{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:24:30Z","timestamp":1789683870770,"version":"4.0.1"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,6,8]],"date-time":"2020-06-08T00:00:00Z","timestamp":1591574400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Central Committee Guiding Local Technology Development Project","award":["0028"],"award-info":[{"award-number":["0028"]}]},{"name":"Clinical research program of Xinqiao Hospital, Army Medical University","award":["2015YLC23"],"award-info":[{"award-number":["2015YLC23"]}]},{"name":"Continuing medical education program of Chongqing","award":["2020-04-07-067"],"award-info":[{"award-number":["2020-04-07-067"]}]},{"name":"Innovative technology in military and clinical medicine","award":["2018JSLC0035"],"award-info":[{"award-number":["2018JSLC0035"]}]},{"name":"Technological Innovation and Application Demonstration Project of Chongqing","award":["cstc2018jscx-msyb0541"],"award-info":[{"award-number":["cstc2018jscx-msyb0541"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To summarize our pioneering surgical practice and clinical outcome of Crowe type III\u2010IV developmental dysplasia of the hip (DDH) with a direct anterior approach total hip arthroplasty in a single teaching hospital in Southwest China.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fourteen patients (15 hips) diagnosed with Crowe type III\u2010IV developmental dysplasia of the hip were involved in this single\u2010center retrospective study between 2016 and 2018. A comprehensive surgical procedure, including preoperative planning and algorithms for leg length equalization, intraoperative stepwise soft tissue release, bone defect reconstruction, and an innovative subtrochanteric osteotomy, was described. Furthermore, advancements in intraoperative CT guidance, computer navigation, and nerve monitoring were available for specific demands. The short\u2010term clinical outcome was evaluated at the endpoint of follow\u2010up by three patient\u2010reported functional scales (Harris, WOMAC, and SF\u201012 scores), and objective data collected at the clinic, including functional recovery (muscle strength of hip flexor and abductor, correction of the pelvic tilt, leg length discrepancy, and limp), radiographic analysis, and complication occurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The intraoperative variables were carefully recorded. The mean operating times in Crowe type III and IV groups were 115.8 min and 156.2 min, and the median blood loss volumes were 520.5 mL and 810.2 mL, respectively. The general changes in the Harris, SF\u201012, and WOMAC scores of the two groups were 46.2, 8.7 and 134.3, respectively, at a mean follow\u2010up of 25.4\u2009months. Enhanced recovery of hip abductor muscle strength was identified in 85.7% of the population at the third postoperative month. The equalization of leg length and correction of the pelvic tile were observed at the sixth postoperative month, with a 36\u2010mm decrease in leg length discrepancy. No radiographic evidence of the loosening or migration of the components was observed. A self\u2010innovated subtrochanteric shortening osteotomy was performed in five patients, and they healed after 6\u2009months. Specific complications included two cases of distal femoral cracks and one case of a periprosthetic fracture needing internal fixation. Two patients received a late iliotibial band release at the 3rd month postoperatively due to progressive genu valgum. No records of infection, dislocation, nerve palsy, bone non\u2010union, or revision surgery were identified.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The direct anterior approach total hip arthroplasty showed potential advantages, including optimum component positioning, improved hip stability, steerable complication rate, and enhanced functional recovery with Crowe type III\u2010IV DDH. The short\u2010term outcome is comparable to that of the traditional posterolateral approach.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.12713","type":"journal-article","created":{"date-parts":[[2020,6,8]],"date-time":"2020-06-08T13:52:25Z","timestamp":1591624345000},"page":"1140-1152","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Direct Anterior Approach in Crowe Type <scp>III\u2010IV<\/scp> Developmental Dysplasia of the Hip: Surgical Technique and 2\u2009years Follow\u2010up from Southwest China"],"prefix":"10.1111","volume":"12","author":[{"given":"Zai\u2010yang","family":"Liu","sequence":"first","affiliation":[{"name":"Joint Disease &amp; Sport Medicine Center, Department of Orthopaedics, Xinqiao Hospital Army Medical University  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Joint Disease &amp; Sport Medicine Center, Department of Orthopaedics, Xinqiao Hospital Army Medical University  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Song\u2010tao","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics People's Hospital of Yunyang  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zi\u2010qiang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopedics People's Hospital of Linshui  Guang'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhong\u2010hua","family":"Xu","sequence":"additional","affiliation":[{"name":"Joint Disease &amp; Sport Medicine Center, Department of Orthopaedics, Xinqiao Hospital Army Medical University  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Zhang","sequence":"additional","affiliation":[{"name":"Joint Disease &amp; Sport Medicine Center, Department of Orthopaedics, Xinqiao Hospital Army Medical University  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Zhou","sequence":"additional","affiliation":[{"name":"Joint Disease &amp; Sport Medicine Center, Department of Orthopaedics, Xinqiao Hospital Army Medical University  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3341-2995","authenticated-orcid":false,"given":"Yuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Joint Disease &amp; Sport Medicine Center, Department of Orthopaedics, Xinqiao Hospital Army Medical University  Chongqing 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