Transverse Subtrochanteric Shortening Osteotomy Research Articles

Transverse subtrochanteric shortening osteotomy with double tension-band fixation during THA for Crowe III-IV developmental dysplasia: 12-year outcomes

BackgroundWhen performing total hip arthroplasty in patients with severe developmental dysplasia, shortening the femur facilitates reduction while also preventing sciatic or crural nerve injury and excessive length of the operated limb. No consensus exists about the optimal type of implant and best internal fixation procedure, two parameters that directly govern the risk of the most common intraoperative and postoperative complications (diaphyseal fractures, dislocation, non-union). To minimise these risks, we developed a technique combining a transverse subtrochanteric shortening osteotomy, a long ovoid-profiled, cementless stem anchored in the metaphysis, and double tension-band wiring for internal fixation. The primary objective of this study was to evaluate the outcomes of this technique with emphasis on (i) complications and femoral implant survival, (ii) clinical outcomes (functional scores and lower-limb length inequality [LLLI]), and time to healing. HypothesisOur technique is associated with low rates of intraoperative and postoperative complications. Material and methodsThis single-centre retrospective cohort study included patients who underwent THA with a transverse subtrochanteric shortening osteotomy and fixation using double tension-band wiring to treat severe (Crowe III or IV) developmental hip dysplasia. The femoral implant was a long, ovoid, cementless stem fully coated with hydroxyapatite. We collected the intraoperative and postoperative complications, survival, LLLI, functional scores (Harris Hip Score [HHS] and Forgotten Joint Score [FJS]), patient satisfaction, and radiographic outcomes. ResultsThe study included 31 hips in 25 patients. Two patients (2/31 hips, 6.5%) were lost to follow-up, leaving 29 hips for the analysis of postoperative outcomes. Mean follow-up was 13.7±4.2 years (range, 5.8–18.3 years). The four intraoperative complications (4/31, 12.9%) consisted fracture of the diaphysis (2/31, 6.5%), fracture of the greater trochanter (1/31, 3.2%), and sciatic nerve injury followed by a full recovery (1/29, 3.4%). The 8 (8/29, 27.5%) postoperative complications consisted of dislocation (2/29, 6.9%), stem subsidence (2/29, 6.9%), and non-union (4/29, 13.8%). Femoral implant survival at last follow-up was 87.1% (95% CI, 76.1–99.7). The mean HHS increased from 39.6±12.0 (range, 14–61) before surgery to 81.7±13.2 (range, 48–100) at last follow-up (p<0.01). The FJS at last follow-up indicated that the joint was forgotten in 14/29 (48.2%) cases and caused only acceptable symptoms in 9/29 (31.0%) of cases. Clinically significant (≥ 1cm) LLLI was present in 8/29 (27.6%) patients postoperatively compared to 19/29 (65.5%) preoperatively. The mean LLLI decreased from 20.8±19.7mm (range, 0–60mm) to 5.0±7.3mm (range, 0–30mm). Mean time to healing was 4.3±2.4 months (range, 2–11 months). ConclusionRegarding these complex procedures, this technique was associated with low rates of intraoperative fractures and early postoperative complications. However, femoral stem survival was shorter than in earlier studies and the non-union rate was high, despite satisfactory functional and clinical outcomes.Level of evidence IV.

Total hip arthroplasty in patients with coxarthrosis due to developmental dysplasia of the hip: Is fixation of the subtrochanteric osteotomy necessary?

This study aims to analyze the clinical, functional, and radiographic results of patients with Crowe type IV developmental dysplasia of the hip (DDH) sequelae undergoing cementless total hip arthroplasty (THA) with transverse subtrochanteric shortening osteotomy without fixation at the osteotomy site. Between March 2013 and February 2020, a total of 42 hips of 34 patients (8 males, 26 females; mean age: 50.7±11.7 years; range, 27 to 76 years) with Crowe type IV DDH treated with subtrochanteric shortening osteotomy combined with primary cementless THA were retrospectively analyzed. Each case was evaluated to the Harris Hip Score (HHS). Crowe classification, location of the rotation center of hip, loosening of the implants, and union at the osteotomy line were evaluated radiologically. The mean follow-up was 57.9±31.5 (range, 24 to 192) months. The mean interval to complete bone union in 40 hips (95%) after surgery was 3.5±0.9 (range, 2 to 6) months. The mean preoperative HHS scores of the patients was 35.6±6.86, while the scores increased to 91.53±5.41 at the final follow-up (p<0.001). Our study results suggest that excellent clinical and radiological results can be obtained in Crowe type IV dysplastic hips in patients undergoing THA with the rectangular femoral component and transverse shortening osteotomy technique, without fixation at the osteotomy site.

