Subtrochanteric Femoral Shortening Osteotomy Research Articles

Mid-Term Outcomes of Cemented Stem and Subtrochanteric Shortening Derotational Osteotomy in Total Hip Arthroplasty for Crowe IV Developmental Dysplasia.

Performing subtrochanteric osteotomy with cemented components in patients with Crowe IV developmental dysplasia of the hip (DDH) is technically challenging and not widely reported. This study aimed to evaluate the mid-term outcomes of cemented stem total hip arthroplasty (THA) with subtrochanteric femoral shortening and transverse derotational osteotomy in patients with Crowe IV DDH. Data collected from patients with Crowe IV DDH who underwent cemented stem THA with subtrochanteric femoral shortening and transverse derotational osteotomy between 2010 and 2018 were retrospectively evaluated. The cemented Lubinus SP II femoral component and the cementless CombiCup acetabular component were used together in all cases. These data, including Harris hip scores, limb length discrepancy (LLD), severity of limp, Trendelenburg test, bone union, length of the resected femur, limb lengthening, level of the osteotomy site, and length bridging the osteotomy site, as well as complications, were analyzed. A paired Student t-test was used to analyze continuous variables, categorical data were compared using Fisher's exact probability test, and correlation analysis was performed using Spearman's rank correlation coefficient. Among 14 included patients (10 females and four males), the mean age was 60.4 years (range, 47-73). The mean follow-up period was 49.1 months, and no patient was lost to follow-up. The mean Harris hip score improved from 40.7 to 87.7. The mean LLD decreased from 52 to 12.7 mm. The mean length of the excised femoral segment was 38.4 mm, and the mean length of limb lengthening was 27.1 mm. The mean distance between the osteotomy site and the lesser trochanter was 21.1 mm after surgery. The mean length of the femoral stem bridging the osteotomy site was 97.6 mm. Finally, the mean osteotomy union time was 10.6 months. No statistically significant correlation was found between the osteotomy union time and these factors. No neurological deficits were noted. Delayed union was observed in one patient, and postoperative dislocation was observed in two patients. Cement leakage into the osteotomy gap was observed in one patient, however, no revisions were required, and no signs of loosening or migration were observed. Cemented stem THA combined with subtrochanteric femoral shortening and transverse derotational osteotomy is safe and effective in treating patients with Crowe IV DDH. Rather than leading to nonunion, cement leakage may negatively affect bone healing.

Step-Cut Subtrochanteric Osteotomy Combined with Total Hip Arthroplasty for Neglected Traumatic Hip Dislocations.

BackgroundTotal Hip Arthroplasty remains the standard treatment protocol for patients with neglected traumatic dislocations of the hip with arthritis. A total hip arthroplasty needs to be frequently combined with a subtrochanteric shortening femoral osteotomy to aid in the reduction of the hip joint in such cases. Still long-term stable implant fixation, rigid construct, and favorable functional outcome remain a challenge. In respect to subtrochanteric shortening osteotomy, various techniques have been described in the literature, including the step-cut, double chevron, transverse, and oblique osteotomies. Out of these types, a subtrochanteric step-cut osteotomy provides a better rotational stability and a larger surface of contact to aid in union. As there is a paucity in the literature regarding the step-cut osteotomy for traumatic dislocations of the hip, we designed this study to evaluate the outcomes of this procedure.MethodsWe prospectively evaluated 24 patients with neglected traumatic dislocations of the hip, who underwent total hip arthroplasty with a step-cut subtrochanteric shortening osteotomy using a long modular stem within a span of 4 years. The indications were severe pain and difficulty in walking and performing activities of daily living. Patients fulfilling the inclusion criteria were evaluated in terms of Harris Hip Score, leg length discrepancy, neurological status, union of the osteotomy, and implant stability.ResultsThe mean Harris Hip Score significantly improved from 33.4 preoperatively to 89.2 postoperatively at the latest follow-up. At the final follow-up, all patients showed union at the osteotomy site and there were no cases of implant loosening or instability. No neurological complications were reported.ConclusionsTotal hip arthroplasty combined with a step-cut subtrochanteric femoral shortening osteotomy in patients with neglected dislocations of the hip was associated with good functional outcome and higher success rates in terms of stable implant fixation and union at the site of osteotomy.

