Clinical observation of modified greater trochanteric osteotomy for the treatment of hip dysplasia in adults with high dislocation

Abstract

Objective: To investigate the feasibility, perioperative complications and early follow-up effect of modified greater trochanteric osteotomy for the treatment of severe hip dysplasia in adults with high dislocation. Methods: a retrospective analysis in January 2017 - June 2020, the modified sliding femoral greater trochanter osteotomy combined proximal femoral prosthesis handle fixed type of bone cement type and biological acetabulum prosthesis for 14 cases of 15 adult hip dysplasia hips high dislocation severe deformity of patients with primary total hip replacement, 1 case of bilateral, an average follow-up of 18.267±8.876 months. Preoperative X-ray films showed that all patients had unequal length of both lower limbs, small and shallow acetabular development, obvious anterior wall defect, small amount of bone in the acetabular wall, increased femoral neck dry angle and anterior inclination angle, and small and irregular medullary cavity, etc. Clinical and imaging evaluations were conducted for hip joint function, unequal length of both lower limbs, postoperative complications and prosthesis survival rate after surgery. Results: As of the last follow-up, all the patients showed significant improvement in walking ability and pain symptoms after surgery. All the 14 patients with Trendelenburg sign were positive before surgery and all the 15 hips were negative after surgery. All Ⅰ healing of incision, cut extremities were osseous healing. Before surgery, Harris score was (43.47±7.10) points, and 3 months after surgery, Harris score improved to (87.73±4.23) points, with statistically significant difference (t =-24.16, P < 0.001).The unequal length of both lower extremities before surgery was (3.94±0.88) cm, and the unequal length of both lower extremities was (0.49±0.24) cm 1 day after surgery, the difference was statistically significant (t =15.30, P < 0.001).The WOMAC score was (110.33±7.91) points before surgery, and improved to (61.53±16.77) points 3 months after surgery, with statistically significant difference (t =14.13, P < 0.001). VAS score before surgery was (6.73±1.44) points, and VAS score 3 days after surgery decreased to (1.87±0.92) points, with statistically significant difference (t =17.78, P < 0.001). Conclusion: modified sliding femoral greater trochanter osteotomy restored in the hip muscle tone, before the reconstruction of the lateral femoral physiological eccentricity and inclination, restored the relative length and lower limb soft tissue tension, reduce the risk of cutting after bone fracture healing, the femoral handle initial stability is good, treatment is one of the effective operation of high dislocation of adult hip dysplasia.