Total hip arthroplasty associated with transverse subtrochanteric shortening osteotomy and conical stem fixation in Crowe type IV hip dysplasia.

Total hip arthroplasty (THA) in high-dislocated hip dysplasia is a surgical challenge, presenting difficulties in the biomechanical reconstruction of the hip. The purpose of the present study is to analyze clinical and radiological outcomes of a series of patients with Crowe type IV hip dysplasia who underwent a THA with transverse subtrochanteric shortening osteotomy and conical stem fixation in our Hip surgery unit. This non-interventional retrospective study included all patients diagnosed with Crowe type IV hip dysplasia who underwent a THA using a subtrochanteric shortening osteotomy and uncemented conical stem fixation between January 1, 2008, and December 31, 2015. Demographic, clinical and radiologic data were analyzed, including Harris Hip Score and Oxford Hip Score. Seventeen hips in 13 patients were included in the final analysis. All patients were women and mean age was 39years (range 35-45). Mean follow-up was 5.6years (range 1-8). Average length of the osteotomy was 3.4cm (range 3-4.5) and mean lowering of the center of rotation was 5.67cm (range 3.8-9.1). Mean time for bone union was 5.5months. No nerve palsy or non-union was detected at the end of follow-up period. The use of cementless conical stem fixation associated with a transverse subtrochanteric shortening osteotomy for treating Crowe type IV hip dysplasia permits to correct the rotational alterations of the femur and provides good stability of the osteotomy, with very low risk of nerve palsy and non-union rates.

Cementless modular total hip arthroplasty with subtrochanteric transverse shortening osteotomy for high hip dislocations

BackgroundPerforming a total hip arthroplasty for a high hip dislocation is technically demanding and presents several challenges, with appropriate evaluation of the bone morphology of the hip and proper implant selection being critical for successful outcomes.ObjectiveThe purpose of our study was to evaluate the clinical and radiographic outcomes of cementless modular total hip arthroplasty for the treatment of high hip dislocations with sub-trochanteric transverse shortening osteotomy.MethodsSixty-eight hips with a high hip dislocation, were treated using a sub-trochanteric transverse shortening osteotomy and cementless modular total hip arthroplasty, retrospectively reviewed. Hip function was assessed using the Harris hip score, with hip abduction strength evaluated using the Trendelenburg test. Radiographic assessment included the measurement of leg length discrepancy, identification of implant loosening, localization of the hip center, and union at the osteotomy site.ResultsThe mean follow-up period was 12.9 (range 5.2–16.8) years. The mean Harris hip score improved from a pre-operative score of 48.6 ± 3.6 to 82.4 ± 4.2 (p < 0.05). The hip was within the true acetabulum in all patients, postoperatively. Osteotomy union was achieved in 67 of the 68 hips (98.5%) in a mean latency of 12.5 ± 0.6 weeks. The mean length of femoral shortening was 66.5 ± 4.5 mm, with a mean pull-down length of the proximal part of 35.5 ± 3.5 mm.ConclusionFor the treatment of high hip dislocations with satisfactory clinical outcomes, the modular stem offers an adjustable anteversion angle to restore sufficient rotational stability and the transverse osteotomy provides sufficient compression pressure across the osteotomy site to facilitate union.Trial registration It was a retrospective study and approved by Istanbul Research and Training Hospital institutional Ethics Review Board (772-05/02/2016).

Total Hip Arthroplasty With the Wagner Cone Femoral Stem in Patients With Crowe IV Developmental Dysplasia of the Hip: ARetrospective Study.

