Subtrochanteric Osteotomy Research Articles

Bilateral High Hip Center Provides Gait Parameters Similar to Anatomical Reconstruction: A Gait Analysis Study in Hip Replacement Patients With Bilateral Developmental Dysplasia

BackgroundTotal hip arthroplasty in severe dysplasia is challenging due to diminished periacetabular bone stock and the highly placed femoral head. Although anatomical reconstruction of the hip, with required interventions such as subtrochanteric osteotomy and graft usage, is the main aim of the procedure, good long-term clinical outcomes of the high hip center technique have also been reported. Information regarding the effect of hip center placement on gait characteristics is limited; therefore, the aim of this study is to analyze the differences in gait parameters between the high hip center technique and anatomical reconstruction of the hip. MethodsTwenty patients (40 hips) with bilateral Crowe type III-IV developmental dysplasia of the hip who underwent bilateral total hip arthroplasty and completed at least 2 years of follow-up were included. Group 1 comprised 10 patients (20 hips) who underwent anatomical hip center reconstruction, while group 2 comprised 10 patients (20 hips) who underwent high hip center reconstruction. The gait characteristics of patients were examined through markers placed in certain anatomical regions, the cameras placed around, and the force plates embedded in the walking platform. ResultsThere was no significant difference in the gait characteristics according to the location of the hip rotation center. The mean temporospatial, kinematic, and kinetic values were similar between the groups. The most prominent difference was in the peak dynamic hip extension, which was lower in group 2 (−9.71° ± 7.46°) compared to group 1 (−6.80° ± 11.44°), although it was not statistically significant (P = .09). ConclusionThe bilateral high hip center technique can provide similar gait characteristics as anatomical reconstruction and may be preferred in particularly difficult cases based on the surgeon’s decision.

Is pseudoacetabulum an important factor determining SSTO application in total hip arthroplasty for Crowe IV hips? a retrospective cohort study

In terms of developmental dysplasia of the hip (short for DDH), several classification systems have been proposed [1–5]. Most literature is published applicating Crowe’s classification system, because it could be suggestive and instructive for surgery. In 1979, Crowe et al. [1] proposed a four-type system classifying the degree of hip dislocation regarding the ratio of proximal displacement distance of the femoral head in relation to the height of the pelvis or the femoral head, resulting in a calculated coefficient, which converts into one of the four types. Crowe practiced as a hand surgeon after that, so this system was used worldwide and never ameliorative for improvement. In 1987, Eftekhar et al [6] proposed a four-type classification system based on the presence or absence of pseudoacetabulum and overlap between the true acetabulum and the false one. In 1996, Hartofilakidis et al. [4] used the pathology of the dysplastic acetabulum to distinguish between three different types of dysplasia, with subtypes discriminating between a primary and a secondary acetabulum and the relation of the head in relation to these structures. In 2008, Hartofilakidis [7] proposed subtypes on the presence or absence of false acetabulum, and in 2013, he analyzed the clinical outcome of THA based on different subtypes [8]. With the classification of Crowe being increasingly popular, especially in the English literature, it may be the best choice for a classification system with the data available today [9]. In 2016, Ma et al. reported different results between hips of Crowe type IV subtypes on the presence or absence of false acetabulum [10]. High dislocation of hip dysplasia is the most serious type of developmental dysplasia of the hip (short for DDH), which is very difficult to reconstruct the original acetabulum and reset the rotation center to equal both legs and avoid nerve injury after total hip arthroplasty (short for THA). Placing the acetabular component at the true hip center has been shown to provide successful long-term results [11]. However, placement of the acetabular component in the original acetabulum location may result in nerve injury by excessive leg lengthening. This can be addressed by subtrochanteric shortening osteotomy (short for SSTO) first described as a treatment for congenital dislocation of the hip in older children [12], which demands accurate anatomical knowledge and technical expertise for durable results. It was later applied to patients with THA [13]. The shortening subtrochanteric osteotomy (short for SSTO) combined with total hip arthroplasty was a good way to solve the difficulty and showed a good outcome of long-term follow-up. Many authors have reported SSTO with un-cemented THA [14–20]. SSTO procedure was complicated and challenging to surgeons. In clinical experience, for Crowe IV type developmental dysplasia of the hip, we found that some cases did not need SSTO and could get reduction while others hardly could not get reduction unless SSTO. With understanding and reviewing both the Crowe and Hartofilakidis classification systems, we presumed that the presence or absence of secondary false acetabulum may result in different biomechanical patterns of proximal femur and pelvis, which may lead to differences in the anatomical morphology of the proximal femur, affecting the depth of implantation of the prosthesis, and thus affecting the reduction and necessity of SSTO. Currently, the S-ROM prosthesis was recognized as the best prosthetic option for severe femoral deformity such as Crowe type IV DDH. This article was designed to investigate the surgical options between the presence and absence of secondary false acetabulum in the treatment of Crowe IV DDH with the S-ROM prosthesis. If difference presents, it is necessary to classify the Crowe IV type DDH into two subtypes depending on if false acetabulum exists or not, which facilitates and instructs surgery.