Total Hip Arthroplasty with Sub-Trochanteric Femoral Shortening Osteotomy for Post-Infective Hip Dysplasia-A Case Report

Total hip arthroplasty is a surgical option for patients with symptomatic arthritis secondary to severe hip dysplasia. These cases are associated with difficulty in identifying the true acetabulum and achieving stable fixation of the acetabular component is challenging. On the femoral side, femurs in dysplastic hip have increased anteversion, shorter femoral necks and reduced intramedullary canal size. The outcome of total hip arthroplasty in these patients improves with restoration of the anatomical centre of the hip. But restoration of the hip centre in a dysplastic hip can lead to excessive limb lengthening and traction nerve injury. So, additional femoral shortening is necessary to allow hip reduction and to avoid excessive limb lengthening. Sub-trochanteric femoral shortening osteotomy is therefore a viable option and can be extremely useful in addressing the limb length discrepancy, facilitate reduction, equalize limb lengths, and protect the sciatic nerve. We report a case of post-infective dysplasia of hip where sub-trochanteric femoral shortening osteotomy was done along with total hip arthroplasty.

Cemented Total Hip Arthroplasty with Subtrochanteric Femoral Shortening Osteotomy, a Cost-effective Procedure to Manage Advanced Osteoarthritis of Hip Joint: A Case report and Review of Literature

Cemented Total Hip Arthroplasty with Subtrochanteric Femoral Shortening Osteotomy, a Cost-effective Procedure to Manage Advanced Osteoarthritis of Hip Joint: A Case report and Review of Literature

Use of proximal humerus plates for the fixation of the subtrochanteric femoral shortening osteotomy during total hip arthroplasty for Crowe type IV developmental dysplasia of the hip patients.

Objectives This study aims to evaluate the efficacy of proximal humerus plate in the fixation of subtrochanteric femoral shortening osteotomy (SFSO) during total hip arthroplasty.Patients and methods Thirty female patients (mean age 49.8 years; range, 22 to 68 years) who underwent hip arthroplasty with a SFSO and fixed with a proximal humerus plate between January 2014 and June 2018 were evaluated retrospectively. Rate of fracture healing, the number of fixed cortices at both sides of the osteotomy, and complications were documented.Results The mean follow-up period was 28 months (range, 12-68 months). The average time to union was 106 days (range, 45-229 days). The mean number of cortices fixed in the proximal segment of the osteotomy was 6.2 (range, 4-9), and the mean number of cortices fixed in the distal segment of the osteotomy was 4.0 (range, 3-7). None of the patients had implant irritation or implant failure at the control visits. We observed only one non-union and our non-union rate was 3.3%.ConclusionIn conclusion, the use of a proximal humerus plate for the fixation of SFSO can be an alternative procedure for achieving adequate rotational stability until a solid union.

Total hip arthroplasty with rectangular stems and subtrochanteric transverse shortening osteotomy in Crowe type IV hips: a retrospective study

