Abstract
BackgroundTotal hip arthroplasty (THA) is a challenging surgical procedure that can be used to treat severely dislocated hips. There are few reports regarding cemented THAs involving subtrochanteric shortening osteotomy (SSO), even though cemented THAs provide great advantages because the femur is generally hypoplastic with a narrow, deformed canal.PurposesWe evaluated the utility of cemented THA with SSO for Crowe group IV hips, and assessed the relationship between leg lengthening and nerve injury. Our goal was to describe surgical techniques for optimizing surgical outcomes while minimizing the risk of nerve injury.MethodsWe retrospectively reviewed 34 cases of cemented THAs with transverse SSO for Crowe group IV. Prior to surgery, mean hip flexion was 93.1° (40°–130°). The mean follow-up period was 5.2 years (3–10 years).ResultsBone union took an average of 7.7 months (3–24 months). Mean leg lengthening was 40.5 mm (15–70 mm) and was greater in patients without hip flexion contracture. None of the patients experienced any nerve injuries associated with leg lengthening, and radiographic evidence of loosening was not observed at the final follow-up.ConclusionsSSO combined with cemented THA is an effective treatment for severely dislocated hips. Leg lengthening is not necessarily associated with nerve injuries, and the likelihood of this surgical complication may be related to the presence of hip flexion contracture.
Highlights
Total hip arthroplasty (THA) for severely dislocated hips can be a very challenging procedure because it is associated with a number of technical difficulties, including lack of bone “stock” in the acetabulum, a narrow femur canal, and a poorly developed abductor mechanism [1]
All of the patients suffered from dysplasia of the hip (DDH), and THAs were performed for only those patients suffering unbearable pain or a marked limp
Japanese Orthopaedic Association (JOA) hip scores improved from a mean of 50.2 points (16–74 points) prior to surgery to an average of 84.6 points (62–97 points) at the latest follow-up
Summary
Total hip arthroplasty (THA) for severely dislocated hips can be a very challenging procedure because it is associated with a number of technical difficulties, including lack of bone “stock” in the acetabulum (for fixing the acetabular component), a narrow femur canal, and a poorly developed abductor mechanism [1]. Placing the acetabular component at the true hip center, with a bone graft, has been shown to provide successful long-term results [2]. Placement of the acetabular component in the true acetabulum may result in nerve injury by causing excessive leg lengthening This can be addressed by subtrochanteric shortening osteotomy (SSO), which demands accurate anatomical knowledge and technical expertise for durable results. This procedure was first described as a treatment for congenital dislocation of the hip in older children [4], and was later applied to patients with THA [5]. Our goal was to describe surgical techniques for optimizing surgical outcomes while minimizing the risk of nerve injury
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