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

Abstract

Background Total 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 Methods We 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. Results The 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. Conclusions Cementless 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 evidence IV.

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

“…Non-union of osteotomy may lead to varus angulation, pain, loss of rotational stability, and prosthetic loosening [6,7,23]. The incidence of non-union at the osteotomy site ranges from 0 to 22% [18,29,[31][32][33]. There are multiple contributing factors.…”

“…Even cemented fixation of the stem has been used to improve the rotational stability [19,22]. Other factors, which affect union, are the contact area between the proximal and distal segments [18][19][20], bone stock, and vascularity. However, a limited bone contact area is a major disadvantage of transverse osteotomy, which may interfere with the bone healing process [18,19].…”

“…Other factors, which affect union, are the contact area between the proximal and distal segments [18][19][20], bone stock, and vascularity. However, a limited bone contact area is a major disadvantage of transverse osteotomy, which may interfere with the bone healing process [18,19]. The consistency of the interfaces and canal diameters between the proximal and distal segments may contribute to union [20].…”

“…However, the risk of non-union remains a major concern during the procedure [16,17]. A limited bone contact area is a major disadvantage of transverse osteotomy, which may interfere with the bone healing process [18,19]. The consistency of the interfaces and canal diameters between the proximal and distal segments may contribute to union; the two osteotomy interfaces should be as smooth as possible to maintain their intactness [20].…”

Optimal Location of Subtrochanteric Osteotomy in Total Hip Arthroplasty for Crowe Type IV Developmental Dysplasia of Hip

“…Non-union of osteotomy may lead to varus angulation, pain, loss of rotational stability, and prosthetic loosening [6,7,23]. The incidence of non-union at the osteotomy site ranges from 0%-22% [18,29,[31][32][33]. There are multiple contributing factors.…”