BackgroundThe complexity of femoral and acetabular anatomy and restoring anatomic center of hip rotation in Crowe type IV developmental dysplasia of the hip (DDH) complicates standard reconstruction. The aim of this study is to evaluate surgical techniques and clinical outcomes of subtrochanteric transverse shortening osteotomy with the use of cementless rectangular cross-section femoral implants in Crowe IV dysplastic hips.MethodsA total of 26 hips of 25 consecutive patients with Crowe type IV DDH who underwent cementless total hip arthroplasty with subtrochanteric femoral transverse shortening osteotomy were retrospectively analyzed. The Harris Hip Score, Visual Analog Scale-pain, leg length discrepancy, and vertical and lateral migration of hip rotation center were recorded.ResultsMean age, follow-up, and time of union were 41 ± 9.7 years, 7.1 ± 1.2 years, and 3.7 ± 1.1 months, respectively. Mean Harris Hip Score significantly improved from 38 ± 5.7 to 86 ± 6.1 points postoperatively (P < .01). Mean leg length discrepancy and Visual Analog Scale significantly decreased from 4.3 ± 1.3 to 1.2 ± 0.6 cm, and 6.4 ± 1.2 to 1.8 ± 0.8 points, respectively (P < .01). One female patient had a dislocation due to acetabular liner wear, which was managed by liner and head change. One patient had Sudeck’s atrophy, while another had pain on the lateral thigh, both of which were resolved with conservative management.ConclusionsCombined transverse subtrochanteric femoral osteotomy and cementless total hip arthroplasty with rectangular cross-section femoral implants is technically demanding, effective, and safe in femoral shortening for treatment of Crowe type IV DDH.

Subtrochanteric femoral shortening osteotomy combined with cementless total hip replacement for Crowe type IV developmental dysplasia: a retrospective study

ABSTRACTBackgroundTotal hip replacement for high dislocation of the hip presents some difficulties, considering patients’ young ages, the abnormal hip anatomy and the high rate of complications. In this study, we present our experience in terms of clinical and radiological results in the treatment of Crowe type IV hips with subtrochanteric femoral shortening osteotomy and cementless total hip replacement.Materials and MethodsWe retrospectively reviewed 15 patients with Crowe type IV hip dysplasia (two bilateral cases for a total of 17 hips) treated with cementless total hip replacement associated with shortening subtrochanteric osteotomies (nine transversal and eight Z-shape osteotomies) between March 2000 to February 2006. The mean follow-up was 88 months (range 63–133). Harris hip score, leg length discrepancy, neurological status, union status of the osteotomy and the component stability were the criteria of the evaluation. All complications were noted.ResultsThe mean HHS improved from 38.3 (range 32–52) to 85.6 (range 69–90). The mean preoperative leg length discrepancy was of 45 mm (range 38–70) and reduced to a mean of 12 mm (range 9–1.6) postoperatively. All osteotomies resulted healed at an average of 12.3 weeks (range 10–15). No cases of delayed union or nonunion were detected. Two patients (11%) showed early symptoms of sciatic nerve palsy which resolved uneventfully in 6 months. There was no migrations and none of the implants required revision.ConclusionsCementless THA with shortening subtrochanteric osteotomy is an effective method in the treatment of patients with Crowe type IV development dysplasia of the hip.Level of evidenceIV.

Total hip arthroplasty with step-cut subtrochanteric femoral shortening osteotomy in high riding hip dislocated patients with previous femoral osteotomy

To evaluate the long-term clinical and radiological outcomes of cementless total hip arthroplasty (THA) in high riding hip dislocated patients with previous proximal femoral osteotomy. Twenty-one consecutive patients with a mean age forty-two years were treated with cementless THA Step-cut subtrochanteric femoral osteotomy was performed in all twenty-eight hips. Metal on polyethylene (MoP) and ceramic on ceramic (CoC) bearings were used in two different consecutive time periods. The mean follow-up time was twelve years. Harris hip score, limb length discrepancy, complications, union status of the osteotomy, survivorship of constructs were the criteria for evaluation. The mean Harris hip score improved from 39.5 to 88.7 points. The mean limb length discrepancy in unilateral cases decreased from 54.5mm to 12.3mm. The mean amount of femoral shortening was 37mm. The mean union time was 3.5 months and there were no delayed union and non-union. There were three cup and two femoral revisions due to osteolysis in patients who had MoP. There was only one femoral revision in patients who had CoC. The Kaplan Meier survivorship with an end point of any revision of the stem and the acetabular component was 94% (95% CI, 75%-98%) and 92% (95% CI, 74%-99%) at ten years respectively. Total hip arthroplasty with subtrochanteric step-cut femoral shortening is a successful technique to improve the hip functions and reconstruct limb length discrepancy in young patients with proximal femoral deformities.

