Subtrochanteric shortening osteotomy during cementless total hip arthroplasty in young patients with severe developmental dysplasia of the hip

Li, Dehua; Li, Qi; Wang, Haoyang; Luo, Zeyu; Yang, Yang; Pei, Fuxing; Zhou, Zongke

doi:10.1186/s12891-017-1857-x

Cited by 37 publications

(42 citation statements)

References 45 publications

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“…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.…”

Section: Discussionmentioning

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

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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.

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Section: Discussionmentioning

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

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“…In this case, subtrochanteric shortening osteotomy combined with the use of an S-ROM prosthesis is effective454748495051525354) in both joint reduction and in the prevention of nerve palsy. Klisic and Jankovic55) introduced a method of making transverse osteotomy distal to the lesser trochanter in 1974.…”

Section: Modular Stems In Complex Primary Thasmentioning

confidence: 85%

Modular Stems: Advantages and Current Role in Primary Total Hip Arthroplasty

2018

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Using modular femoral stems in total hip arthroplasty enables surgeons to make fine adjustments to individual joints and offers intraoperative flexibility. The concept of modularity has been developed in numerous shapes, resulting in a vast range of options. Among them, the greatest achievement has been made for prostheses with modular proximal sleeves. The use of these implants has resulted in excellent mid- to long-term results in a number of cases. Although the use of tapered stems with a broaching technique is gaining popularity in straightforward primary surgeries, modular femoral implants are still associated with a number of potential challenges (e.g., developmental dysplasia of the hip, infection sequelae, and skeletal dysplasia). Based on published results, it is advisable to consider it as an option for complicated cases where the proximal femur is severely deformed.

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“…On the contrary, transverse osteotomy was easier to perform but it is insufficient of rotational stability at the osteotomy site [25]. Moreover, Wang et al [26] considered the nonunion rate was related to damage of the periosteum circumferentially. Keep the osteoblastic activity of periosteum could increase bone union rate.…”

Section: Discussionmentioning

confidence: 99%

Mid-term results of total hip arthroplasty with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip

Jin

Yoon

Park

et al. 2020

Preprint

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Introduction: The objective of this study was to explore mid-term clinical results of cementless total hip arthroplasty (THA) with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip (DDH).Patients and method: Thirteen patients (13 hips) with Crowe type IV DDH who underwent THA used modified trochanteric osteotomy between May 2013 and October 2019 were retrospectively analyzed. Mean follow-up was 5.2 ± 0.8 years (range, 4.9-6.1 years).Results: Mean Harris Hip Score (HHS) significantly (p < 0.05) improved from 30.7 ± 5.8 (range, 22-38) to 87.5 ± 3.6 (range, 83-93). The mean leg length discrepancy (LLD) was 53.4 ± 9.1 mm (range, 42.1-68.5 mm) preoperatively. The final LLD was 5.6 ± 2.4 mm (range, 2.4-9.1 mm). The mean leg length after surgery was 47.4 ± 10 mm (range, 33.6-67.2 mm). The average duration of bone union for greater trochanter (GT) was 2.5 ± 0.6 months (range, 1.5-3.6 months). There was no infection, GT non-union, or loosening (septic or aseptic) of the stem or cup in any case.Conclusions: THA with modified trochanteric osteotomy with cementless cup is an effective treatment for Crowe type IV developmental dysplasia of the hip. It can rebuild complex biomechanics and biology of hip dysplasia without increasing complications.

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Subtrochanteric shortening osteotomy during cementless total hip arthroplasty in young patients with severe developmental dysplasia of the hip

Cited by 37 publications

References 45 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

Modular Stems: Advantages and Current Role in Primary Total Hip Arthroplasty

Mid-term results of total hip arthroplasty with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip

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