Cementless hip arthroplasty and transverse shortening femoral osteotomy with the S-ROM stem for Crowe type IV developmental dysplasia

Nečas, Libor; Hrubina, M; Melišík, Marian; Cibula, Zoltán; Chmúrny, M; Daniel, Matěj; Šteňo, Boris

doi:10.1007/s00590-019-02400-y

Cited by 35 publications

(36 citation statements)

References 29 publications

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“…The other two aspects that influence stability are the morphology of the femoral stem and the fixation method used. A cylindrical prosthesis, such as S-ROM stem (Courtesy of DePuy Orthopaedics, Warsaw, IN, USA), was recommended due to its distal slit and proximal fixation, which provides better distal engagement and facilitates rotational stability [25,35,36]. Several studies have also described transverse osteotomy with strut grafts using a cable or plate and screws for fixation [7,32,37].…”

Section: N a N A N A N A N A N A N A N A N A N A N A N A N A N Amentioning

confidence: 99%

Optimal location of subtrochanteric osteotomy in total hip arthroplasty for crowe type IV developmental dysplasia of hip

Huang

Liu

et al. 2020

BMC Musculoskelet Disord

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Background: When 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. Methods: We 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 (mm 2), and the ratio of contact area to distal ring area as coincidence rate R. Results: N 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. Conclusions: Our 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 registration: Retrospectively registered.

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Section: N a N A N A N A N A N A N A N A N A N A N A N A N A N Amentioning

confidence: 99%

Optimal location of subtrochanteric osteotomy in total hip arthroplasty for crowe type IV developmental dysplasia of hip

Huang

Liu

et al. 2020

BMC Musculoskelet Disord

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“…Some reports indicated that the intensity of early postoperative pain increases the risk of chronic postsurgical pain [Puolakka PA et al, 2010;Fletcher D et al, 2015]. THA with femoral shortening osteotomy is an effective and reliable technique [Thorup B et al, 2009;Wang D et al, 2017;Necas L et al, 2019]. However, on the basis of this study, for patients who will undergo THA with femoral shortening osteotomy, it is desirable to explain before surgery that the postoperative rehabilitation will be more serious and pain may persist unlike in with normal cases.…”

Section: Questionnairementioning

confidence: 82%

Patient-reported outcomes following primary total hip arthroplasty in Crowe type Ⅲ or Ⅳ developmental dysplasia are comparable to those in Crowe type Ⅰ: a case-control study of 96 hips with intermediate-term follow-up

Ueoka

Kabata

Kajino

et al. 2020

Preprint

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Background: A few previous studies have investigated patient satisfaction after total hip arthroplasty (THA) according to the degree of pelvic deformity. This study compared patient-reported outcomes after primary THA for Crowe types Ⅲ, Ⅳ and I dysplasia.Methods: This retrospective, single-center, single-surgeon case-control study included patients who underwent primary THA between 2008 and 2016. We sent postal questionnaires to 38 patients with Crowe type III and IV dysplasia. Among the questionnaire respondents, 23 patients, excluding those with a follow-up period of < 1 year, were enrolled as the H group. The control group included 46 patients with Crowe type I, matched for sex, age, body mass index and surgical approach. To investigate the influence of femoral shortening osteotomy, the H group was divided according to whether femoral shortening osteotomy was performed. Ten patients underwent THA with femoral shortening osteotomy (FO group), while 12 patients underwent THA without femoral shortening osteotomy (N-FO group). Patient demographics, mean follow-up period, surgical information, pre- and postoperative leg length discrepancy (LLD), and perioperative complications were investigated. Clinical evaluations were performed using the Japanese Orthopaedic Association (JOA) scores, 36-item short-form survey (SF-36), net promotor score (NPS), visual analogue scale (VAS), and questionnaires. The VAS and SF-36 scores were determined only at final follow-up.Results: The H and control groups were not significantly different in the postoperative JOA scores and SF-36. In the H group, VAS at the final follow-up was significantly higher, and significantly more patients felt that postoperative rehabilitation was serious, expressing that they underwent THA for LLD correction. In addition, the VAS scores in the FO group was higher than those in the N-FO group. Postoperative LLD was significantly greater in the H group than in the control group. Each group had an NPS of >50.Conclusion: The postoperative VAS score was higher in Crowe type Ⅲ and Ⅳ dysplasia than in Crowe type I dysplasia, but no significant differences were detected in the postoperative satisfaction, JOA score, and SF-36 score. These findings may help explain the effects of THA preoperatively to patients with Crowe type Ⅲ and Ⅳ dysplasia.Level of Evidence: Therapeutic Level 3b