The Effect of Graft Positions on the Stability of Total Hip Arthroplasty with Different Types of Subtrochanteric Shortening.

Objective The aim of the present study is to investigate the biomechanical stability of different subtrochanteric osteotomy types and graft positions in cases of dysplastic coxarthrosis that require total hip arthroplasty with shortening osteotomy, as well as to find out the most effective osteotomy type and graft position. Method Femur sawbones were used to compare different types of femoral shortening osteotomy (transverse, oblique, and step-cut). Strut grafts, which were prepared at the side of the subtrochanteric shortening osteotomy, were fixed in different positions (anterolateral, mediolateral, and anteroposterior). The fixation of the strut grafts was performed using two steel cables (with 2.0 mm of thickness) with the same strength. The failure values of composite femurs were recorded for axial and rotational loadings. Results Biomechanically, there were no statistically significant differences between the types of femoral subtrochanteric shortening osteotomy and the positions of the applied strut graft. Conclusion No superiority was observed between the types of femoral subtrochanteric shortening osteotomy regarding stability. Additionally, against stress, similar results were obtained for different strut graft positions. In conclusion, we believe that using the method in which the surgeon is experienced and that is the easiest to apply would be the best choice.

Treatment of Crowe IV developmental dysplasia of the hip with cementless total hip arthroplasty and shortening subtrochanteric osteotomy.

ObjectiveThis study was performed to document the clinical and radiographic results of consecutive patients with Crowe IV developmental dysplasia of the hip (DDH) treated by cementless total hip arthroplasty (THA) using an S-ROM femoral component with shortening derotational subtrochanteric osteotomy.MethodsTwenty-three hips of 21 patients with Crowe IV DDH were treated by cementless THA combined with shortening derotational subtrochanteric osteotomy from January 2005 to January 2011. The mean preoperative modified Harris hip score (mHHS) and University of California, Los Angeles (UCLA) activity score were 40.7 and 4.2, respectively.ResultsThe mean follow-up was 105 months. The mean mHHS and UCLA score improved to 87.0 and 9.1, respectively, at the latest follow-up. Nine of the 23 hips had a negative Trendelenburg sign. One of the 23 hips was outside the Lewinnek acetabular cup inclination safe range, and 3 of the 23 hips were outside the Lewinnek acetabular cup anteversion safe range. The probability of prosthesis survival was 100% at 5 years and 91.3% at 10 years.ConclusionPatients with Crowe IV DDH can be treated by cementless THA combined with shortening derotational subtrochanteric osteotomy. This method can greatly improve hip joint function and relieve pain without significant complications.

