Cementless total hip arthroplasty with extended sliding trochanteric osteotomy for high congenital hip dislocation

Abstract

Total hip arthroplasty (THA) for high congenital hip dislocation (CHD) is technically demanding. The purpose of this retrospective study was to evaluate the results of cementless THA combined with extended sliding trochanteric osteotomy. We also assessed whether chronic low back pain was relieved after surgery.The study included 19 patients (23 hips) with high CHD treated with cementless THA using extended sliding trochanteric osteotomy technique. Clinical and radiographic outcomes were evaluated.Harris Hip Score, WOMAC score, visual analog scale for low back pain and Trendelenburg sign were significantly improved (P < 0.01) compared with the preoperative. Average limb-length discrepancy in the 15 unilateral hips was reduced from 38.2 ± 7.9 mm to 6.7 ± 4.1 mm (P < 0.01). No dislocation, deep vein thrombosis, or infection occurred. Two patients (8.7%) developed sciatic nerve palsy. One (4.3%) developed symptomatic greater trochanteric bursitis. Two (8.7%) sustained proximal femur shaft fracture during implantation of the femoral component. All femoral components showed successful bony ingrowth at the final follow-up. No stem subsidence was detected. There was no acetabular loosening. Bony union of the reattached greater trochanter was obtained in all hips. Wire breakage occurred in 3 hips (13%).Cementless THA with extended sliding trochanteric osteotomy may be appropriate options for patients with high CHD.Abbreviations: CHD = congenital hip dislocation, HHS = Harris Hip Score, THA = total hip arthroplasty, VAS = visual analog scale, WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index.

Subtrochanteric Shortening Osteotomy Provides Superior Function to Trochanter Slide Osteotomy in THA for Patients With Unilateral Crowe Type IV Dysplasia at a Minimum of 3 Years

“…Only a few previous studies have evaluated the efficacy of trochanteric slide osteotomy for hips with Crowe Type IV dysplasia [8,11,14,15,17], and to our knowledge, the two techniques have not been directly and exclusively compared in Crowe Type IV hips.…”

“…Various methods of shortening osteotomy are available to facilitate femoral head reduction during THA in patients with high-riding hips. Although femoral shaft shortening osteotomy [23] and femoral supracondylar shortening osteotomy [3] have been described, subtrochanteric shortening osteotomies and trochanteric slide osteotomies are the most common techniques [8,11,14,15,17]. Subtrochanteric osteotomy lowers the risk of injury to the greater trochanter and preserves the normal anatomy of the proximal femur but is more difficult [13,25,26].…”

Clinical observation of modified greater trochanteric osteotomy for the treatment of hip dysplasia in adults with high dislocation

“…Bhan et al believe that for patients with ankylosis of external flexion of the hip joint, greater trochanter osteotomy can increase the risk of exposing and avoiding injury to the gluteus medius and gluteus minimus [15]. On this basis, some scholars used the modified great trochanter sliding osteotomy to retain the posterior external rotator group and the bone part of the joint capsule insertion, thus making the posterior structure more stable [16].…”

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

“…Luo et al found good outcomes in 19 patients (23 hips) with high-dislocation DDH who underwent extended greater trochanteric osteotomy. They performed 8 cm to 12 cm extended greater trochanteric osteotomies to facilitate acetabular and femoral exposure and reported bony healing of the greater trochanter in all patients 1 year after the procedure ( 25 ).…”