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“…Necas et al [21] 28 where transverse, oblique, Z, and double chevron osteotomy methods were investigated, the superiority of osteotomy methods among each other had not been demonstrated. [7] In previous studies in which SFSO was fixed with strut autograft and cable, Wang et al [17] reported their non-union rate as 3.5% and Kilicoglu et al [6] reported their non-union rate as 4%.…”

Section: Discussionmentioning

confidence: 99%

Use of proximal humerus plates for the fixation of the subtrochanteric femoral shortening osteotomy during total hip arthroplasty for Crowe type IV developmental dysplasia of the hip patients

et al. 2020

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The number of patients undergoing total hip arthroplasty is rising. [1] Developmental dysplasia of the hip (DDH) is a frequent diagnosis for total hip arthroplasty and a subtrochanteric femoral shortening osteotomy (SFSO) is often required for the Crowe type IV patients. [2,3] After the SFSO, fixation may be necessary to obtain the rotational stability. [4] However, the femoral stem reduces the space required for fixation which makes this procedure challenging. Cables, cables with strut grafts, plate and screws, cable plates, and various osteotomy methods are used for fixation of the SFSO during total hip arthroplasty. [4-9] Non-union and implant irritation are the major problems encountered with these methods. [10,11] Denis et al. [12] compared plate and cable in their biomechanical study for the fixation around the femoral stem in periprosthetic fracture model and it was shown that unicortical screw fixation proximal to osteotomy was biomechanically stronger than cable fixation. For this reason, we considered that a proximal humerus plate may be a good alternative for SFSO fixation as it has many locking screws option Objectives: This study aims to evaluate the efficacy of proximal humerus plate in the fixation of subtrochanteric femoral shortening osteotomy (SFSO) during total hip arthroplasty. Patients and methods: Thirty female patients (mean age 49.8 years; range, 22 to 68 years) who underwent hip arthroplasty with a SFSO and fixed with a proximal humerus plate between January 2014 and June 2018 were evaluated retrospectively. Rate of fracture healing, the number of fixed cortices at both sides of the osteotomy, and complications were documented. Results: The mean follow-up period was 28 months (range, 12-68 months). The average time to union was 106 days (range, 45-229 days). The mean number of cortices fixed in the proximal segment of the osteotomy was 6.2 (range, 4-9), and the mean number of cortices fixed in the distal segment of the osteotomy was 4.0 (range, 3-7). None of the patients had implant irritation or implant failure at the control visits. We observed only one non-union and our non-union rate was 3.3%. Conclusion: In conclusion, the use of a proximal humerus plate for the fixation of SFSO can be an alternative procedure for achieving adequate rotational stability until a solid union.

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Cementless hip arthroplasty and transverse shortening femoral osteotomy with the S-ROM stem for Crowe type IV developmental dysplasia

Cited by 35 publications

References 29 publications

Optimal location of subtrochanteric osteotomy in total hip arthroplasty for crowe type IV developmental dysplasia of hip

Optimal location of subtrochanteric osteotomy in total hip arthroplasty for crowe type IV developmental dysplasia of hip

Patient-reported outcomes following primary total hip arthroplasty in Crowe type Ⅲ or Ⅳ developmental dysplasia are comparable to those in Crowe type Ⅰ: a case-control study of 96 hips with intermediate-term follow-up

Use of proximal humerus plates for the fixation of the subtrochanteric femoral shortening osteotomy during total hip arthroplasty for Crowe type IV developmental dysplasia of the hip patients

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