The aim of this study is to assess treatment of Crowe type IV hip dysplasia with the Wagner cone femoral stem combined with transverse subtrochanteric shortening osteotomy and augmenting the osteotomy site using the intercalary segment as a strut autograft. One hundred twenty-seven hips of 91 patients diagnosed with Crowe type IV hip dysplasia and treated with total hip arthroplasty using the Wagner cone stem combined with transverse subtrochanteric shortening osteotomy were retrospectively evaluated by clinical and radiographic outcomes as well as complications. The mean follow-up was 8.4 years. The Harris Hip Score and the Western Ontario and McMaster University Osteoarthritis Index scores were significantly improved postoperatively (P= .000). Intraoperative femoral cracks were observed in 70 hips (55.1%) and all femurs healed smoothly. Femoral cracks did not have a significant effect on clinical outcomes, except for heterotopic ossifications (P= .032). The probability of 10-year survivorship of the components free of revision for any reasons as end point was 94.5%; when only the femoral components were considered the survivorship was of 96.9%. Transverse subtrochanteric shortening and augmenting the osteotomy site using the intercalary segment of bone resected from the shortened femur with the Wagner cone stem is an effective and reliable technique in the management of total hip arthroplasty in Crowe type IV hip dysplasia. Stable and firm placing of the femoral component which leads to an increased frequency of intraoperative femoral cracks does not have an unfavorable effect on clinical and radiological outcomes.

Long-Term Outcomes of Total Hip Arthroplasty With Transverse Subtrochanteric Shortening Osteotomy and Modular Stem in Crowe IV Developmental Dysplasia

BackgroundThe reconstruction of high dislocation related to developmental dysplasia of the hip (DDH) remains challenging for joint surgeons. The aim of this study is to evaluate the rate of union, the revision rate, functional scores, and complications in patients with Crowe IV DDH treated with total hip arthroplasty, transverse subtrochanteric shortening osteotomy, and modular stem in an average 10-year follow-up. MethodsTwenty-eight patients (33 hips) with Crowe IV DDH who were operated on between 2008 and 2013 were followed. All patients underwent uncemented total hip arthroplasty with transverse subtrochanteric shortening osteotomy and anatomical acetabular cup implantation. The mean age was 36.6 years, and the mean follow-up period was 121 months. Clinical and radiological outcomes were evaluated. ResultsThe mean Harris Hip Score significantly improved from 47.0 preoperatively to 89.6 postoperatively. The mean limb length discrepancy was significantly reduced from 3.8 to 0.8 cm. The mean osteotomy union time was 6.8 months. At the mean follow-up of 121 months, there were 3 cases of postoperative dislocation, 2 cases of intraoperative fracture, and 1 case of posterior tibial venous thrombosis. No revision occurred, and no signs of component loosening or migration were observed at the last follow-up. ConclusionCrowe IV DDH patients treated with transverse subtrochanteric shortening osteotomy, modular stem, and anatomic acetabular component insertion can have satisfactory and reliable 10-year clinical outcomes.

Total Hip Arthroplasty Combined With Subtrochanteric Transverse Shortening Osteotomy: Factors Associated With Delayed Union at the Osteotomy Site.

Background:Total hip arthroplasty (THA) with subtrochanteric shortening osteotomy for Crowe type IV hips poses the risk of nonunion at the osteotomy site. The aim of this study was to analyze the factors that affect the bone union rate at the osteotomy site.Methods:We retrospectively reviewed a consecutive series of 27 THAs with subtrochanteric transverse shortening osteotomy performed for Crowe type IV hips. The effects of patient-related and surgery-related factors on the risk of delayed union were analyzed using univariate and multivariate regression analyses.Results:The mean follow-up period was 10.0 (1.4 to 19.1) years. The implant survival rate was 87.8% (95% confidence interval: 60.2% to 97.2%) at 10 years. The length of femoral bone resection was the only factor associated with the risk of delayed union. Longer bone resection lengths were significantly correlated with the reduced risk of delayed union (odds ratio: 0.63 [0.030 to 0.90], P = 0.0013). Other variables, including the use of a cement stem (P = 0.34) and the presence of a gap >1 mm at the osteotomy site (P = 0.98), were not associated with the risk of delayed union.Discussion:THA with subtrochanteric transverse osteotomy provides satisfactory long-term results for Crowe type IV hips. For shorter required femoral resection lengths, the risk of delayed union was higher. A longer resection could permit fabrication of longer autologous longitudinal bone struts and likely contributes to enhanced stability at the osteotomy site.

Outcomes after Total Hip Arthroplasty Using a Cementless S-ROM Modular Stem for Patients with High Hip Dislocation Secondary to Hip Pyogenic Arthritis.

