Subtrochanteric shortening osteotomy combined with cemented total hip arthroplasty for Crowe group IV hips

Abstract

BackgroundTotal hip arthroplasty (THA) is a challenging surgical procedure that can be used to treat severely dislocated hips. There are few reports regarding cemented THAs involving subtrochanteric shortening osteotomy (SSO), even though cemented THAs provide great advantages because the femur is generally hypoplastic with a narrow, deformed canal.PurposesWe evaluated the utility of cemented THA with SSO for Crowe group IV hips, and assessed the relationship between leg lengthening and nerve injury. Our goal was to describe surgical techniques for optimizing surgical outcomes while minimizing the risk of nerve injury.MethodsWe retrospectively reviewed 34 cases of cemented THAs with transverse SSO for Crowe group IV. Prior to surgery, mean hip flexion was 93.1° (40°–130°). The mean follow-up period was 5.2 years (3–10 years).ResultsBone union took an average of 7.7 months (3–24 months). Mean leg lengthening was 40.5 mm (15–70 mm) and was greater in patients without hip flexion contracture. None of the patients experienced any nerve injuries associated with leg lengthening, and radiographic evidence of loosening was not observed at the final follow-up.ConclusionsSSO combined with cemented THA is an effective treatment for severely dislocated hips. Leg lengthening is not necessarily associated with nerve injuries, and the likelihood of this surgical complication may be related to the presence of hip flexion contracture.

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

“…All femoral osteotomies were stabilized with a plate and cable system in all hips, but did not use any strut allografts as mechanical support to ostoetomy site. The mean time to union has been reported between 8.8 weeks to 7.7 months for transverse subtrochanteric shortening ostetomy in the literature [7,13,21,[24][25][26][27][28]. In our study group, it was 5.2 months similarly to the previous studies.…”

“…Imarisio et al reported the average leg lengthening was 36 mm in cementless total hip replacement for Crowe Type-IV dysplasia [24]. In a series of transverse subtrochanteric shortening osteotomies combined with cemented total hip arthroplasty the mean leg lengthening was 40.5 mm [25]. Kilicoglu et al reported that the mean greater trochanter height relative to the estimated hip center improved from 6.8 cm to −1 cm radiologically [15].…”

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

“…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].…”

Endoprothese bei Dysplasiecoxarthrose

“…Wenn die Fixation allein über ein Schaftimplantat erfolgen soll, muss in der zementfreien Anwendung ein entsprechend geeignetes Stieldesign mit Rotationsstabiltät und diaphysärer Verankerung gewählt werden. Die zementierte Schaftwahl ist ebenfalls beschrieben [34,55], birgt aber das Risiko eines Zementaustrittes in den Osteotomiespalt mit unterbleibender knöcherner Ausheilung. Sehr instruktive Beschreibungen des operativen Vorgehens sind publiziert [44,68], wobei die Abfolge einzelner Schritte bei den jeweiligen Autoren naturgemäß unterschiedlich ist.…”

“…Selbst komplexe Rekonstruktionen weisen bei der Versorgung in Zentren mit entsprechender Erfahrung gute Ergebnisse auf [34,39,44,55,59]. Im australischen Endoprothesenregister [8] werden im ersten postoperativen Jahr etwas höhere kumulative Revisionsraten bei der endoprothetischen Versorgung von Dysplasiecoxarthrosen (2,2 %; 95 %-Konfidenzintervall 1, 8) im Vergleich zu primä-ren Coxarthrosen (1,5 %; 1,4-1,5) beobachtet.…”