Hip arthroplasty with femoral shortening osteotomy in dysplastic hip Crowe IV
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Published:
May 11, 2015
Keywords:
dysplasia, subtrochanteric osteotomy, Crowe IV, total hip arthroplasty
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Abstract
ObjectiveThe reconstruction of the anatomic center of rotation (COR) is one of the main purposes in Crowe grade IV developmental dysplasia of the hip (DDH). Among the alternatives to achieve this reconstruction has emerged subtrochanteric shortening osteotomy (SSO). The aim of this paper is to analyze the clinical and radiological results as the complications obtained with this surgical technique.MaterialTen cases were evaluated in 8 patients with grade IV DHD who were performed SSO. All were female, 6 of them were unilateral and 2 bilateral. The average age was 42.2 years (range 36-55). Preoperative lower limb discrepancy was in average of 41 mm. All patients were operated through a posterolateral approach. In 7 cases uncemented stems were implanted with modular metaphyseal fixation (S-ROM) and in 3 cases we implanted polished cemented stems (2 Exeter and one C-Stem).ResultsAt an average follow-up of 38 months (range 12-63 months), all the cases showed radiological healed osteotomies. The postoperative COR was lowered an average of 42 mm (range 35-52 mm). Postoperative limb discrepancy was 6 mm (range 3-12 mm). Complications were: one aseptic femoral loosening, one subluxation due to excessive femoral anteversion, one dislocation, one acute infection and one acute femoral neuropraxia.ConclusionIn these series of patients with Crowe IV dysplastic hips, the SSO technique was associated with a high rate of consolidation, correction of the COR limb lenght compensation.
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Quinteros, C. M., Buttaro, M. A., Comba, F. M., & Piccaluga, F. (2015). Hip arthroplasty with femoral shortening osteotomy in dysplastic hip Crowe IV. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 80(3), 171-176. https://doi.org/10.15417/254
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Clinical Research
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References
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2. Stans AA, Pagnano MW, Shaughnessy WJ, Hanssen AD. Results of total hip arthroplasty for Crowe type III developmental hip
dysplasia. Clin Orthop Relat Res 1998;348:149-57.
3. MacKenzie JR, Kelley SS, Johnston RC. Total hip replacement for coxarthrosis secondary to congenital dysplasia and dislocation
of the hip. Long-term results. J Bone Joint Surg Am 1996;78:55-61.
4. Charity JA, Tsiridis E, Sheeraz A, Howell JR, Hubble MJ, Timperley AJ, et al. Treatment of Crowe IV high hip dysplasia
with total hip replacement using the Exeter stem and shortening derotational subtrochanteric osteotomy. J Bone Joint Surg Br
2011;93(1):34-8.
5. Biant LC, Bruce WJ, Assini JB, Walker PM, Walsh WR. The anatomically difficult primary total hip replacement: medium- to
long-term results using a cementless modular stem. J Bone Joint Surg Br 2008;90(4):430-5.
6. Huo MH, Salvati EA, Lieberman JR, Burstein A, Wilson PD Jr. Custom-designed femoral prostheses in total hip arthroplasty
done with cement for severe dysplasia of the hip. J Bone Joint Surg Am 1993;75:1497-1504.
7. Krych AJ, Howard JL, Trousdale RT, Cabanela ME, Berry DJ. Total hip arthroplasty with shortening subtrochanteric osteotomy
in Crowe type-IV developmental dysplasia. J Bone Joint Surg Am 2009;91(9):2213-21.
8. Dunn HK, Hess W. Total hip reconstruction in chronically dislocated hips. J Bone Joint Surg Am 1976;58:838-45.
9. Reikeraas O, Lereim P, Gabor I, Gunderson R, Bjerkreim I. Femoral shortening in total arthroplasty for completely dislocated
hips: 3-7 year results in 25 cases. Acta Orthop Scand 1996;67(1):33-6.
10. Krych AJ, Howard JL, Trousdale RT, Cabanela ME, Berry DJ. Total hip arthroplasty with shortening subtrochanteric osteotomy
in Crowe type-IV developmental dysplasia: surgical technique. J Bone Joint Surg Am 2010;92(Suppl 1 Pt 2):176-87.
