Abstract
BackgroundThis retrospective study was designed to determine complications, functional and radiographic results of transverse subtrochanteric osteotomy during cementless, modular total hip arthroplasty (THA) in a series of active patients younger than 45 years with Crowe Type-III or IV developmental dysplasia of the hip (DDH).MethodsWe followed 49 patients (56 hips) with DDH who were treated with cementless THA, where the acetabular cup was positioned in the anatomic hip center and where a simultaneous transverse femoral osteotomy was performed. Complication rate evaluation and clinical outcomes were measured by validated clinical scores and radiographic evaluation were performed at a mean follow up of 10 years (range, 4.8–14.3 years).ResultsThe mean limb-length discrepancy was reduced from 4.2 cm to 1.1 cm (P < 0.01). The mean Harris hip score (HSS) significantly improved from 40.6 points to 87.4 points (P < 0.01). Similarly, severity of low back pain, modified MAP, HOOS, and SF-12 also showed significant improvement (P < 0.01). There were 3 cases of postoperative dislocation, 3 cases of transient nerve palsy, 2 cases of nonunion, and 4 cases of intraoperative fracture. At 10 years follow-up, the estimated survival rate with any component revision as end points was 92%.ConclusionThe cementless THA combined with transverse subtrochanteric osteotomy is a reliable technique with restoration of a more normal limb, satisfactory clinical outcomes, and mid-term survival of components.
Highlights
This retrospective study was designed to determine complications, functional and radiographic results of transverse subtrochanteric osteotomy during cementless, modular total hip arthroplasty (THA) in a series of active patients younger than 45 years with Crowe Type-III or IV developmental dysplasia of the hip (DDH)
Patients We retrospectively reviewed 53 consecutive patients (62 hips) in whom cementless THA combined with transverse subtrochanteric shortening osteotomies was performed for Type-III or IV DDH according to Crowe classification from 2002 to 2012 in joint registry
The major finding of this study was that the cementless THA combined with transverse subtrochanteric shortening osteotomy could improve function, resort a more normal limb, and provide stable fixation in hips with Crowe Type-III and IV DDH
Summary
This retrospective study was designed to determine complications, functional and radiographic results of transverse subtrochanteric osteotomy during cementless, modular total hip arthroplasty (THA) in a series of active patients younger than 45 years with Crowe Type-III or IV developmental dysplasia of the hip (DDH). Placement of the acetabular cup in the true acetabulum has proved to obtain durable clinical and favorable biomechanical. To address these concerns during THA for severe dysplasia, femoral shortening is sometimes necessary and an effective in most cases to correct femoral malrotation, facilitate the reduction, and equalize limb lengths without tension forces and increased risk of neurological traction injury [5, 7, 8]. We have performed cementless THA combined with transverse subtrochanteric osteotomy with use of modular stem in most patients with severe dysplasia [13]
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