Krych, J Bone Joint Surg Am 2009 - Total Hip Arthroplasty with Shortening Subtrochanteric Osteotomy in Crowe Type-IV Developmental Dysplasia

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Total Hip Arthroplasty with Shortening Subtrochanteric Osteotomy in Crowe Type-IV Developmental Dysplasia

Krych, Berry, et al.·J Bone Joint Surg Am·2009·132 citations·Retrospective cohort

Background

When surgeons perform total hip arthroplasty for hips with a high dislocation related to developmental dysplasia of the hip, obtaining long-term stable implant fixation and optimizing patient function remain challenges. The purpose of this paper was to evaluate the results of cementless arthroplasty with a simultaneous subtrochanteric shortening osteotomy in a group of patients with Crowe type-IV developmental dysplasia of the hip.

Methods

In a retrospective study, we evaluated the results and complications of 28 consecutive primary cementless total hip arthroplasties in 24 patients (20 women and 4 men), all of whom had Crowe type-IV developmental dysplasia of the hip.
The arthroplasty was performed in combination with a subtrochanteric shortening osteotomy and with placement of the acetabular component at the level of the anatomic hip center.
The patients were evaluated at a mean of 4.8 years postoperatively.

Results

The mean Harris hip score increased from 43 points preoperatively to 89 points at the time of final follow-up (p < 0.01).
12 (43%) of the 28 hips had an early or late complication or a reoperation.
2 (7%) of the 28 subtrochanteric osteotomies were followed by nonunion.
There was one instance of isolated loosening of the femoral stem.
One acetabular component loosened, and one acetabular liner disengaged.
4 hips dislocated postoperatively.
All remaining components were well-fixed at the time of the last radiographic follow-up.
No sciatic neurapraxic injuries were identified.

Conclusions

Cementless total hip arthroplasty combined with a subtrochanteric femoral shortening osteotomy in patients with a high hip dislocation secondary to developmental dysplasia was associated with high rates of successful fixation of the implants and healing of the osteotomy site and a mean postoperative Harris hip score of 89 points. The complication rate, however, was substantially higher than that associated with primary total hip arthroplasty in patients with degenerative arthritis.

Copyright remains with the authors and publisher.

Total Hip Arthroplasty with Shortening Subtrochanteric Osteotomy in Crowe Type-IV Developmental Dysplasia.

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Total Hip Arthroplasty with Shortening Subtrochanteric Osteotomy in Crowe Type-IV Developmental Dysplasia

Krych, Berry, et al.·J Bone Joint Surg Am·2009·132 citations·Retrospective cohort

Background

When surgeons perform total hip arthroplasty for hips with a high dislocation related to developmental dysplasia of the hip, obtaining long-term stable implant fixation and optimizing patient function remain challenges. The purpose of this paper was to evaluate the results of cementless arthroplasty with a simultaneous subtrochanteric shortening osteotomy in a group of patients with Crowe type-IV developmental dysplasia of the hip.

Methods

In a retrospective study, we evaluated the results and complications of 28 consecutive primary cementless total hip arthroplasties in 24 patients (20 women and 4 men), all of whom had Crowe type-IV developmental dysplasia of the hip.
The arthroplasty was performed in combination with a subtrochanteric shortening osteotomy and with placement of the acetabular component at the level of the anatomic hip center.
The patients were evaluated at a mean of 4.8 years postoperatively.

Results

The mean Harris hip score increased from 43 points preoperatively to 89 points at the time of final follow-up (p < 0.01).
12 (43%) of the 28 hips had an early or late complication or a reoperation.
2 (7%) of the 28 subtrochanteric osteotomies were followed by nonunion.
There was one instance of isolated loosening of the femoral stem.
One acetabular component loosened, and one acetabular liner disengaged.
4 hips dislocated postoperatively.
All remaining components were well-fixed at the time of the last radiographic follow-up.
No sciatic neurapraxic injuries were identified.

Conclusions

Cementless total hip arthroplasty combined with a subtrochanteric femoral shortening osteotomy in patients with a high hip dislocation secondary to developmental dysplasia was associated with high rates of successful fixation of the implants and healing of the osteotomy site and a mean postoperative Harris hip score of 89 points. The complication rate, however, was substantially higher than that associated with primary total hip arthroplasty in patients with degenerative arthritis.

Copyright remains with the authors and publisher.

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