Femoral shortening and cementless arthroplasty in Crowe type 4 congenital dislocation of the hip

Abstract

Purpose In reconstruction of congenital hip dislocation by total hip arthroplasty (THA), positioning of the acetabular component in the true acetabulum is sometimes accompanied by shortening of the femur. Shortening of the femur is of importance for minimising risk of damaging neurovascular structures due to excessive limb lengthening. Furthermore, reduction of the femoral head into the true acetabulum remains challenging without shortening of the femur. Methods We performed a consecutive case series of cementless THA with femoral shortening and Crowe type 4 congenital dislocation. All acetabular cups were placed in their original anatomical location. In all cases a proximal diaphyseal step-cut shortening osteotomy was performed and stabilised with two to three titanium cerclage bands. Results At an average of 60 months follow-up (range 36-96), 12 patients (13 THA) were scored clinically by the Merle D'Aubigne and Harris hip scores. In ten cases good to excellent outcome scores were observed. During the followup period no cases of aseptic loosening, nerve palsy, nonunions or dislocations were found. Conclusions This technique seems to be an excellent treatment option in the case of Crowe type 4 hips presenting with endstage osteoarthritis.

Transverse Subtrochanteric Shortening Osteotomy During Cementless Total Hip Arthroplasty in Crowe Type-III or IV Developmental Dysplasia

“…Placement of the acetabular component in the true acetabulum generally requires a femoral shortening osteotomy in most of the cases. Although various techniques of shortening osteotomy with satisfactory clinical outcomes have been discussed in the literature, no consensus has been established yet [7][8][9][13][14][15][16][19][20][21]. To our knowledge, this is the largest reported series in which the clinical outcomes of transverse subtrochanteric femoral shortening osteotomies performed during cementless THA in Crowe Type-III and IV DDH were evaluated.…”

“…However, placement of the acetabular component in the true acetabulum generally leads to a hip that is difficult to reduce because of severe soft tissue contractures, and a limb which is relatively lengthened [6]. Femoral shortening osteotomy is required in most cases to facilitate reduction, equalize limb lengths, and avoid overstretching of neurovascular structures [5,[7][8][9]. Furthermore, it will also allow correction of the femoral malrotation.…”

Total hip arthroplasty for Crowe IV hip without subtrochanteric shortening osteotomy -a long term follow up study

“…However, there have been few reports on the long-term results of THA with shortening osteotomy [20-22]. Although these results seem encouraging, the long-term outcome at more than 10 years after THAs with shortening osteotomy remains unknown.…”

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

“…Other surgeons accept subtrochanteric osteotomy for Fig. 6 The appropriate size of acetabular prosthesis was confirmed and labeled on the pelvic X-ray film by template preoperatively limb shortening of between 1 and 3 cm while applying a non-cemented long prosthetic shaft in cases of Crowe IV DDH [23,24], but we considered this to be unsatisfactory in view of the complications of difficulties in implantation, rotational displacement of the femoral shaft, nonunion of fracture, loosening of the prosthesis and leg length discrepancy that can occur in patients who undergo subtrochanteric osteotomy. Kerboull et al [25] insist that there is not genuine shortening but rather a change in the pathway of the sciatic nerve in patients with Crowe type IV, and safe lengthening of the lower limb of more than 7 cm can be achieved by thorough release of soft tissue.…”