11. Merle d’Aubigné R, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 1954;36:
451-5.
12. DeLee J, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res
1976;121:20-32.
13. Engh C, Massin P, Suthers K. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components.
Clin Orthop Relat Res 1990;257:107-28. Erratum in: Clin Orthop Relat Res 1992;284:310-2.
14. Gruen TA, Mc Neice GM, Amstutz HC. Modes of failure of cemented stem-type femoral components: a radiographic analysis of
loosening. Clin Orthop Relat Res 1979;141:17-27.
15. Brooker A, Bowerman J, Robinson R, Riley L. Ectopic ossification following total hip replacement. Incidence and a method of
classification. J Bone Joint Surg Am 1973;55:1629-32.
16. Howie CR, Ohly NE, Miller B. Cemented total hip arthroplasty with subtrochanteric osteotomy in dysplastic hips. Clin Orthop
Relat Res 2010;468(12):3240-7.
17. Takao M, Ohzono K, Nishii T, Miki H, Nakamura N, Sugano N. Cementless modular total hip arthroplasty with subtrochanteric
shortening osteotomy for hips with developmental dysplasia. J Bone Joint Surg Am 2011;93(6):548-55.
18. Park MS, Kim KH, Jeong WC. Transverse subtrochanteric shortening osteotomy in primary total hip arthroplasty for patients
with severe hip developmental dysplasia. J Arthroplasty 2007;22(7):1031-6.
19. Tanzer M, Chan S, Brooks CE, Bobyn JD. Primary cementless total hip arthroplasty using a modular femoral component a
minimum 6-year follow-up. J Arthroplasty 2001;16(8 Suppl 1):64-70.
20. Eskelinen A, Helenius I, Remes V, Ylinen P, Tallroth K, Paavilainen T. Cementless total hip arthroplasty in patients with high
congenital hip dislocation. J Bone Joint Surg Am 2006;88:80-91.
21. Erdemli B, Yilmaz C, Atalar H, Güzel B, Cetin I. Total hip arthroplasty in developmental high dislocation of the hip. J Arthroplasty
2005;20:1021-8.
22. Masonis JL, Patel JV, Miu A, Bourne RB, McCalden R, Macdonald SJ, et al. Subtrochanteric shortening and derotational
osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia: 5-year follow-up. J Arthroplasty 2003;
18(3 Suppl 1):68-73.
23. Zadeh HG, Hua J, Walker PS, Muirhead-Allwood SK. Uncemented total hip arthroplasty with subtrochanteric derotational
osteotomy for severe femoral anteversion. J Arthroplasty 1999;14:682-8.
24. Symeonides PP, Pournaras J, Petsatodes G, Christoforides J, Hatzokos I, Pantazis E. Total hip arthroplasty in neglected congenital
dislocation of the hip. Clin Orthop Relat Res 1997;341:55-61.
25. Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop
1987;218:136-41.
1979;61:15-23.
2. Stans AA, Pagnano MW, Shaughnessy WJ, Hanssen AD. Results of total hip arthroplasty for Crowe type III developmental hip
dysplasia. Clin Orthop Relat Res 1998;348:149-57.
3. MacKenzie JR, Kelley SS, Johnston RC. Total hip replacement for coxarthrosis secondary to congenital dysplasia and dislocation
of the hip. Long-term results. J Bone Joint Surg Am 1996;78:55-61.
4. Charity JA, Tsiridis E, Sheeraz A, Howell JR, Hubble MJ, Timperley AJ, et al. Treatment of Crowe IV high hip dysplasia
with total hip replacement using the Exeter stem and shortening derotational subtrochanteric osteotomy. J Bone Joint Surg Br
2011;93(1):34-8.
5. Biant LC, Bruce WJ, Assini JB, Walker PM, Walsh WR. The anatomically difficult primary total hip replacement: medium- to
long-term results using a cementless modular stem. J Bone Joint Surg Br 2008;90(4):430-5.