ObjectiveTo evaluate the midterm results of the cementless S‐ROM modular femoral stem used with subtrochanteric transverse shortening osteotomy for the treatment of high hip dislocation secondary to hip pyogenic arthritis.MethodsWe retrospectively reviewed the data of 49 patients (49 hips) with an average infection quiescent period of 37.4 years who underwent cementless total hip arthroplasty (THA) with simultaneous subtrochanteric transverse shortening osteotomy from July 2008 to June 2012. There were 23 men and 26 women with a mean age of 44.3 years at the time of surgery. The following clinical outcomes were evaluated: the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, Harris hip score (HSS), modified Merle d'Aubigne‐Postel hip (MAP) score, low back pain visual analog scale score, 12‐item short‐form health survey questionnaire score, limp, and Trendelenburg sign. Radiographic outcomes and complications were also evaluated.ResultsThe mean follow‐up period was 8.7 years (range, 5.5–10 years). No infection recurrence was observed after THA. The average HSS significantly improved from 45.0 to 84.8. The WOMAC score improved from 70.1 ± 3.5 (range, 65–76) to 43.1 ± 13.4 (range, 21–67). The modified MAP score improved from 5.9 ± 1.9 (range, 3–9) to 14.3 ± 2.4 (range, 11–18). The low back pain visual analog scale score, 12‐item short‐form health survey questionnaire score, limp, and Trendelenburg sign also improved significantly. The average limb length discrepancy decreased from 39.6 mm (range, 30–55 mm) to 7.2 mm (range, 0–22 mm). Two patients had temporary sciatic nerve paralysis but recovered within 6 months without any functional defects; one had an intraoperative fracture fixed by cerclage wires. One hip required revision surgery because of femoral stem aseptic loosening.ConclusionsThe cementless S‐ROM modular femoral stem used with subtrochanteric transverse shortening osteotomy is safe and effective for high hip dislocation secondary to pyogenic arthritis and provides satisfactory midterm results. Significant improvements in clinical function were observed, as were high rates of stable fixation of the cementless implant, restoration of more normal limb lengths, and a low incidence of complications.

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.

Cementless hip arthroplasty and transverse shortening femoral osteotomy with the S-ROM stem for Crowe type IV developmental dysplasia

The aim of this study has been to present outcomes after cementless arthroplasty for developmental dysplasia Crowe type IV of the hip, with transverse subtrochanteric shortening osteotomy and using the S-ROM stem. We evaluated radiographs, functional scores and complications in a consecutive series of 23 patients (28 hips) with high dislocation of the hip. The average age of patients at surgery was 49.9 (range 22-68) years. The operations were performed between 2007 and 2013. Patients were assessed retrospectively-clinically and radiographically during the year 2018. The mean follow-up period was 94 (range 60-134) months. The average Harris hip score improved from 39.9 to 84.0. The mean leg length discrepancy decreased from 5cm preoperatively to 1.4cm at the final follow-up. All acetabular components were implanted into the true acetabulum, and all prostheses were stable at the latest examination. No neurovascular damage was recorded. We have identified specific complications in seven hips (25%) in total: Intraoperative femoral fracture required fixation in four hips; three hips (10.7%) needed revision: Recurrent dislocation, with the need for cup reorientation, occurred in two hips (in one of them, this was followed by the subsequent need for resection of heterotopic ossification); there was one aseptic stem loosening with the need of one-stage revision. All the osteotomies healed within 8months. Hip arthroplasty with transverse shortening femoral osteotomy, using S-ROM stem, is an acceptable, but not complication-free treatment method in patients with Crowe type IV developmental hip dysplasia, in the midterm.

Total hip arthroplasty with a monoblock conical stem and subtrochanteric transverse shortening osteotomy in Crowe type IV dysplastic hips.

This series assessed the clinical and radiographic outcomes of total hip arthroplasty (THA) with femoral shortening osteotomy for the management of patients with Crowe type IV hip dysplasia. Only patients with Crowe type IV hip dysplasia who underwent primary THA combined with a subtrochanteric transverse osteotomy with an uncemented monoblock conical stem were included. The clinical and radiographic evaluations were performed before and immediately after surgery, and at last follow-up. The hip function was assessed with the Harris Hip Score (HHS). Seventy-four patients (102 hips) with a mean age of 53.9 (range, 20-83) were evaluated at an average follow-up of 11.3years (range, 5-25). Stem revision occurred in two (1.9%) cases, with a survivorship of 95.9% (95%IC, 91.9-99.9%) at tenyears. The average HHS increased from 44 (range, 15-78) pre-operatively to 90.3 (range, 62-100) at last follow-up (p < 0.001). Osteotomy site non-union and early dislocation were observed in 3.9 and 3.8%, respectively. No cases of nerve palsy were reported. THA with a monoblock conical stem associated with subtrochanteric transverse osteotomy provides good long-term survival, clinical and radiographic results. It may be considered an effective management of patients with Crowe IV hip dysplasia.