Nerve Palsy after Total Hip Arthroplasty without Subtrochanteric Femoral Shortening Osteotomy for a Completely Dislocated Hip Joint.

Background: Neurological injuries are a rare but devastating complication after total hip arthroplasty (THA). The purpose of this study was to retrospectively determine the frequency of nerve palsy after THA without subtrochanteric femoral shortening osteotomy in patients with a completely dislocated hip joint without pseudo-articulation between the femoral head and iliac bone.Methods:Between October 1999 and September 2001, nine primary THAs were performed for patients with a completely dislocated hip joint. The limb lengths, neurological abnormalities, and the extent of their neurological recovery were evaluated. Three THAs were combined with subtrochanteric femoral shortening osteotomy, and six THAs were combined without subtrochanteric femoral shortening osteotomy.Results:The mean length of the operation was 4.8 cm (range, 3.0-6.5 cm). Sciatic nerve palsy developed in four of the nine patients after THA. None of the cases with sciatic nerve palsy were combined with subtrochanteric femoral shortening osteotomy. Three of four patients did not completely recover from sciatic nerve palsy.Conclusions:THA for patients with a completely dislocated hip was associated with a high risk of nerve palsy due to excessive limb lengthening; the potential for recovery from nerve palsy was observed to be poor. Subtrochanteric femoral shortening osteotomy should be used in combination with THA in patients with a completely dislocated hip.

Highly Cross-linked Polyethylene Liner Dissociation from a Cement-less Modular Acetabular Shell: Two Case Reports.

Liner dissociation of polyethylene from a cementless acetabular socket following total hip arthroplasty (THA) is a rare complication. Cross-linked polyethylene liner dissociation from AMS-HA shell (KYOCERA Med, Osaka, Japan) occurred in 2 out of the 4153 (0.04%) cases approximately 10 years after undergoing surgery at our institute. First case was an 80-year-old female who underwent right THA along with subtrochanteric femoral shortening osteotomy due to complete dislocation hip, and second case was a 72-year-old male, who underwent right THA due to coxarthrosis. A 26 mm femoral head and CPE liner were used in both cases and the inclination degree of the acetabular socket was within 50°.There was no implant loosening in both cases. There was partial damage in the elevated rim on the alternative side and scratches on the back side in the both extracted CPE liner. It was surmised that liner dissociation was caused due to a problem in the liner fixing format of the push in type of the present model.

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

BackgroundThe purpose of this study was to evaluate the functional and radiographic results of patients with Crowe type-IV hip dysplasia treated by cementless total hip arthroplasty and double chevron subtrochanteric osteotomy. MethodsFrom January 2000 to February 2006, cementless total hip arthroplasty with a double chevron subtrochanteric shortening osteotomy was performed on 18 patients (22 hips) with Crowe type-IV dysplasia. The acetabular cup was placed in the position of the anatomic hip center, and subtrochanteric femoral shortening osteotomy was performed with the use of a double chevron design. The clinical and radiographic outcomes were reviewed with a mean follow-up of 6.5 years (5-10 years). ResultsThe mean amount of femoral subtrochanteric shortening was 38 mm (25-60 mm). All osteotomy sites were healed by 3-6 months without complications. The mean Harris Hip Score improved significantly from 47 points (35-65 points) preoperatively to 88 points (75-97 points) at the final follow-up. The Trendelenburg sign was corrected from a positive preoperative status to a negative postoperative status in 12 of 22 hips. No acetabular and femoral components have loosened or required revision during the period of follow-up. ConclusionCementless total hip arthroplasty using double chevron subtrochanteric osteotomy allowed for restoration of anatomic hip center with safely functional limb lengthening, achieved correction of preoperative limp, and good functional and radiographic outcomes for 22 Crowe type-IV dislocation hips at the time of the 5- to 10-year follow-up.

