Partial greater trochanter osteotomy for hip reduction in total hip arthroplasty for high dislocated hip: a preliminary report

Abstract

BackgroundHip reduction in total hip arthroplasty for high dislocated hips is difficult. Various femur osteotomy procedures have been used for hip reduction, but these methods increase operative time and risk of nonunion. We investigated the efficacy of a novel partial greater trochanter osteotomy technique for hip reduction in total hip arthroplasty for patients with high hip dislocation.MethodsTwenty-one patients (23 hips) with high dislocated hip were treated with total hip arthroplasty that included partial greater trochanter osteotomy, i.e., the upper 2/3 greater trochanter was resected, and the gluteus medius muscle attachment was spared. The clinical outcome was evaluated by comparing the Harris hip scores and radiographic exam results, obtained before surgery and at follow-ups.ResultsFollow-ups of 21 patients ranged from 13 to 56 months. The mean Harris hip score increased from preoperative 55.0 (36–69) to postoperative 86.1 (71–93; P = 0.00). The average preoperative leg length discrepancy in patients with unilateral high hip dislocation was 46 mm (28–65 mm); postoperatively leg length discrepancy was less than 1 cm in 11 patients, between 1 and 2 cm in 8 patients, and more than 2 cm in 2 patients. The average leg lengthening at the time of surgery was 36 mm (24–54 mm). Trendelenburg’s gait changed from positive to negative in 20 hips by the last follow-up. No nerve injury occurred postoperative.ConclusionPartial greater trochanter osteotomy is an effective method to render hip reduction in total hip arthroplasty for patients with high dislocation of the hip.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-293) contains supplementary material, which is available to authorized users.

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.…”

“…Patients with this condition have several complex deformities, including proximal femoral abnormalities, anteverted and defective acetabula, and significant leg length discrepancies (LLDs) [22]. In addition, anatomic abnormalities and long-term soft tissue contracture complicate hip reduction after cup implantation at the anatomic site in these patients and may lead to neurovascular complications [14]. Consequently, femoral osteotomies of various configurations were introduced to address the problem [5,21].…”

“…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].…”