Cemented Total Hip Arthroplasty With Subtrochanteric Osteotomy in Dysplastic Hips

Abstract

Background Total hip arthroplasty (THA) in the presence of developmental dysplasia of the hip (DDH) can be technically challenging. Restoring the anatomic center of hip rotation may require femoral osteotomy. Techniques using cementless components are widely reported but less is known about using cemented components that may be more appropriate with osteopenic bone. Questions/purposes We therefore determined the rate of union, complications, and early functional score in a series of patients with DDH who underwent cemented THA and simultaneous subtrochanteric osteotomy. Methods We retrospectively reviewed 28 patients (35 hips) who underwent a cemented THA for DDH at a mean age of 47.3 years. Two patients (two hips) died within 12 months of surgery of unrelated conditions. The clinical notes and radiographs were reviewed with a minimum followup of 2 years (mean, 5.6 years; range, 2-14 years). Complications were noted. SF-12 and Oxford hip scores (OHS) were recorded for 18 patients preoperatively and after 6 and 12 months. Results Union occurred in 32 of 33 femora (97%); one patient had an infected nonunion. The overall revision rate was 20% (9% femoral revision rate). There were three dislocations, two of which had further surgery. Two patients had a transient neuropraxia. The mean SF-12 physical component score increased from 32 to 52 and mean SF-12 mental component score increased from 48 to 51. The mean OHS decreased from 40 to 27. Conclusion Combined subtrochanteric osteotomy and cemented THA is technically demanding with a higher complication rate than routine THA. The rate of union, complications, implant survival, and early OHS were comparable to those for similar techniques using cementless components.

Total Hip Replacement in Developmental Dysplasia of the Hip: Pitfalls and Challenges

“…A total of 28 patients (35 hips) who underwent a cemented THA for DDH had been reviewed retrospectively. The overall revision rate was found 20%, and femoral revision rate was found 9% [57].…”

Endoprothese bei Dysplasiecoxarthrose

“…Wenn die Fixation allein über ein Schaftimplantat erfolgen soll, muss in der zementfreien Anwendung ein entsprechend geeignetes Stieldesign mit Rotationsstabiltät und diaphysärer Verankerung gewählt werden. Die zementierte Schaftwahl ist ebenfalls beschrieben [34,55], birgt aber das Risiko eines Zementaustrittes in den Osteotomiespalt mit unterbleibender knöcherner Ausheilung. Sehr instruktive Beschreibungen des operativen Vorgehens sind publiziert [44,68], wobei die Abfolge einzelner Schritte bei den jeweiligen Autoren naturgemäß unterschiedlich ist.…”

The techniques of soft tissue release and true socket reconstruction in total hip arthroplasty for patients with severe developmental dysplasia of the hip

“…There are many options of surgery for reduction of femoral head dislocation for severe DDH cases, such as subtrochanteric osteotomy and superior reconstruction of the acetabular socket, both of which have inevitable complications [8][9][10][11][12], whereas the technique of soft tissue release and balance we recommend has obvious advantages including lengthening the limb and reconstructing the true socket, restoration of the anatomical course of the abductor and balance of its muscular strength.…”