Cementless modular total hip arthroplasty with subtrochanteric transverse shortening osteotomy for high hip dislocations

Abstract

Background Performing a total hip arthroplasty for a high hip dislocation is technically demanding and presents several challenges, with appropriate evaluation of the bone morphology of the hip and proper implant selection being critical for successful outcomes. Objective The purpose of our study was to evaluate the clinical and radiographic outcomes of cementless modular total hip arthroplasty for the treatment of high hip dislocations with sub-trochanteric transverse shortening osteotomy. Methods Sixty-eight hips with a high hip dislocation, were treated using a sub-trochanteric transverse shortening osteotomy and cementless modular total hip arthroplasty, retrospectively reviewed. Hip function was assessed using the Harris hip score, with hip abduction strength evaluated using the Trendelenburg test. Radiographic assessment included the measurement of leg length discrepancy, identification of implant loosening, localization of the hip center, and union at the osteotomy site. Results The mean follow-up period was 12.9 (range 5.2–16.8) years. The mean Harris hip score improved from a pre-operative score of 48.6 ± 3.6 to 82.4 ± 4.2 (p < 0.05). The hip was within the true acetabulum in all patients, postoperatively. Osteotomy union was achieved in 67 of the 68 hips (98.5%) in a mean latency of 12.5 ± 0.6 weeks. The mean length of femoral shortening was 66.5 ± 4.5 mm, with a mean pull-down length of the proximal part of 35.5 ± 3.5 mm. Conclusion For the treatment of high hip dislocations with satisfactory clinical outcomes, the modular stem offers an adjustable anteversion angle to restore sufficient rotational stability and the transverse osteotomy provides sufficient compression pressure across the osteotomy site to facilitate union. Trial registration It was a retrospective study and approved by Istanbul Research and Training Hospital institutional Ethics Review Board (772-05/02/2016).

Preoperative Leg Length Discrepancy >2 cm in the Supine Decubitus Position May Induce Compensatory Pelvic Obliquity in Patients during Total Hip Arthroplasty

“…A Trendelenburg test was performed to evaluate the abduction strength of the hip. 19 During the procedure, cementless acetabular cups were implanted in select patients. Pinnacle acetabular cups (Depuy, Warsaw, IN, USA) were randomly used in 78 patients, and Trilogy acetabular components (Zimmer, Warsaw, IN, USA) were implanted in 57 patients.…”

“…The general characteristics, gait, and presence of low back pain were recorded for each patient. A Trendelenburg test was performed to evaluate the abduction strength of the hip 19 . During the procedure, cementless acetabular cups were implanted in select patients.…”

Greater trochanteric osteotomy and subtrochanteric osteotomy in primary/revision total hip arthroplasty

“…Previously reported incidences of nonunion in subtrochanteric osteotomies for high-dislocation DDH ranged between 2.8% and 7.1% (27). In the subtrochanteric osteotomy, it is important to fix the osteotomy site to provide a proper environment for bone healing and maintain the normal femoral anteversion angle, facilitating osseointegration of the femoral component.…”

“…A meta-analysis was performed to compare the influence of transverse and other subtrochanteric osteotomies in terms of patient complications and prosthesis survival rates, and no differences were found ( 32 ). Erhan Sukur et al analyzed 56 patients (68 hips) with Crowe type IV DDH who were treated with uncemented subtrochanteric transverse osteotomy and found that most of the patients had good clinical outcomes at a mean follow-up of 12.9 years while 9(13.2%) patients had complications and 8(11.7%)patients had secondary revision surgery ( 27 ). Cagri Ors et al retrospectively analyzed 91 Crowe IV hip dysplasia patients (127 hips) treated with transverse subtrochanteric osteotomy using Wagner-cone stem.…”

Alignment analysis of Brainlab knee 3 navigation-guided total knee arthroplasty using the adjusted mechanical method

“…If necessary, the deep layer of the soleus muscle and the attachment of the semimembranosus muscle at the tibial epiphysis can also be released with a bone chisel, thus exposing the medial tibia. Although deep MCL release and osteophyte resection is routinely performed in TKA, the medial soft tissue should be released as less as possible because the excessive release of the medial soft tissue may lead to medial instability, mid-flexion instability, hematoma formation, knee joint elevation, and the need for constrained implants, which contribute to poor postoperative outcomes (30). In our study, soft tissue was released up to the deep part of the MCL, 1-1.5 cm distal to the knee joint line.…”