6. Huo MH, Salvati EA, Lieberman JR, Burstein A, Wilson PD Jr. Custom-designed femoral prostheses in total hip arthroplasty
done with cement for severe dysplasia of the hip. J Bone Joint Surg Am 1993;75:1497-1504.
7. Krych AJ, Howard JL, Trousdale RT, Cabanela ME, Berry DJ. Total hip arthroplasty with shortening subtrochanteric osteotomy
in Crowe type-IV developmental dysplasia. J Bone Joint Surg Am 2009;91(9):2213-21.
8. Dunn HK, Hess W. Total hip reconstruction in chronically dislocated hips. J Bone Joint Surg Am 1976;58:838-45.
9. Reikeraas O, Lereim P, Gabor I, Gunderson R, Bjerkreim I. Femoral shortening in total arthroplasty for completely dislocated
hips: 3-7 year results in 25 cases. Acta Orthop Scand 1996;67(1):33-6.
10. Krych AJ, Howard JL, Trousdale RT, Cabanela ME, Berry DJ. Total hip arthroplasty with shortening subtrochanteric osteotomy
in Crowe type-IV developmental dysplasia: surgical technique. J Bone Joint Surg Am 2010;92(Suppl 1 Pt 2):176-87.
11. Merle d’Aubigné R, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 1954;36:
451-5.
12. DeLee J, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res
1976;121:20-32.
13. Engh C, Massin P, Suthers K. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components.
Clin Orthop Relat Res 1990;257:107-28. Erratum in: Clin Orthop Relat Res 1992;284:310-2.
14. Gruen TA, Mc Neice GM, Amstutz HC. Modes of failure of cemented stem-type femoral components: a radiographic analysis of
loosening. Clin Orthop Relat Res 1979;141:17-27.
15. Brooker A, Bowerman J, Robinson R, Riley L. Ectopic ossification following total hip replacement. Incidence and a method of
classification. J Bone Joint Surg Am 1973;55:1629-32.
16. Howie CR, Ohly NE, Miller B. Cemented total hip arthroplasty with subtrochanteric osteotomy in dysplastic hips. Clin Orthop
Relat Res 2010;468(12):3240-7.
17. Takao M, Ohzono K, Nishii T, Miki H, Nakamura N, Sugano N. Cementless modular total hip arthroplasty with subtrochanteric
shortening osteotomy for hips with developmental dysplasia. J Bone Joint Surg Am 2011;93(6):548-55.
18. Park MS, Kim KH, Jeong WC. Transverse subtrochanteric shortening osteotomy in primary total hip arthroplasty for patients
with severe hip developmental dysplasia. J Arthroplasty 2007;22(7):1031-6.
19. Tanzer M, Chan S, Brooks CE, Bobyn JD. Primary cementless total hip arthroplasty using a modular femoral component a
minimum 6-year follow-up. J Arthroplasty 2001;16(8 Suppl 1):64-70.
20. Eskelinen A, Helenius I, Remes V, Ylinen P, Tallroth K, Paavilainen T. Cementless total hip arthroplasty in patients with high
congenital hip dislocation. J Bone Joint Surg Am 2006;88:80-91.
21. Erdemli B, Yilmaz C, Atalar H, Güzel B, Cetin I. Total hip arthroplasty in developmental high dislocation of the hip. J Arthroplasty
2005;20:1021-8.
22. Masonis JL, Patel JV, Miu A, Bourne RB, McCalden R, Macdonald SJ, et al. Subtrochanteric shortening and derotational
osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia: 5-year follow-up. J Arthroplasty 2003;
18(3 Suppl 1):68-73.
23. Zadeh HG, Hua J, Walker PS, Muirhead-Allwood SK. Uncemented total hip arthroplasty with subtrochanteric derotational
osteotomy for severe femoral anteversion. J Arthroplasty 1999;14:682-8.
24. Symeonides PP, Pournaras J, Petsatodes G, Christoforides J, Hatzokos I, Pantazis E. Total hip arthroplasty in neglected congenital
dislocation of the hip. Clin Orthop Relat Res 1997;341:55-61.
25. Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop
1987;218:136-41.