Oblique femoral shortening osteotomy in total hip arthroplasty for high dislocation in patients with hip dysplasia

Zagra, Luigi; Bianchi, Luca; Mondini, A.; Ceroni, R. Giacometti

doi:10.1007/s00264-015-2865-9

Cited by 40 publications

(23 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2). The reasons we regarded the 8 cm mark below the lesser trochanter the most distant point were the following: (1) most osteotomies located at the proximal femur, including immediately distal to the lesser trochanter [21][22][23][24][25], are at 1-3 cm below the lesser trochanter [7,20,26,27]; and (2) according to Su et al [28], the femoral isthmus begins 8 cm below the lesser trochanter, which influences the stability of the prosthesis and, therefore, osteotomy should not be performed at or beyond this level.…”

Section: Methodsmentioning

confidence: 99%

Optimal location of subtrochanteric osteotomy in total hip arthroplasty for crowe type IV developmental dysplasia of hip

Huang

Liu

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background: When reconstructing a hip with developmental dysplasia and high dislocation, sub-trochanteric shortening osteotomy is typically needed for placing the acetabular component in the appropriate anatomical position. However, the procedure can result in complications such as non-union of the osteotomy. We evaluated the contact area and the coincidence rate between the proximal and distal fragments at different femoral osteotomy levels and lengths. We then determined the optimal location of subtrochanteric femoral shortening transverse osteotomy in patients with unilateral Crowe type IV developmental dysplasia of the hip (DDH). The consistency between the proximal and distal segments was assessed as a possible predictive indicator of the union at the osteotomy site. Methods: We retrospectively reviewed 57 patients with unilateral Crowe type IV DDH who underwent X-ray imaging of both hip joints. We labelled the inner and outer diameters of the circular ring as N (mm) and M (mm), respectively. We defined the overlapped area between the proximal and distal ring as contact area S (mm 2), and the ratio of contact area to distal ring area as coincidence rate R. Results: N varied from 9.8-15.2 mm and M varied from 20.7-24 mm, both demonstrated a decreasing trend in the proximal to distal direction. At osteotomy lengths ranging from 0.5-2 cm, there were no differences in S between the different levels of osteotomy in each group. At osteotomy lengths ≤2.5 cm, a significant higher coincidence rate was noted from 2 cm below the lesser trochanter to other positions below the level. At osteotomy lengths from 3 to 5.5 cm, a significantly higher coincidence rate was observed from the level of 1.5 cm below the lesser trochanter to other positions below the level. Conclusions: Our findings suggest that femoral shortening transverse osteotomy at the optimal subtrochanteric level can predictably increase the contact area and coincidence rate, which may contribute to the union at the osteotomy site. Considering the stability of the prostheses, it appears appropriate that osteotomy location should be shifted slightly distally. Trial registration: Retrospectively registered.

show abstract

Section: Methodsmentioning

confidence: 99%

Optimal location of subtrochanteric osteotomy in total hip arthroplasty for crowe type IV developmental dysplasia of hip

Huang

Liu

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…In restoring the anatomic center of hip rotation in cases of THA for severe DDH, the limb may need to be lengthened greater than 4 cm, placing neurovascular structures at risk of traction injury and increasing the risk of aseptic loosening of components due to excessive joint reactive forces from over-tensioned abductors [19]. In cases where this degree of lengthening is required, subtrochanteric shortening osteotomy of the femur can be performed, which allows for rotational correction of the often over-anteverted femoral neck, in addition to facilitating safe reduction of the hip without compromising neurovascular structures [13,19,20]. If an osteotomy is used, a modular stem, such as the one used in this case, may be beneficial to correct for the often over-anteverted femoral neck seen in DDH, provide good fit in the often hypoplastic femoral canal, obtain torsional stability at the osteotomy site, and allow for easy control of femoral offset and leg lengths [21].…”