Total hip arthroplasty in the developmental dysplasia of the hip using transverse subtrochanteric osteotomy

BackgroundWe assessed the results of the transverse subtrochanteric femoral shortening osteotomy technique and the cementless THA process applied to Crowe type III and IV patients with developmental dysplasia of the hips. MethodsWe retrospectively evaluated 25 patients (32 hips) between 2006 and 2014. ResultsThe mean follow-up time was 5.1 years. The mean preoperative Harris hip score was 49.5, which increased to 87.1 postoperatively. The mean preoperative leg-length discrepancy was 3.6cm; the mean postoperative discrepancy was 0.5cm. ConclusionTHA with subtrochanteric femoral shortening osteotomy technique is an effective technique for treating developmental dysplasia of the hip.

Long-Term Results of Total Hip Arthroplasty With Shortening Subtrochanteric Osteotomy in Crowe IV Developmental Dysplasia

BackgroundNumerous series have documented short-term successes with cementless total hip arthroplasty (THA) and subtrochanteric shortening osteotomy for Crowe IV developmental dysplasia of the hip (DDH). However, data are lacking regarding long-term implant fixation and patient function. In this study, we aimed to evaluate the 10-year results of cementless THA with simultaneous subtrochanteric shortening osteotomy for Crowe IV DDH. MethodsWe retrospectively reviewed 28 consecutive primaries cementless THAs performed in 24 patients with Crowe IV DDH between 1992 and 2005. Evaluation was performed through Harris Hip Scores, physical examination, and radiographic analysis. ResultsAt mean follow-up 10 years, 5 hips were revised, and 3 patients had died leaving 20 hips for clinical analysis. Harris Hip Score was significantly improved compared to preoperative values (43 vs 87 P < .0001). The 10-year survivorship free from revision for aseptic loosening was 89%. Twenty-nine percent patients had an early complication, but these did not have long-term deleterious effects on the reconstruction, and there were no reoperations for any reason after 7 years. ConclusionsIn the longest series to date, cementless THA combined with a subtrochanteric femoral shortening osteotomy in patients with a high hip dislocation secondary to dysplasia was associated with high rates of successful implant fixation and stable clinical improvement.

Biomechanical Comparison of 2 Different Femoral Stems in the Shortening Osteotomy of the High-Riding Hip

BackgroundWe hypothesized that a rectangular cross-sectional femoral stem may produce more initial stability of the transverse subtrochanteric femoral shortening osteotomy rather than a circular cross-sectional stem. MethodsTwenty, fourth-generation, synthetic femur models were inserted with either circular or rectangular cross-sectional femoral stems after 3 cm of transverse subtrochanteric shortening. Half of the models were tested with axial bending and the other half with torsional loads. After the femora underwent cyclic loading, they were loaded until failure. Outcome parameters were stiffness values before and after cyclical loading, failure loads/torques, and displacements at the osteotomy sites. ResultsIn axial bending tests, the results were not significantly different between the groups. Under rotational forces, the mean stiffness value before cyclical loading and failure torque of the cylindrical stems was significantly higher than that of rectangular cross-sectional stems (11.8 ± 1.2 vs 7.1 ± 2.8 Nm/degree; P = .009 and 136.9 ± 60.2 vs 27.1 ± 17.5 Nm; P = .027 Nm, respectively). The mean amounts of displacements at the osteotomy sites were not significantly different between the groups in any direction in both axial and rotational tests. ConclusionsAccording to the results of the study, using straight, cylindrical femoral stems can increase rotational stability of the transverse osteotomy more than the rectangular cross-sectional stems although the latter one has the advantages of rectangular geometrical design.

