Total hip arthroplasty with femoral subtrochanteric osteotomy after Schanz osteotomy

Sonohata, Motoki; Kitajima, Masaru; Tanaka, Reina; Mawatari, Masaaki

doi:10.1016/j.jos.2016.02.012

Cited by 13 publications

(12 citation statements)

References 15 publications

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“…THA after several kinds of osteotomy is accompanied by various technical difficulties [ 10 , 11 , 27 - 29 ]. However, the effects of differences in varus osteotomy procedures on surgical difficulties of THA are unclear.…”

Section: Discussionmentioning

confidence: 99%

“…The indication for femoral subtrochanteric osteotomy was a requirement to shorten the femur for a highly dislocated hip or to correct the shape of the femur for a deformed proximal femur [ 30 ]. Some papers have reported good clinical and radiographic results of THA combined with subtrochanteric osteotomy; however, this is a technically demanding treatment option with characteristic complications, such as pseudarthrosis and intraoperative fracture [ 29 - 31 ].…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Total Hip Arthroplasty Outcomes after Failed Femoral Wedge or Curved Varus Osteotomy

Sonohata¹,

Kitajima²,

Mawatari³

2018

TOORTHJ

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Background:Differences in clinical and radiographic results following total hip arthroplasty between failed wedge and curved varus osteotomy are unclear.Objective:To investigate differences in clinical and radiographic results following total hip arthroplasty in patients who exhibited failed wedge or curved varus osteotomy.Method:We performed 18 total hip arthroplasties after failed femoral varus osteotomy. Hips were divided into two groups: 14 had failed wedge varus osteotomy and four had failed curved varus osteotomy. Average ages at osteotomy and total hip arthroplasty were 27 years old (range, 10-46 years old) and 56 years old (range, 25-74 years old), respectively. The average duration of follow-up monitoring was 72.2 months (range, 54-91 months). Clinical and radiographic evaluations were completed for each group.Results:The Japanese Orthopaedic Association hip score of total hip arthroplasty after failed varus osteotomy significantly improved at the last follow-up in both groups. However, hip score at the last follow-up was significantly higher after failed curved varus osteotomy than after failed wedge varus osteotomy (p<0.01). Four hips that failed wedge varus osteotomy underwent subtrochanteric corrective osteotomy with total hip arthroplasty. Radiographic evaluation showed that three stems for total hip arthroplasty after failed wedge varus osteotomy were inserted in malposition, and all stems in total hip arthroplasty after failed curved varus osteotomy were inserted in the normal position.Conclusion:Surgeons performing femoral varus osteotomy should consider possible future conversion to total hip arthroplasty. Curved varus osteotomy is more suitable than wedge varus osteotomy for future conversion to total hip arthroplasty.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of Total Hip Arthroplasty Outcomes after Failed Femoral Wedge or Curved Varus Osteotomy

Sonohata¹,

Kitajima²,

Mawatari³

2018

TOORTHJ

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“…Recently, there have been several reports for the combined application of primary THA and subtrochanteric femoral shortening osteotomy for hips with Crowe type IV dysplastic hip. [ 1 – 7 ] There have been various types of osteotomies, such as V-shaped osteotomy, [ 6 ] step-cut osteotomy, [ 4 , 5 ] and chevron osteotomy, [ 3 ] to avoid non-union and to obtain stability of the distal femur. Furthermore, various types of stems have been used, including reports using a cementless stem with mainly an S-ROM stem [ 5 , 7 ] as well as reports using a cement stem.…”

Section: Discussionmentioning

confidence: 99%

Subtrochanteric femoral shortening osteotomy concomitantly performed with revision total hip arthroplasty

Takeda

Fukunishi²,

Nishio³

et al. 2018

Medicine

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Rationale:Total hip arthroplasty (THA) concomitant with subtrochanteric femoral shortening osteotomy for Crowe type IV dysplastic hip has been reported. However, the combination of subtrochanteric femoral osteotomy and revision THA has only been mentioned in one case report.Patient concerns:A 67-year-old female had a history of congenital dislocation of both hips.Diagnoses:Right hip was diagnosed the aseptic loosening of THA with extremely high replacement of the acetabular component.Interventions:Revision THA concomitant with subtrochanteric femoral shortening osteotomy using a cement stem was performed. Before the revision surgery, primary THA with subtrochanteric shortening osteotomy was performed on the opposite side. Regarding leg length, the actual leg length of the affected side was 9 mm longer, and the subjective leg length discrepancy was 45 mm shorter in the affected limb due to pelvic obliquity. Subtrochanteric osteotomy was performed with an amount of osteotomy equal to the amount of distal translation of the hip center to the original acetabulum.Outcomes:As a result, pelvic obliquity improved, and the subjective leg length discrepancy disappeared after revision surgery.Lessons:The combination of subtrochanteric femoral shortening osteotomy with revision THA resulted in a satisfactory outcome.

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“…After a transverse cut of the femur has been made and the length of femur to be removed has been determined, the double chevron osteotomy site can be marked with ink and then proximal and distal chevon osteotomies can be completed with a reciprocating saw. Double chevron osteotomy can be completed with specialized devices as well, such as multi‐holed broaches, femoral cutting slot guides, and guide pins.…”

Section: Direct Anterior Approach Total Hip Arthroplastymentioning

confidence: 99%

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

Shi

Han

et al. 2019

Orthopaedic Surgery

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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.

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Total hip arthroplasty with femoral subtrochanteric osteotomy after Schanz osteotomy

Cited by 13 publications

References 15 publications

Comparison of Total Hip Arthroplasty Outcomes after Failed Femoral Wedge or Curved Varus Osteotomy

Comparison of Total Hip Arthroplasty Outcomes after Failed Femoral Wedge or Curved Varus Osteotomy

Subtrochanteric femoral shortening osteotomy concomitantly performed with revision total hip arthroplasty

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

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