Mid-term results of total hip arthroplasty with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip

Abstract

Background This study aimed to explore mid-term clinical results of cementless total hip arthroplasty (THA) with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip (DDH). Methods Thirteen patients (13 hips) with Crowe type IV DDH who underwent THA with modified trochanteric osteotomy between May 2013 and October 2015 were retrospectively analyzed. The mean follow-up duration was 5.2 years (range, 4.9–6.1 years). Results The mean Harris Hip Score (HHS) significantly (p < 0.05) improved from 30.7 (range, 22–38) to 87.5 (range, 83–93). The mean leg length discrepancy (LLD) was 53.4 mm (range, 42.1–68.5 mm) preoperatively. The final LLD was 5.6 mm (range, 2.4–9.1 mm; p < 0.05). The mean leg length after surgery was 47.4 mm (range, 33.6–67.2 mm) and the femur shortening distance was 43.8 mm (range, 31.2–53.4 mm). The average duration of bone union for the greater trochanter (GT) was 2.5 months (range, 1.5–3.6 months). There was no infection, GT non-union, or loosening (septic or aseptic) of the stem or cup in any case. Conclusions THA with modified trochanteric osteotomy with a cementless cup is an effective treatment for Crowe type IV DDH. It can rebuild complex biomechanics and biology of hip dysplasia without increasing complications.

CORR Insights®: 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

“…Because several previous reports showed that THAs with trochanteric slide osteotomy had favorable clinical outcomes with fewer complications [5,8,12], the unsatisfactory results of the present study [13] are unexpected. In recent reports, no patients showed nonunion of the greater trochanter and residual nerve palsy, although there were fewer than 20 patients in these studies [8,12]. The outcomes of these procedures are influenced by many factors, including patient selection, operative techniques, and postoperative management.…”

“…For that reason, simpler alternatives that might reduce the risk of osteotomy and nerve-related complications while achieving a durable, functional THA would be desirable. Greater trochanteric osteotomy with and without distal advancement has been described as a possible approach [5,8,12]. Instead of femoral shortening at the subtrochanteric site, the proximal femur around the femoral neck and lesser trochanter is shortened progressively and the femoral component is placed distally to help address the issue of leg length.…”

“…Instead of femoral shortening at the subtrochanteric site, the proximal femur around the femoral neck and lesser trochanter is shortened progressively and the femoral component is placed distally to help address the issue of leg length. The clinical scores and radiographic implant stability of those surgeries were reported to be favorable [8,12], but these studies were mostly case series in which the same procedure was used. Without comparisons to other reasonable surgical alternatives, it's hard to place these procedures in context.…”

“…Given the unexpected finding in the current study [13], future, larger studies should seek to confirm or refute it. The outcomes of surgical procedures for highly dislocated DDH hips have been reported mainly with respect to survivorship, reoperation, clinical scores, and complications such as dislocation, infection, and nerve palsy [1,5,7,8,12]. Compared with THAs in patients with no or milder DDH, patients with severe DDH are likely to present with gait disturbance, low back and knee pain, and limitations to daily life activities owing to leg length discrepancy and soft tissue laxity or contracture surrounding the hip.…”

Implant loosening following THA with S-ROM prosthesis and subtrochanteric osteotomy: Three case reports

“…The combination of total hip arthroplasty and femoral shortening osteotomy is a successful treatment for Crowe IV DDH. In contrast to traditional prostheses, S-ROM prostheses are typically used for patients with DDH, and postoperative recovery is satisfactory (3)(4)(5)(6). Routine postoperative prosthesis loosening is a frequent complication of THA, and aseptic loosening is considered a leading cause of revision total hip arthroplasty (RTHR) (7).…”