The stabilising effect by a novel cable cerclage configuration in long cephalomedullary nailing of subtrochanteric fractures with a posteromedial wedge

BackgroundClinical studies suggest that an adjunctive cerclage in intramedullary nailing of subtrochanteric fractures improves the outcome. Despite this, to what extent various cerclage configurations influences the fixation strength, remains undocumented. We tested the hypothesis that the stability of subtrochanteric fractures with a posteromedial wedge treated with long cephalomedullary nail varies with cerclage configuration. Methods40 composite femurs with a subtrochanteric osteotomy including a posteromedial-wedge were locked by cephalomedullary nailing (T2 recon, Stryker) and divided into 4 groups. In Group-A no cerclage was applied. The Group-B received a lateral tension-band (cerclage cable with crimp, Depuy-Synthes). Without any fixation, the wedge-component was removed in these groups. The Group-C was fixed with a cerclage encircling the wedge-component, while in the Group-D a novel figure-of-8 cerclage stabilised the wedge-component. Each femur was tested quasi-static in a material-testing-machine for stiffness calculation, first horizontally to simulate seated-position and then vertically to simulate standing-position. Finally, cyclic testing was performed in the upright-posture to measure deformation over time. FindingsIn Group-D the mean stiffness in the sitting-position was 6.4, 5.8 and 3.1 times higher than the Groups-A, B and C, respectively, and correspondingly 2.0, 2.1 and 1.7 times higher in the standing-position (p < 0.05). Over time, Group-D demonstrated less mean deformation than tension-band (p = 0.05), while the deformation was not significantly different from the other groups. InterpretationAdditional use of cerclage enhances the stability of intramedullary nailed subtrochanteric fractures, and use of the figure-of-8 cerclage configuration, compressing the entire posteromedial-buttress, is the superior technique.

The causes and management of nonunion of femoral subtrochanteric shortening osteotomy in a THA patient: a case report

BackgroundTotal hip arthroplasty (THA) is considerably difficult to perform in patients with Crowe type IV developmental dysplasia of the hip (DDH). Some Crowe type IV DDH patients require a femoral subtrochanteric shortening osteotomy to equalize the length of the lower extremities and decrease the difficulty of intraoperative reduction. Subtrochanteric transverse osteotomy has been proven to have superior clinical efficacy, but some cases of nonunion occur.Case presentationWe present the case of a 62-year-old male patient who underwent right THA with femoral subtrochanteric transverse osteotomy due to Crowe type IV DDH. Nonunion of the osteotomy occurred during the follow-up period. In July 2017, the patient underwent right THA and femoral subtrochanteric transverse osteotomy due to Crowe type IV DDH. In November 2017, a slight feeling of bone rubbing and slight pain in the hip were reported. The ends of the osteotomy had rotated and united poorly. However, the patient requested to undergo continued observation. In December 2017, the patient reported an obvious sensation of bone rubbing and aggravated hip pain. The ends of the osteotomy had rotated and continued to exhibit nonunion. On December 26, 2017, the patient was treated with plate and screw internal fixation with bone morphogenetic protein (BMP) following our suggestion. In August 2018, the ends of the osteotomy had united after internal fixation was applied.ConclusionsTHA with femoral subtrochanteric transverse osteotomy exhibits good efficacy for the treatment of patients with Crowe type IV DDH. However, postoperative nonunion occurs in a small number of cases. The causes of nonunion should be analysed, and effective measures should be taken to prevent this situation. Plate and screw internal fixation with BMP is an effective treatment for nonunion of the ends of an osteotomy.

Some Aspects of Total Hip Replacement with Subtrochanteric Shortening Osteotomy in Patients with Congenital Hip Dislocation (Review)

