An oblique osteotomy is better for subtrochanteric shortening in total hip arthroplasty for high hip dislocation: a mechanical comparison of four techniques

Abstract

Background: Subtrochanteric femoral shortening is used during total hip arthroplasty for high hip dislocation in developmental dysplasia of hip patients. Methods: We mechanically tested the stability of various commonly used subtrochanteric osteotomy techniques. As the equivalent of a femoral stem placed in a shortened femur without any stable fixation at the osteotomy line, 2 polyvinylchloride pipes were loosely intertwined. 4 different osteotomies (Z-subtrochanteric osteotomy, oblique-45° osteotomy, double Chevron-90° and 120° subtrochanteric osteotomy) were simulated. Torsional and axial loads were applied, and torsional stiffness was calculated for each test model. Results: Z, double Chevron-90° and 120° subtrochanteric osteotomy models demonstrated lower mean torsional stiffness than oblique-45° osteotomy. With the highest torsional stiffness oblique-45° provides the best stability for treatment of high dislocation hips when a subtrochanteric osteotomy is added. Conclusions: This matches our previous clinical experience. Oblique osteotomy may also provide higher contact surfaces in the osteotomy lines to promote bone healing.

Implant loosening following THA with S-ROM prosthesis and subtrochanteric osteotomy: Three case reports

“…THA combined with subtrochanteric osteotomy demonstrated positive effects in the DDH group ( 5 ). Osteotomy under the lesser trochanter can be performed using various techniques ( 14 , 15 ), There have various types of osteotomies have been reported, such as V-shaped osteotomy ( 16 ), Z-osteotomy ( 17 ), step-cut osteotomy ( 18 ), chevron osteotomy ( 19 ) and transverse osteotomy. Chen et al and Zeng et al suggested that transverse osteotomy is better ( 9 , 20 ).…”

Total Hip Arthroplasty Combined with Proximal Femoral Reconstruction Effectively Treats Severe Hip Deformities: A Novel Osteotomy Technique

“…According to Crowe classification, 16 52 cases (92.9%) were classified as Crowe type IV, three cases (5.4%) as Crowe type III, and one case (1.8%) as Crowe type I. The mean follow-up was 25.6 months (range, [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. The demographic and clinical characteristics are summarized in Table 1.…”

“…In 1932, Ombreddanne proposed subtrochanteric shortening osteotomy, and Sponseller and McBeath et al 17 described femoral shortening osteotomy for joint replacement procedures in DDH patients. With the continuous development of this technique, several improvements and modifications have been reported, such as transverse osteotomy, 18 oblique osteotomy, 19 and V-shaped osteotomy, 20 all of which demonstrated favorable clinical outcomes and patient satisfaction. However, the complete transection of the femur below the trochanters reduces the contact area between the two sections, compromising rotational stability.…”

Greater trochanteric osteotomy and subtrochanteric osteotomy in primary/revision total hip arthroplasty

“…A finite element analysis study of osteotomy angles showed that 45° is more appropriate, with minimal micromovement of the osteotomy surface among 30°, 45°, 60°, and 90° ( 34 ). Dogan Atlihan et.al compared the biomechanical stability of four different subtrochanteric osteotomy approaches and they found oblique osteotomy could provide a larger contact surface in the osteotomy to promote bone healing ( 35 ). Oblique subtrochanteric osteotomy can improve rotational stability compared to transverse subtrochanteric osteotomy.…”