Total Hip Arthroplasty with Subtrochanteric Femoral Shortening Osteotomy for High Hip Dislocation

To evaluate the outcomes of total hip arthroplasty (THA) with subtrochanteric femoral shortening osteotomy for high hip dislocation. In this retrospective study, the results of 24 primary THAs with acetabular reconstruction and subtrochanteric femoral shortening osteotomy in 21 patients with high hip dislocation were evaluated. The acetabula were reconstructed with cemented or uncemented cups and bone grafting. Transverse subtrochanteric femoral shortening osteotomies were applied and the osteotomy sites treated by bone grafting and cable fixation. Assessment was by Hip Harris scores and radiographic evaluation. The mean follow-up time was 42 months (18-108 months), three cases being lost to follow-up 18-27 months postoperatively. The HHS improved from 47.5 ± 8.7 to 88.5 ± 3.1. The mean length of femoral segments removed was 2.5 ± 0.8 cm (range, 1.0-4.5 cm) and mean acetabular inclination 43° ± 5° (range, 31°-54°). Caudalization of the femoral head center was 3.2 ± 3.0 mm (range, -3 to 12 mm) and lateralization 4.0 ± 4.0 mm (range, -9 to 11 mm). Mean greater trochanter height relative to theoretical hip center was 5.2 ± 1.0 cm (range, 3.5-7.1 cm) preoperatively and 0.2 ± 0.6 cm (range, -0.9 to 1.2 cm) postoperatively. Intraoperative trochanteric fractures occurred in three cases and sciatic nerve palsy in one. THA with subtrochanteric femoral shortening osteotomy is an effective technique for treating high hip dislocation. Its advantages include improvement in limb imbalance and decreased risk of sciatic nerve injury.

Leg length discrepancy treatment with subtrochanteric shortening osteotomy and blade plate fixation.

Subtrochanteric femoral shortening osteotomy is a method of surgical treatment of lower limb discrepancy (LLD). It is less commonly used due to numerous limitations and the resulting decrease in height, which is an undesirable effect for most patients. The aim of this study was to analyze the results and complications of treatment of leg length discrepancy (LLD) by femoral shortening osteotomy fixed with a blade plate and screws. The study group comprised 18 patients treated by subtrochanteric shortening osteotomy fixed with a blade or straight plate and screws. The age of patients at the time of the operation ranged from 12 years and two months to 24 years and 3 months (mean 17 years and 8 months). Before the operation, the mean LLD amounted to 4.1cm (from 2,5 to 7,0). The size of the same-time resection of the femur at the level of the subtrochanteric osteotomy ranged from 2.5 cm to 5.0 cm (mean 3.7). The follow-up period ranged from 6 months to 15 years and 9 months (mean 3 years and 6 months). The analysis of the results was based on the following criteria. A good result was defined as obtaining an equal length of both legs or achieving the intended amount of shortening. A fair result was defined as a post-operative LLD from 0.5 cm to 1 cm. A poor result comprised patients with post-operative LLD greater than 1 cm or with complications that leave a lasting impact or complications requiring revision surgery. A good result was obtained in 15 patients and a fair one in 3 patients. Complications appeared in 5 (28%) patients. The most common complication was delayed bone healing. Full weight -bearing of the operated limb was allowed between 12 and 32 weeks post-surgery (mean 19 weeks). The final LLD ranged from 0 cm to 3 cm (mean 0.6 cm). Equal limb length was obtained in 13 (72%) patients. 1. Subtrochanteric femoral shortening osteotomy fixed with a plate and screws, taking into consideration the limitation of possible correction to 5-6 cm, is an effective method of treatment of lower limb discrepancy with a relatively low complication rate. 2. The most common complications of subtrochanteric shortening osteotomy are disorders of bone union. 3. The use of lag screws for stabilisation of the osteotomy with an angle plate may reduce the risk of complications.