Total hip replacement (THR) in patients with a high congenital dislocation of the hip (Crowe type IV dysplasia in Crowe classification) is a technically difficult operation, associated with a high risk of complications. The most common variations of THRs used to restore the true center of rotation of the hip are subtrochanteric shortening osteotomy and proximal shortening osteotomy using the Paavilainen technique. Numerous publications refer to the technique and outcomes of subtrochanteric osteotomy, but fundamental differences of opinion persist on a number of points relating to the topic.The objective of the study is to analyze the publications on the treatment for crowe type IV hip dislocations using total replacement of the hip joint (HJ) with subtrochanteric shortening osteotomy.The hypothesis of the study was as follows: the method of fixation of the femoral component, the type of osteotomy and the design features of the implant (philosophy) are the factors that determine the effectiveness of the operation. The electronic databases eLIBRARY and PubMed were searched for publications containing keywords in Russian or English: high dislocation of the hip, total replacement of the Hj, shortening subtrochanteric osteotomy. As a result of the study, the proposed hypothesis was partially confirmed. There were only minor differences in the overall incidence of complications and the survivorship of implants when using different types of cementless stems. The incidence of non-unions after the installation of cemented femoral components was higher than with the implantation of cementless. We did not find convincing evidence of the advantage of the step-cut, V-shaped and oblique osteotomies compared with the transverse osteotomy. Typical complications for such operations were the nerve injuries, intraoperative hip fractures, dislocations and non-unions of the femur at the osteotomy site.

Using the Ilizarov technique for the correction of coxa vara

Background and objective: Coxa vara was treated previously by subtrochanteric and inter-trochanteric valgus osteotomies with internal fixation. Recently; more attention was paid for achieving corrections of limb deformities and length discrepancies through less invasive means using external fixator systems including Ilizarov fixation. This study aimed to describe the performance of Ilizarov fixation technique in the surgical correction of coxa vara of different etiologies and limb lengthening. Methods: In this case series study, nine patients (11 hips) with coxa vara of different etiologies were treated surgically by sub-trochanteric osteotomy done percutaneously with the use of Ilizarov fixation device, in 15 months at Erbil teaching hospital. Patients between four and ten years of age with coxa vara with neck – shaft angle less than 120° or Hilgenreiner epiphyseal angle of more than 40° were included in this study. Results: All osteotomies achieved the targeted correction in the Hilgenreiner –epiphyseal angle and the neck-shaft angle with a P value <0.001. All osteotomies healed primarily and on follow-up, no intra-operative complications developed, and no patient needed the post-operative blood transfusion. Three patients needed limb lengthening, one patient needed shelf osteotomy, and two patients had superficial pin tract infection. Four patients had postoperative knee stiffness which resolved completely. Radiological analysis revealed a maintained improvement in the Hilgenreiner-epiphyseal angle and neck-shaft angle. Conclusion: Ilizarov technique is a safe and less invasive technique for the surgical management of coxa vara of different etiologies and limb length discrepancy.

Position of the greater trochanter and functional femoral antetorsion: Which factors matter in the management of femoral antetorsion disorders?

The primary aim of this study was to define and quantify three new measurements to indicate the position of the greater trochanter. Secondary aims were to define 'functional antetorsion' as it relates to abductor function in populations both with and without torsional abnormality. Three new measurements, functional antetorsion, posterior tilt, and posterior translation of the greater trochanter, were assessed from 61 CT scans of cadaveric femurs, and their reliability determined. These measurements and their relationships were also evaluated in three groups of patients: a control group (n = 22), a 'high-antetorsion' group (n = 22) and a 'low-antetorsion' group (n = 10). In the cadaver group, the mean anatomical antetorsion was 14.7° (sd 8.5; 0 to 36.5) and the functional antetorsion 21.5° (sd 8.1; 3.6 to 44.3): the posterior tilt was 73.3° (sd 10.8; 46.9 to 88.7) and the posterior translation 0.59 (sd 0.2; 0.2 to 0.9). These measurements had excellent intra and interobserver agreement with a range from 0.93 to 0.99. When the anatomical antetorsion decreased, the greater trochanter was more tilted and translated posteriorly in relation to the axis of the femoral neck, and the difference between functional and anatomical antetorsion increased. The results the three patient groups were similar to those of the cadaver group. The position of the greater trochanter and functional antetorsion varied with anatomical antetorsion. In the surgical management of femoral retrotorsion, subtrochanteric osteotomy can result in an excessively posterior position of the greater trochanter and an increase in functional antetorsion. Cite this article: Bone Joint J 2018;100-B:712-19.