Total hip arthroplasty for patients with Crowe type IV developmental dysplasia of the hip: Ten years results

Background and objectivesThe aim of this study was to determine the rate of union, functional results and complications in patients with Crowe IV developmental dysplasia of the hip (DDH) who underwent cementless total hip arthroplasty (THA) with S-ROM prostheses and subtrochanteric transverse shortening osteotomy. MethodsForty-five patients (52 hips) operated between January 2005 and May 2008, with a mean age of 40.6 years at surgery were followed. The mean follow-up period was 9.8 years. Clinical outcomes, radiographic outcomes and complications were evaluated. ResultsOsteotomy union occurred in 52 of 52 femurs (100%). Mean Harris hip score improved from 33.7 ± 4.7 preoperatively to 81.2 ± 6.3, 90.8 ± 5.3 and 89.8 ± 7.1 at 1, 5 and 10 years postoperatively. Two patients had temporary sciatic nerve paralysis postoperatively, and 2 patients experienced early postoperative dislocation. Two patients complained about mild longer limb length than the non-operated limb at the last follow-up. Three hips showed osteolysis in Gruen zone 1, and 1 hip showed osteolysis in zone 1 and 7. No implants were revised, and no signs of component loosening and migration were observed at the last follow-up visit. ConclusionsS-ROM stem combined with transverse subtrochanteric shortening osteotomy in THA for patients with Crowe type IV DDH has good clinical results with small risk of complications.

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

BackgroundWhen surgeons reconstruct hips with a high dislocation related to severe developmental dysplasia of the hip (DDH) in total hip arthroplasty (THA), archiving long-term stable implant fixation and improving patient function and satisfaction remain challenging. The purpose of this study was to evaluate the 10-year outcomes of transverse subtrochanteric shortening osteotomy in cementless, modular THA in Crowe type IV-Hartofilakidis type III DDH. MethodsWe reviewed 62 patients (76 hips) who underwent cementless THA with transverse subtrochanteric shortening osteotomy from 2002-2010. There were 49 women and 13 men with a mean age of 38.8 years, all of whom had Crowe type IV DDH. Mean follow-up period was 10 years. The acetabular cup was implanted in placement of the anatomical hip center in all hips. ResultsThe mean Harris Hip Score significantly improved from 38.8 points to 86.1 points. Similarly, modified Merle d'Aubigne and Postel Hip Score, Hip dysfunction and Osteoarthritis Outcome Score, and SF-12 also significantly improved. The mean limb length discrepancy was reduced from 4.3 cm to 1.0 cm. At mean follow-up of 10 years, there were 3 cases of postoperative dislocation, 2 cases of transient nerve palsy, 1 case of nonunion, and 4 cases of intraoperative fracture. Revision surgery was performed in 2 patients due to isolated loosening of acetabular component and femoral stem, respectively. ConclusionOur data demonstrated that the cementless, modular THA combined with transverse subtrochanteric shortening osteotomy was an effective and reliable technique with high rates of successful fixation of the implants and satisfactory clinical outcomes.

Comparison of Total Hip Arthroplasty With and Without Femoral Shortening Osteotomy for Unilateral Mild to Moderate High Hip Dislocation

BackgroundThis study compares the outcome between THA with and without femoral shortening osteotomy for unilateral mild to moderate high hip dislocation in developmental dysplasia of the hip patients. MethodsThe data on 42 hips in 42 patients who had undergone THA for unilateral mild to moderate high hip dislocation were retrospectively reviewed after being prospectively collected. In 22 patients, hips were reduced by soft tissue release and direct leverage using an elevator, without the osteotomy. The remaining 20 patients were treated with a subtrochanteric transverse shortening osteotomy. The mean follow-up of patients was 5 years (standard deviation = 1.0) for the nonosteotomy group and 6.2 years (standard deviation = 1.6) for the osteotomy group. ResultsThe Harris Hip Score significantly improved in both groups. In the nonosteotomy group, we observed a lower leg length discrepancy compared with the osteotomy group (0.4 cm and 2.2 cm, respectively). Four patients (18.2%) in the nonosteotomy group and 15 patients (75%) in the osteotomy group developed a limp (P < .0001). Three patients (13%) developed femoral nerve palsy in the nonosteotomy group, but they all recovered completely within 6 months after the surgery. Nineteen patients in the nonosteotomy group showed knee valgus deformity immediately after the surgery but only 4 cases in the osteotomy group. ConclusionCompared with THA with femoral shortening osteotomy, THA without the osteotomy was associated with a lower number of patients who developed a limp at the end of follow-up; however, the rehabilitation was slower and more difficult, and a larger number of patients showed reversible nerve palsy and knee valgus deformity.