Surgical results of developmental dysplasia of the hip in older children based on using three-dimensional computed tomography

BackgroundThe surgical management of developmental dysplasia of the hip (DDH) in older children has been the subject of controversy. The purpose of this study was to evaluate the outcome in patients with neglected DDH who underwent individual procedures based on using three-dimensional computed tomography. MethodsForty-seven patients (59 hips) were treated using Pemberton osteotomy or Dega plus Pemberton osteotomy. Subtrochanteric transverse femoral shortening and derotation osteotomy were performed for all patients. The average age at the time of surgery was 10.5 y for group 1 (bilateral dislocation, 24 hips) and 11.2 y for group 2 (unilateral dislocation, 35 hips). Mean follow-up was 5.3 y for group 1 and 5.8 y for group 2. ResultsAt the end of follow-up, 13 hips (54.2%) were rated excellent, eight hips (33.3%) were good, and three hips (12.5%) were fair in group 1. In group 2, 20 hips (57.1%) were rated excellent, 10 hips (28.6%) were good, and five hips (14.3%) were fair. There were five patients who had a limb length discrepancy of approximately 1.5 cm in group 2. Six hips in group 1 and seven hips in group 2 had osteonecrosis of varying severity. ConclusionsWe believe that preoperation three-dimensional computed tomography evaluation, personalized operation plans, and experience with the surgical procedure are the main reasons for the satisfactory therapeutic effects achieved in this study in older children with DDH.

A Reduction Technique of Arthroplasty Without Subtrochanteric Femoral Shortening Osteotomy for the Treatment of Developmental High Dislocation of Hip: A Case Series of 28 Hips

In total hip arthroplasty for the treatment of developmental dysplasia of the hip (DDH) with high hip dislocation, it can be technically challenging to locate the true acetabulum and restore limb length without subtrochantric femoral shortening osteotomy. We explored and described total hip arthroplasty without subtrochanteric femoral shortening osteotomy in 28 hips with Crowe type III and IV dislocation by intravenous injection of rocuronium at 0.9mg/kg 1minute before reduction and hip reduction combined with continuous strong traction of the affected limb with patients in a position with hip and knee flexion. All patients did not show dislocation, prosthesis loosening, and other severe complications. It is thus a safe and feasible reduction technique for arthroplasty of Crowe type III or IV dislocation of DDH.

Total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe IV developmental dysplasia of the hip

Objective To evaluate the clinical efficacy of total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe IV developmental dysplasia of the hip. Methods From September 2003 to September 2012, 21 patients （24 hips） underwent total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe IV developmental dysplasia of the hip in our hospital. There were 3 males and 18 females, aged from 28 to 71 years （average, 54±10 years）. The ceramic- polyethylene articulation was used in 17 patients （20 hips）, and metal-polyethylene articulation in 4 patients （4 hips）. The osteoto- my site was treated with autologous bone graft in 18 patients （21 hips） and allogeneic bone graft in 3 patients （3 hips）. The Harris hip score was used to assess the clinical results. Results A total of 18 patients were followed up for 0.5 to 9 years （average, 3.5 years）. The Harris hip score was improved from preoperative 47.9±9.1 to 88.4±3.5 at 6 months postoperatively. For most patients, hip pain relieved significantly; range of motion of the hip was improved, and the gait returned to normal. Sciatic nerve palsy occurred in 1 patient. There was no wound infection. X-rays 6 months after operation showed that the position of prostheses was satisfactory, without loosening of prostheses and bone block resorption. Conclusion Total hip arthroplasty with subtrochanteric femoral shortening osteotomy can achieve good clinical effect in Crowe IV developmental dysplasia of the hip. Moreover, it can improve leg length discrepancy and decrease the risk of sciatic nerve injury. Key words: Hip dislocation, congenital; Acetabulum; Arthroplasty, replacement, hip

Crowe type IV dislocated hip treated by total hip arthroplasty with subtrochanteric step-cut femoral shortening osteotomy and Wagner cone stem

Crowe type IV dislocated hip treated by total hip arthroplasty with subtrochanteric step-cut femoral shortening osteotomy and Wagner cone stem