 (2020).","journal-title":"J. Arthroplast."},{"issue":"3","key":"87543_CR10","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1016\/j.arth.2013.07.038","volume":"29","author":"K Oinuma","year":"2014","unstructured":"Oinuma, K. et al. Total hip arthroplasty with subtrochanteric shortening osteotomy for Crowe grade 4 dysplasia using the direct anterior approach. J. Arthroplast. 29(3), 626\u2013629 (2014).","journal-title":"J. Arthroplast."},{"issue":"Suppl 11","key":"87543_CR11","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1302\/0301-620X.95B11.32899","volume":"95","author":"K Gustke","year":"2013","unstructured":"Gustke, K. The dysplastic hip: not for the shallow surgeon. Bone Joint J. 95(Suppl 11), 31\u201336 (2013).","journal-title":"Bone Joint J."},{"issue":"5","key":"87543_CR12","doi-asserted-by":"publisher","first-page":"334","DOI":"10.5435\/00124635-200209000-00005","volume":"10","author":"J Sanchez-Sotelo","year":"2002","unstructured":"Sanchez-Sotelo, J. et al. Surgical treatment of developmental dysplasia of the hip in adults: II Arthroplasty options. J. Am. Acad. Orthop. Surg. 10(5), 334\u2013344 (2002).","journal-title":"J. Am. Acad. Orthop. Surg."},{"issue":"10","key":"87543_CR13","doi-asserted-by":"publisher","first-page":"2041","DOI":"10.1007\/s00264-016-3125-3","volume":"40","author":"PJ York","year":"2016","unstructured":"York, P. J. et al. Total hip arthroplasty via the anterior approach: Tips and tricks for primary and revision surgery. Int. Orthop. 40(10), 2041\u20132048 (2016).","journal-title":"Int. Orthop."},{"issue":"2","key":"87543_CR14","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1016\/j.artd.2020.02.008","volume":"6","author":"ZY Liu","year":"2020","unstructured":"Liu, Z. Y. et al. Direct anterior approach total hip arthroplasty for crowe III and IV dysplasia. Arthroplast. Today. 6(2), 251\u2013256 (2020).","journal-title":"Arthroplast. Today."},{"issue":"7","key":"87543_CR15","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1302\/0301-620X.99B7.BJJ-2016-1328.R1","volume":"99","author":"Y Li","year":"2017","unstructured":"Li, Y. et al. Equalisation of leg lengths in total hip arthroplasty for patients with Crowe type-IV developmental dysplasia of the hip: Classification and management. Bone Joint J. 99(7), 872\u2013879 (2017).","journal-title":"Bone Joint J."},{"issue":"2","key":"87543_CR16","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/j.arth.2016.07.050","volume":"32","author":"X Li","year":"2017","unstructured":"Li, X. et al. Treatment of crowe type-IV hip dysplasia using cementless total hip arthroplasty and double chevron subtrochanteric shortening osteotomy: A 5- to 10-year follow-up study. J. Arthroplast. 32(2), 475\u2013479 (2017).","journal-title":"J. Arthroplast."},{"issue":"7624","key":"87543_CR17","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","volume":"335","author":"E von Elm","year":"2007","unstructured":"von Elm, E. et al. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 335(7624), 806\u2013808 (2007).","journal-title":"BMJ"},{"issue":"4","key":"87543_CR18","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1016\/j.arth.2016.11.005","volume":"32","author":"D Wang","year":"2017","unstructured":"Wang, D. et al. Long-term results of cementless total hip arthroplasty with subtrochanteric shortening osteotomy in crowe type IV developmental dysplasia. J. Arthroplast. 32(4), 1211\u20131219 (2017).","journal-title":"J. Arthroplast."},{"issue":"6","key":"87543_CR19","doi-asserted-by":"publisher","first-page":"548","DOI":"10.2106\/JBJS.I.01619","volume":"93","author":"M Takao","year":"2011","unstructured":"Takao, M. et al. Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia. J. Bone Joint Surg. Am. 93(6), 548\u2013555 (2011).","journal-title":"J. Bone Joint Surg. Am."},{"issue":"11","key":"87543_CR20","doi-asserted-by":"publisher","first-page":"3401","DOI":"10.1007\/s11999-015-4230-0","volume":"473","author":"D Sheth","year":"2015","unstructured":"Sheth, D. et al. Anterior and anterolateral approaches for THA are associated with lower dislocation risk without higher revision risk. Clin. Orthop. Relat. Res. 473(11), 3401\u20133408 (2015).","journal-title":"Clin. Orthop. Relat. Res."