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Total hip arthroplasty with subtrochanteric femoral shortening osteotomy for high hip dislocation.

ABSTRACT: OBJECTIVE:To evaluate the outcomes of total hip arthroplasty (THA) with subtrochanteric femoral shortening osteotomy for high hip dislocation. METHODS:In this retrospective study, the results of 24 primary THAs with acetabular reconstruction and subtrochanteric femoral shortening osteotomy in 21 patients with high hip dislocation were evaluated. The acetabula were reconstructed with cemented or uncemented cups and bone grafting. Transverse subtrochanteric femoral shortening osteotomies were applied and the osteotomy sites treated by bone grafting and cable fixation. Assessment was by Hip Harris scores and radiographic evaluation. RESULTS:The mean follow-up time was 42 months (18-108 months), three cases being lost to follow-up 18-27 months postoperatively. The HHS improved from 47.5 ± 8.7 to 88.5 ± 3.1. The mean length of femoral segments removed was 2.5 ± 0.8?cm (range, 1.0-4.5?cm) and mean acetabular inclination 43° ± 5° (range, 31°-54°). Caudalization of the femoral head center was 3.2 ± 3.0?mm (range, -3 to 12?mm) and lateralization 4.0 ± 4.0?mm (range, -9 to 11?mm). Mean greater trochanter height relative to theoretical hip center was 5.2 ± 1.0?cm (range, 3.5-7.1?cm) preoperatively and 0.2 ± 0.6?cm (range, -0.9 to 1.2?cm) postoperatively. Intraoperative trochanteric fractures occurred in three cases and sciatic nerve palsy in one. CONCLUSION:THA with subtrochanteric femoral shortening osteotomy is an effective technique for treating high hip dislocation. Its advantages include improvement in limb imbalance and decreased risk of sciatic nerve injury.

SUBMITTER: Hua WB

PROVIDER: S-EPMC6583667 | biostudies-literature | 2015 May

REPOSITORIES: biostudies-literature

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Total hip arthroplasty with subtrochanteric femoral shortening osteotomy for high hip dislocation.

Hua Wen-bin WB Yang Shu-hua SH Xu Wei-hua WH Ye Shu-nan SN Liu Xian-zhe XZ Wang Jing J Feng Yong Y

Orthopaedic surgery 20150501 2

<h4>Objective</h4>To evaluate the outcomes of total hip arthroplasty (THA) with subtrochanteric femoral shortening osteotomy for high hip dislocation.<h4>Methods</h4>In this retrospective study, the results of 24 primary THAs with acetabular reconstruction and subtrochanteric femoral shortening osteotomy in 21 patients with high hip dislocation were evaluated. The acetabula were reconstructed with cemented or uncemented cups and bone grafting. Transverse subtrochanteric femoral shortening osteot ...[more]

PMID: 26033991

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Project description:BackgroundWhen 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.MethodsWe 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 (mm2), and the ratio of contact area to distal ring area as coincidence rate R.ResultsN 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.ConclusionsOur 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 registrationRetrospectively registered.

Project description:BackgroundTotal hip arthroplasty (THA) performed on patients with Perthes-like deformities are technically challenging because of the patient's abnormal hip anatomy. Patients with Perthes-like deformities are at a higher risk of revision, aseptic loosening, nerve injury, and intraoperative fracture after THA, especially if shortening osteotomies are performed. This analysis sought to examine the clinical and radiographic outcomes of a patient cohort with Perthes-like deformities receiving THA with a conical stem, an elevated hip center, and no shortening femoral osteotomy.MethodsTwenty-six patients (27 hips) received THA with MODULUS femoral stems, ceramic or metal femoral heads, and highly cross-linked polyethylene liners between April 2011 and March 2016. All patients were treated at a single center by 4 participating surgeons. Patients completed 2 questionnaires preoperatively and at the final follow-up visit (between 1 and 5 years postoperatively): Harris Hip Score and Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire. Differences in patient-reported outcome measures (PROM) scores were measured by paired t-tests. Preoperative and postoperative anteroposterior radiographs were analyzed to monitor patient outcomes.ResultsSignificant clinical improvements were observed in all individual subcategories of the Harris Hip Score and of the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire; the largest magnitude improvements were observed in the subcategory of pain relief for both questionnaires. No complications, including intraoperative and postoperative femoral fractures, nerve palsy, dislocations, or deep venous thrombosis, were observed.ConclusionThis study found that patients treated with an elevated hip center and low stem-positioning technique using a conical, modular implant system had good clinical outcomes and did not suffer complications at the mean follow-up from surgery of 2.8 years (range: 1-5 years).

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Total hip arthroplasty with subtrochanteric femoral shortening osteotomy for high hip dislocation.

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Total hip arthroplasty with subtrochanteric femoral shortening osteotomy for high hip dislocation.

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