Minimum 10-Year Outcome of One-Stage Total Hip Arthroplasty Without Subtrochanteric Osteotomy Using a Cementless Custom Stem for Crowe III and IV Hip Dislocation

BackgroundOptions for total hip arthroplasty (THA) in high dislocated hips include subtrochanteric osteotomy (STO), high hip center positioning, and 2-stage surgery with progressive lowering using an external fixator before THA. We described the long-term results of 1-stage THA performed without STO, using a cementless customized stem associated if necessary with sequential tenotomies and/or greater trochanteric osteotomy. MethodsNinety-eight consecutive THA without STO were performed using this technique. Of those 98 hips, 26 hips with high dislocation (12 class III and 14 class IV according to the Crowe classification) were evaluated at an average follow-up of 16 (10-22) years. ResultsAt the time of last follow-up, the mean Harris Hip Score was 86 points (37-100). The mean leg-length discrepancy was 7 ± 5 mm (0-17). Two transient (7.7%) nerve palsies (1 sciatic and 1 femoral) were notified. A revision was required for 6 hips (23.1%). Kaplan-Meier survivorship analysis at 15 years regarding aseptic loosening of the femoral component was 87.5% (95% confidence interval, 76.5-99.1). During the same period, acetabular implant survivorship free from revision for aseptic loosening was 96.1% (95% confidence interval, 92.7-99.9). ConclusionThe combination of intramedullary fit and extramedullary adaptation for offset and anteversion provided by the custom stem can avoid additional procedures associated to THA in high developmental dysplasia of the hip. The clinical function and long-term survival reported in this series is encouraging for THA performed in case of high hip dislocation.

A study of total hip arthroplasty with subtrochanteric osteotomy in Crowe type Ⅳ developmental dysplasia of hip

To evaluate the effectiveness of total hip arthroplasty (THA) combined with subtrochanteric osteotomy in the treatment of Crowe type Ⅳdevelopmental dysplasia of the hip (DDH). Between April 2008 and June 2016, 71 patients with unilateral Crowe type Ⅳ DDH were treated with THA. Of 71 cases, 44 were performed with subtrochanteric osteotomy (osteotomy group) and 27 were performed without subtrochanteric osteotomy (non-osteotomy group). There was no significant difference in gender, age, body mass, height, body mass index, affected side, and preoperative Harris score between 2 groups ( P>0.05). The complications were recorded and the effectiveness was assessed by Harris score. Besides, the femoral dislocation height and the settling depth of sleeve were measured in the pelvic anteroposterior X-ray film pre- and post-operatively. Osteotomy group was followed up 12-90 months (mean. 34.77 months), and non-osteotomy group was followed up 12-79 months (mean, 34.33 months). There was no significant difference in follow-up time between 2 groups ( t=-0.088, P=0.930). There was 11 cases of intraoperative or postoperative complications in osteotomy group, and 3 cases of postoperative complications in non-osteotomy group. Among the osteotomy group, 1 case had nonunion due to infection and received revision after 20 months. No loosening or dislocation of the implant occurred in both 2 groups. Significant differences were found in femoral dislocation height and settling depth of sleeve between 2 groups ( t=-8.452, P=0.000; t=6.783, P=0.000). Moreover，the osteotomy length was not correlated with the settling depth of sleeve ( r=-0.038, P=0.806). At last follow-up, there was no significant difference in Harris score between 2 groups ( t=-1.160, P=0.254). THA combined with subtrochanteric osteotomy can provide a favorable outcome for treating Crowe type Ⅳ DDH. Furthermore, patients with higher femoral dislocation and severely narrow femoral proximal canals are prone to be peformed with subtrochanteric osteotomy.