Section: Discussionmentioning

confidence: 99%

Total hip arthroplasty in an adult patient with pelvic dysmorphism, unilateral sacroiliac joint autofusion, and developmental hip dysplasia

et al. 2020

View full text Add to dashboard Cite

a b s t r a c tThis case describes the challenges associated with total hip arthroplasty in a patient with unique anatomy, including developmental dysplasia of the hip, pelvic dysmorphism, and unilateral sacroiliac joint autofusion. A 30-year-old female, with a history of developmental dysplasia of the hip treated with presumed pelvic osteotomy complicated by postoperative infection, presented with hip pain refractory to conservative management. Radiographic studies demonstrated a 10-cm leg length discrepancy, 20 of acetabular retroversion, severe hemipelvic dysmorphism, ipsilateral sacroiliac joint autofusion, and significant femoral head dysplasia. Total hip arthroplasty was performed using a revision acetabular component and modular femoral component, resulting in improvement in the postoperative leg length discrepancy. There were no neurovascular or other perioperative complications, and the patient was ambulating without pain or assistive devices at 1-year follow-up.

show abstract

“…Although some authors have suggested a 45° oblique osteotomy line, to our knowledge, a significant association between line angle and operation outcome has not been established (Fig. ).…”

Section: Direct Anterior Approach Total Hip Arthroplastymentioning

confidence: 91%

Total Hip Arthroplasty for Crowe Type IV Hip Dysplasia: Surgical Techniques and Postoperative Complications

Shi

Han

et al. 2019

Orthopaedic Surgery

View full text Add to dashboard Cite

Total hip arthroplasty (THA) of Crowe type IV developmental dysplasia of the hip (DDH) is challenging. Although traditional (lateral, posterolateral, and posterior) THA approaches have been used with great anatomic success, they damage periarticular muscles, which are already quite weak in type IV DDH. The recently developed direct anterior approach (DAA) can provide an inter‐nerve and inter‐muscle approach for THA of type IV dysplasia hips. However, femur exposure with the DAA could be difficult during surgery and it is hard to apply femoral shortening osteotomy. THA techniques used for type IV DDH include anatomic hip center techniques (true acetabular reconstruction) and high hip center techniques, wherein an acetabulum is reconstructed above the original one. Although anatomic construction of the hip center is considered “the gold standard” treatment, it is impossible if the anatomical acetabular is too small and shallow. Procedures used to support type IV DDH reduction with anatomic hip center techniques include greater trochanter osteotomy, lesser trochanter osteotomy, and subtrochanteric osteotomy. However, these techniques have yet to be standardized, and it is unclear which is best for type IV DDH. One‐state and two‐state non‐osteotomy reduction techniques have also been introduced to treat type IV DDH. Potential complications of THA performed in patients with type IV DDH include leg length discrepancy (LLD), peri‐operative femur fracture, nonunion of the osteotomy site, and nerve injury. It is worth noting that nowadays an increasing number of Crowe type IV DDH patients are more sensitive to postoperative LLD.

show abstract

Oblique femoral shortening osteotomy in total hip arthroplasty for high dislocation in patients with hip dysplasia

Abstract: With the numbers given the oblique femur shortening osteotomy led to an increased rotational stability and proved to be a simple and effective method. Compared with transverse osteotomy and as related to our experience, this technique may be a method of choice in selected cases.

Cited by 40 publications

References 40 publications

Optimal location of subtrochanteric osteotomy in total hip arthroplasty for crowe type IV developmental dysplasia of hip

Optimal location of subtrochanteric osteotomy in total hip arthroplasty for crowe type IV developmental dysplasia of hip

Total hip arthroplasty in an adult patient with pelvic dysmorphism, unilateral sacroiliac joint autofusion, and developmental hip dysplasia

Total Hip Arthroplasty for Crowe Type IV Hip Dysplasia: Surgical Techniques and Postoperative Complications

Contact Info

Product

Resources

About