Subtrochanteric Transverse Shortening Osteotomy in Cementless Total Hip Arthroplasty Achieved Using a Modular Stem

Abstract

It is challenging to reconstruct normal hip motion after a high hip dislocation. Although total hip arthroplasty (THA) with shortening osteotomy is a solution for high hip dislocation, osteotomy nonunion is a major complication. To improve the rate of osteotomy union, subtrochanteric transverse shortening osteotomy was performed using a modular-type stem, S-ROM, that can be fixed to both the proximal and distal parts of the femur individually with a stepped proximal sleeve and polished distal flutes with fins, respectively. The stem can facilitate union of the osteotomy by maintaining rigid rotational stability and generating compression pressure between bone parts of the femur even in simple transverse osteotomy. Moreover, transverse osteotomy is technically simple and minimizes the damage of the periosteum at the osteotomy. In our series, this procedure was performed on 6 hips in 6 patients with high hip dislocation. The mean follow-up period was 8.1 years. Osteotomy union was achieved in all patients for a mean of 8.8 weeks. This procedure is a good option for surgical treatment of high hip dislocation.

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

“…All femoral osteotomies were stabilized with a plate and cable system in all hips, but did not use any strut allografts as mechanical support to ostoetomy site. The mean time to union has been reported between 8.8 weeks to 7.7 months for transverse subtrochanteric shortening ostetomy in the literature [7,13,21,[24][25][26][27][28]. In our study group, it was 5.2 months similarly to the previous studies.…”

“…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.…”

“…Allowing simultaneous shortening and correction of the rotational deformity, preservation of the proximal femoral metaphysis, and easier application are the main advantages of transverse subtrochanteric femoral shortening osteotomy in patients undergoing THA for the treatment of severe dysplasia [5]. According to Ogawa et al transverse osteotomy is technically simple and minimizes the damage of the periosteum at the osteotomy [21]. Yasgur et al advocated the use of a diaphyseal locking press-fit stem supplemented with struts to improve the rotational stability of the construct [26].…”

Total Hip Arthroplasty with Subtrochanteric Femoral Shortening Osteotomy for High Hip Dislocation

“…The proximal osteotomy was made slightly distal to the minor trochanteric level in a superior lateral‐to‐inferior medial direction at a 90° angle relative to the longitudinal axis of the femur. The prosthesis template with proximal femur was reset to the acetabular prosthesis, and then the distal femur was pulled in the opposite direction to determine the extent of shortening and the distal transverse osteotomy line (Fig. ).…”

Modular Stems: Advantages and Current Role in Primary Total Hip Arthroplasty

“…In this case, subtrochanteric shortening osteotomy combined with the use of an S-ROM prosthesis is effective454748495051525354) in both joint reduction and in the prevention of nerve palsy. Klisic and Jankovic55) introduced a method of making transverse osteotomy distal to the lesser trochanter in 1974.…”