Functional Outcome of Crowe IV Congenital Dysplasia of the Hip Managed by Total Hip Arthroplasty with Subtrochanteric Osteotomy

Functional Outcome of Crowe IV Congenital Dysplasia of the Hip Managed by Total Hip Arthroplasty with Subtrochanteric Osteotomy

FEATURES OF THA IN PATIENTS WITH HIGH CONGENITAL HIP DISLOCATION

There are a fair number of papers presenting the outcomes of total hip arthroplasty with shortening subtrochanteric osteotomy in neglected hip dislocation. In most of them the authors used long modular stems or Wagner stems as a femoral component. The reports describing the outcomes of such procedures with standard femoral stems are rather rare.The purpose of this study was to evaluate short-term and medium-term outcomes of total hip arthroplasty with standard femoral stems and shortening subtrochanteric osteotomy for treatment of high hip dislocation.Materials and methods. From 2010 to 2016 the authors performed 18 hip arthroplasties with shortening subtrochanteric osteotomy in 16 patients with high hip dislocation. All patients were clinically evaluated using Harris Hip Score and radiography prior to and after the surgery.Results. The mean Harris Hip Score significantly improved compared to preoperative values from 39.7±1.4 to 84.7±1.6. At mean follow-up of 24±2.4 mounts the authors observed 2 case of nonunion at osteotomy site and 1 case of transient nerve palsy. Revision surgery was performed in 2 patients due to nonunion. The mean limb lengthening was 3.65±0.21 cm.Conclusion. Our data demonstrated that total hip arthroplasty with subtrochanteric osteotomy is an effective technique for treatment of Crowe type III-IV congenital hipdislocation with high rate of successful fixation on the typical femoral stem, healing of osteotomy site and satisfactory shortand medium-term clinical outcomes. The non-modular tapered stem provides sufficient stability in distal and proximal parts of the femur. The use of standard tapered stem allows to achieve good healing rates of the osteotomy.

Mid-term results of total hip replacement with subtrochanteric osteotomy, modular stem, and ceramic surface in Crowe IV hip dysplasia.

BackgroundTotal hip athroplasty (THA) in Crowe IV developmental dysplasia of the hip (DDH) presents many challenges for surgeons with regard to acetabular and femoral deformities. The purposes of this study are to (1) report the mid-term results of THA with subtrochanteric transverse osteotomy using S-ROM prosthesis and ceramic-on-ceramic (COC) surface for Crowe type IV DDH; and (2) compare the wear performance between COC and metal-on-polyethylene (MOP) bearing couple.MethodsEighty Crowe IV DDH patients (103 hips) treated with cementless THA were retrospectively reviewed. The S-ROM prosthesis was used in all the hips and subtrochanteric osteotomy was performed in 74 hips. COC and MOP bearing surfaces were compared through the evaluation.ResultsAt mean follow-up of 65.6 months, the mean Harris hip score improved from 54.2 to 87.7 points; however, Trendelenberg sign positive was confirmed in 20.4% of the hips. Postoperative dislocation occurred in 6 cases and overall 4 hips were revised. With any component revision as endpoint, Kaplan-Meier survival curve showed that 8-year cumulative survival rate in the COC group was 97.2% and 9-year survival rate in the MOP group was 85.9%. The mean linear wear rate for COC and MOP surface was 0.006 and 0.175 mm/y, respectively.ConclusionsSubtrochanteric osteotomy combined with the modular S-ROM prosthesis and COC surface in Crowe IV DDH has achieved satisfactory mid-term results. However, postoperative dislocation and limp remain major complications. Linear wear rate for MOP surface is high and the long-term prosthesis survival is affected. Ceramic or highly cross-linked polyethylene should be preferred.

Shortening subtrochanteric osteotomy and cup placement at true acetabulum in total hip arthroplasty of Crowe III\u2013IV developmental dysplasia: results of midterm follow-up