Transverse Subtrochanteric Shortening Osteotomy During Cementless Total Hip Arthroplasty in Crowe Type-III or IV Developmental Dysplasia

The purpose of this study was to review the outcomes of transverse subtrochanteric shortening osteotomy during cementless total hip arthroplasty in Crowe Type-III or IV developmental dysplasia. Seventy-three osteotomies were included in our study. Mean follow-up was 61months. Harris hip score, leg length discrepancy, neurological status, union status of the osteotomy, and femoral component stability were the criteria for evaluation. All complications were noted. The mean Harris hip score improved from 38.6 points to 83.7 points. The mean leg length discrepancy decreased from 56.5mm to 10.7 at the latest follow-up. The mean union time was 5.2months. We observed 4 non-unions. Transverse subtrochanteric shortening osteotomy is an effective and reliable method in restoration of a more normal limb.

Cementless Total Hip Arthroplasty with Subtrochanteric Transverse Shortening Osteotomy in Patients with High Hip Dislocation

목적: 고관절 고위 탈구 환자에서 전자하 횡형 단축 절골술을 이용하여 무시멘트성 인공 고관절 전치환술을 시행하고 그 임상적 및 방사선학적 결과를 알아보고자 하였다. 대상 및 방법: 2001년부터 2012년까지 고관절 고위 탈구로 대퇴 전자하부 횡형 단축 절골술과 함께 금속판 또는 케이블 고정 및 절골부위의 골이식을 시행하여 무시멘트성 인공 고관절 전치환술을 시행하였던 환자 18명(18예)을 대상으로 하였다. 평균 추시 기간은 5.2년(2-8.3년)이었다. 임상적으로 Harris 고관절 점수, 파행, 하지 부동의 변화를 측정하였고, 방사선학적으로 골용해, 삽입물의 해리 및 절골 부위의 유합 유무를 평가하였다. 결과: 최종 추시 시 전 예에서 Harris 고관절 점수, 파행 및 하지 부동의 호전이 관찰되었다. 방사선학적으로 감염이 발생했던 2예를 제외한 전 예에서 삽입물의 해리, 골용해 등을 보인 경우는 없었으며, 전 예에서 절골부의 유합 소견을 보였다. 합병증으로 감염 2예, 탈구 1예가 있었으며 감염으로 재수술을 시행한 2예 중 1예에서 좌골 신경 마비가 발생하였다. 결론: 고관절 고위 탈구 환자에서 전자하부 횡형 단축 절골술을 이용한 무시멘트성 인공 고관절 전치환술은 비교적 만족할 만한 결과를 보였다. 그러나 감염 등의 합병증 발생이 상대적으로 높게 나타 나이에 대한 각별한 주의가 필요할 것으로 생각된다.

Predicting Leg-Length Change after Total Hip Arthroplasty by Measuring Preoperative Hip Flexion under General Anaesthesia

To measure preoperative hip flexion under general anaesthesia in patients with developmental dysplasia of the hip and analyse its correlation with leg-length change. 79 women and 6 men aged 27 to 82 (mean, 59) years underwent 92 total hip arthroplasties for severe developmental dysplasia of the hip of Crowe types II (n=60), III (n=17), and IV (n=15). All such patients had severe pain and/or considerable difficulty in walking and performing daily activities. 16 of the hips were treated with transverse subtrochanteric shortening osteotomy, whereas the remaining 76 had no femoral osteotomy. Preoperative passive hip flexion was measured under general anaesthesia with a goniometer by a single investigator. Its mean value in patients with Crowe type-III deformity was 60.3º. Therefore, >60º of flexion was defined as high. Postoperative leg-length change was measured radiographically. The distraction of the greater trochanter was equal to the leg-length change in patients treated without femoral osteotomy, whereas leg-length change was calculated by subtracting the amount of resection of the femur from the distraction of the greater trochanter in patients treated with femoral osteotomy. Of the 16 hips treated with a transverse subtrochanteric shortening femoral osteotomy, 2, 2, and 12 were Crowe types II, III, and IV, respectively. In these 16 hips, hip flexion was high in 10 (mean, 86º) and low in 6 (mean, 36º). Leg-length change was significantly greater in the high than low flexion groups (31 vs. 13 mm, p<0.01). In the 76 hips without osteotomy, hip flexion was high in 54 (mean, 85º) and low in 22 (mean, 40º). Leg-length change was significantly greater in the high than low flexion groups (25 vs. 19 mm, p=0.016). Preoperative hip flexion under general anaesthesia correlated with leg-length change in hips with osteotomy (r=0.850, p=0.0002) and without osteotomy (r=0.267, p=0.019). Preoperative hip flexion measured under general anaesthesia may predict leg-length change after THA.