},{"issue":"3 Suppl 1","key":"87543_CR21","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1054\/arth.2003.50104","volume":"18","author":"JL Masonis","year":"2003","unstructured":"Masonis, J. L. et al. Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia: 5-year follow-up. J. Arthroplast. 18(3 Suppl 1), 68\u201373 (2003).","journal-title":"J. Arthroplast."},{"issue":"3","key":"87543_CR22","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1111\/os.12672","volume":"12","author":"Y Zhang","year":"2020","unstructured":"Zhang, Y., Zhang, X. & Zhou, Y. Direct anterior approach: The outlook of total hip arthroplasty in crowe type III-IV hip dysplasia. Orthop. Surg. 12(3), 1016\u20131018 (2020).","journal-title":"Orthop. Surg."},{"key":"87543_CR23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/os.12713","volume":"1","author":"ZY Liu","year":"2020","unstructured":"Liu, Z. Y. et al. Direct anterior approach in crowe type III-IV developmental dysplasia of the hip: Surgical technique and a two years follow-up from Southwest China. Orthopaed. Surg. 1, 1. https:\/\/doi.org\/10.1111\/os.12713 (2020).","journal-title":"Orthopaed. Surg."},{"issue":"5","key":"87543_CR24","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1016\/S0883-5403(96)80113-6","volume":"11","author":"HU Cameron","year":"1996","unstructured":"Cameron, H. U., Botsford, D. J. & Park, Y. S. Influence of the Crowe rating on the outcome of total hip arthroplasty in congenital hip dysplasia. J. Arthroplast. 11(5), 582\u2013587 (1996).","journal-title":"J. Arthroplast."},{"issue":"6","key":"87543_CR25","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1089\/sur.2017.089","volume":"18","author":"H Cheng","year":"2017","unstructured":"Cheng, H. et al. Prolonged operative duration increases risk of surgical site infections: A systematic review. Surg. Infect. (Larchmt). 18(6), 722\u2013735 (2017).","journal-title":"Surg. Infect. (Larchmt)."},{"issue":"8","key":"87543_CR26","doi-asserted-by":"publisher","first-page":"2466","DOI":"10.1016\/j.arth.2017.03.043","volume":"32","author":"M Kawasaki","year":"2017","unstructured":"Kawasaki, M. et al. Muscle damage after total hip arthroplasty through the direct anterior approach for developmental dysplasia of the hip. J. Arthroplast. 32(8), 2466\u20132473 (2017).","journal-title":"J. Arthroplast."},{"issue":"1 Suppl","key":"87543_CR27","doi-asserted-by":"publisher","first-page":"S87","DOI":"10.1016\/j.otsr.2012.12.003","volume":"99","author":"JY Lazennec","year":"2013","unstructured":"Lazennec, J. Y., Brusson, A. & Rousseau, M. A. Lumbar-pelvic-femoral balance on sitting and standing lateral radiographs. Orthop. Traumatol. Surg. Res. 99(1 Suppl), S87\u2013S103 (2013).","journal-title":"Orthop. Traumatol. Surg. Res."},{"issue":"2","key":"87543_CR28","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/j.artd.2019.01.003","volume":"5","author":"N Mercer","year":"2019","unstructured":"Mercer, N. et al. Optimum anatomic socket position and sizing for the direct anterior approach: Impingement and instability. Arthroplast. Today. 5(2), 154\u2013158 (2019).","journal-title":"Arthroplast. Today."},{"issue":"1","key":"87543_CR29","doi-asserted-by":"publisher","first-page":"e0025","DOI":"10.2106\/JBJS.OA.18.00025","volume":"4","author":"Y Okuzu","year":"2019","unstructured":"Okuzu, Y. et al. Hip-spine syndrome: acetabular anteversion angle is associated with anterior pelvic tilt and lumbar hyperlordosis in patients with acetabular dysplasia: A retrospective study. JB JS Open Access. 4(1), e0025 (2019).","journal-title":"JB JS Open Access."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-87543-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-87543-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-87543-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T01:35:48Z","timestamp":1670031348000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-87543-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,14]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["87543"],"URL":"https:\/\/doi.org\/10.1038\/s41598-021-87543-x","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-139607\/v1","asserted-by":"object"}]},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,14]]},"assertion":[{"value":"2 January 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"8105"}}