IntroductionThe anatomic abnormalities in developmental dysplasia of hip (DDH) often make total hip replacement (THR) inevitable at a younger age. However, there is no universal gold standard technique of THR for high dislocated dysplastic hips.Materials and methodsHere we present the outcomes of midterm follow-up after THR in patients diagnosed with DDH Crowe type III and IV hospitalized in a tertiary center in Iran for whom placement of a cup in true acetabulum and selective transverse subtrochanteric osteotomy was performed. Pre- and postoperative Harris Hip Score, leg length discrepancy and postoperative complications were evaluated.ResultsA total of 48 patients with DDH Crowe type III and IV (uni- or bilateral which made 52 hips) were studied. Mean age of patients was 41 years with minimum follow-up ranging from 12 months to 3 years. Mean Harris Hip Score significantly improved from 41.70 preoperatively to 88.1 at last follow-up postoperatively. Leg length discrepancy of less than 2 cm was observed which was well tolerated using shoe lifts. Regarding postoperative complications, two patients had transient peroneal nerve palsy in early postoperative period which recovered within 2 months. No other major complication was encountered.ConclusionTHR in patients with DDH (Crowe III and IV) with a cup positioned in true acetabulum and transverse subtrochanteric osteotomy is a safe successful procedure.

Subtrochanteric shortening osteotomy during cementless total hip arthroplasty in young patients with severe developmental dysplasia of the hip

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.

A finite element analysis of stability of subtrochanteric oblique osteotomy in total hip arthroplasty for type IV developmental dysplasia of the hip

Objective Finite element analysis was used to evaluate the effects of different angles of subtrochanteric osteotomy on the bone and prosthesis stress and the stability of the osteotomy surface. Methods CT scan of A 50 year old female patient with Crowe type developmental dysplasia of the hip (DDH) was subjected to the CT scan, the femur data were extracted, the digital model was established, components were digitalized, and the operation was simulated. The osteotomy was done under the rotor downward inclination of 30°, 45°, 60°, 90°. The affected lateral single leg standing was developed by mechanical loading. The stress distribution, relative displacement and measurement of each model were detected. Results The stress distribution of the femoral and hip replacement was different from that of the whole femur. After the subtrochanteric osteotomy, the stress concentration appeared in both the prosthesis and the femur, and the stress concentration area of the femur was mainly located at the distal end of the osteotomy. From the angle of the displacement of the osteotomy plane, the relative displacements after 30°, 45°, 60° and 90° osteotomy were 101, 29, 48, and 133 μm respectively. The rotation and axial displacement of the osteotomy face were balanced when the inclination was 45°, and the overall displacement was minimum. Conclusion The finite element analysis shows that the subtrochanteric osteotomy can cause the stress concentration of the distal femur of the osteotomy. Because of the small overall displacement, the tilt of the rotor under 45° osteotomy is expected to obtain the best stability of the osteotomy surface. Key words: Developmental dysplasia of the hip; Total hip arthroplasty; Subtrochanteric oblique osteotomy; Finite element analysis

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.

Does restoration of hip center with subtrochanteric osteotomy provide preferable outcome for Crowe type III–IV irreducible development dysplasia of the hip??

BackgroundSubtrochanteric osteotomy and proximal placement of acetabular components are two common procedures used to manage irreducible, high riding developmental dysplasia of the hip (DDH). Some common and specific complications are observed in both procedures. We aimed to compare both the outcomes and complications between these two procedures. MethodsTwenty-one patients with unilateral, Crowe type III–IV DDH who were seen between 2002 and 2014 were included in this study. Subtrochanteric osteotomy with restoration of the hip center and proximal placement of the acetabular component were performed on 10 and 11 patients, respectively. Harris hip score (HHS) and radiographic images were used for outcome assessment. All patients completed a minimum of 2-year follow-up. ResultsThe HHS in patients who had undergone subtrochanteric osteotomy and proximal placement of the acetabular component were 89.4 and 91.9 points, respectively. However, this difference was not significant. There were six complications, including transient sciatic nerve palsy in two patients, nonunion at the junction in two, an intra-operative fracture in one and cup loosening in another. The complication rates in the subtrochanteric osteotomy and proximal placement of the acetabular component group were 30% and 27.5%, respectively. ConclusionWith regard to both clinical outcomes and complication rates, restoration of the hip center using subtrochanteric osteotomy may provide similar benefits to those patients with proximal placement of the acetabular component in treating Crowe type III–IV DDH.

Percutaneous multiplanar subtrochanteric osteotomy with external fixation for developmental coxa vara (preliminary results).

Level IV.