Treatment of high hip dislocation with a cementless stem combined with a shortening osteotomy

Abstract

Cementless total hip arthroplasty combined with subtrochanteric osteotomy for the treatment of patients with Crowe Group IV developmental dysplasia of the hip is an effective technique to reduce the hip to its original acetabular location and restore the rotational deformities. Plate and screw fixation is a viable option for a secure and stable fixation of femoral stem after subtrochanteric osteotomy.

Two-Stage Progressive Femoral Lowering Followed by Cementless Total Hip Arthroplasty for Treating Crowe IV–Hartofilakidis Type 3 Developmental Dysplasia of the Hip

“…They did not have any complications either during the distraction or in the THA post-operative phase (specifically, no patient suffered from a pin-tract infection or from neurovascular complications). All of them had a clinical and a recent radiographic control, at a mean follow-up of 11 ± 5 years (median: 12; range: [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

“…Nevertheless, the following procedure-related complications have been documented: nerve palsy [3,[21][22][23][24][25], non-union, delayed union, or cement interposition at the osteotomy site [4,5,21,23,24,27], intraoperative femoral fracture [3,4,27,28], and dislocation [3,4,[23][24][25]28]. The major limit of the technique remains, however, the residual postoperative leg length discrepancy [23,25,28].…”

“…Subtrochanteric femoral shortening osteotomy is considered the "gold-standard" technique and has had quite satisfactory results [3][4][5][6][21][22][23][24][25][26][27][28]. Nevertheless, the following procedure-related complications have been documented: nerve palsy [3,[21][22][23][24][25], non-union, delayed union, or cement interposition at the osteotomy site [4,5,21,23,24,27], intraoperative femoral fracture [3,4,27,28], and dislocation [3,4,[23][24][25]28].…”

“…In the early cases, at the beginning of our experience, two or three pins were driven into the iliac bone, some centimeters above the acetabulum and in the mid of the femoral diaphysis (Figs. [2][3][4][5]. In the more recent cases we have modified our technique by moving the external fixator pins more distally from the hip joint, in order to avoid bacterial contamination.…”

“…In fact, the acetabulum can be severely hypoplastic, the proximal femur is displaced upward, and the femoral head usually articulates with a neo-acetabulum. In addition, the femoral neck is often quite anteverted.In these cases, the placement of the acetabular component in the true acetabulum is considered the best choice for biomechanical reasons and has led to the best results [3,4]. However, restoration of the anatomic hip center usually requires limb lengthening in excess of 4 centimeters, with the consequences that this may lead to increased risks for neurovascular traction injuries [5,6].…”