Treatment of high hip dislocation with a cementless stem combined with a shortening osteotomy

The purpose of this study was to review the clinical and radiographic outcomes and report the major complications in a group of hips with Crowe type IV developmental dysplasia that underwent reconstruction with a cementless total hip arthroplasty and a transverse subtrochanteric shortening osteotomy fixed with locking compression plate and screws. Fifteen consecutive patients (21 hips) who had coxarthrosis secondary to Crowe Group IV developmental dysplasia of the hip were treated with a cementless prosthesis and a transverse subtrochanteric osteotomy fixed with locking compression plates at a mean age of 41. The mean follow-up period was 5 years. The acetabular cup was placed in the position of the anatomical hip center in every patient. Subtrochanteric femoral shortening osteotomy was fixed with plates and screws in all patients. The mean Harris hip score improved from 36.2 ± 9.8 points to 90.8 ± 2.5 points. Trendelenburg sign was positive in seven hips and two patients complained about continuing anterior thigh pain at the final follow-up. There was no infection. No cases of nonunion were encountered. Two patients had dislocation on early postoperative period (15th and 20th postoperative day). Of these patients, femoral head was changed to 28 mm with stem revision in one patient, and one had acetabular component revision with use of constrained acetabular liner. There was one permanent sciatic nerve palsy. One patient had implant related pain during lying laterally. Plate and screws were removed at postoperative 16th month. Cementless total hip arthroplasty combined with subtrochanteric osteotomy for the treatment of patients with Crowe Group IV developmental dysplasia of the hip is an effective technique to reduce the hip to its original acetabular location and restore the rotational deformities. Plate and screw fixation is a viable option for a secure and stable fixation of femoral stem after subtrochanteric osteotomy.

Subtrochanteric Transverse Shortening Osteotomy in Cementless Total Hip Arthroplasty Achieved Using a Modular Stem

It is challenging to reconstruct normal hip motion after a high hip dislocation. Although total hip arthroplasty (THA) with shortening osteotomy is a solution for high hip dislocation, osteotomy nonunion is a major complication. To improve the rate of osteotomy union, subtrochanteric transverse shortening osteotomy was performed using a modular-type stem, S-ROM, that can be fixed to both the proximal and distal parts of the femur individually with a stepped proximal sleeve and polished distal flutes with fins, respectively. The stem can facilitate union of the osteotomy by maintaining rigid rotational stability and generating compression pressure between bone parts of the femur even in simple transverse osteotomy. Moreover, transverse osteotomy is technically simple and minimizes the damage of the periosteum at the osteotomy. In our series, this procedure was performed on 6 hips in 6 patients with high hip dislocation. The mean follow-up period was 8.1 years. Osteotomy union was achieved in all patients for a mean of 8.8 weeks. This procedure is a good option for surgical treatment of high hip dislocation.

Cemented Total Hip Arthroplasty With Transverse Subtrochanteric Shortening Osteotomy for Crowe Group IV Dislocated Hip

A consecutive series of 19 cemented total hip arthroplasties with transverse subtrochanteric shortening osteotomy was performed for Crowe group IV hip, with a mean follow-up of 38 (6-96) months. The osteotomy sites were covered with onlay grafts of the excised fragments. The conditions of the osteotomy sites were classified into 3 types according to the presence of a remaining gap and cement interposition within it. Three cases had a noticeable gap, and 2 of them showed cement interposition. All osteotomy sites became united involving the onlay grafts, with an average time to union of 4.9 (3-8) months. Our findings suggest that cemented total hip arthroplasty with subtrochanteric transverse osteotomy provides satisfactory short-term results without major complications for Crowe group IV hip.