The reverse sleeve in total hip arthroplasty for patients with trochanter valgus deformity: surgical technique and case series

Abstract

Background: Ttrochanter valgus deformity (TVD) is a rare condition of total hip arthroplasty (THA). The femoral osteotomy might be required to correct the deformity to implant the femoral stem in severe TVD. In this study, we described one unpublished technique of reverse sleeve of S-ROM to get through the complex situation. The aim of this study was to summarize the technical challenges of this special sleeve-implanting method and evaluate its effectiveness and safety. Methods: From January 2006 to December 2014, the patients who had the reverse sleeve to solve the TVD in THA were enrolled. Their demographics, perioperative and postoperative information were recorded. To explore its indication, we measured and analyzed the ratio of greater trochanter/lesser trochanter (G/L ratio) and trochanter valgus angle (TVA). Results: Twelve patients (1 male and 11 female, average age 42.30±10.23) who had the complete clinical data were analyzed. The survivorship of femoral prosthesis were 100% with mean follow-up of 6 years. No other complications were found, except for two patients with intraoperative fracture of femur. The Harris hip score (HHS) increased from preoperative 34.31±14.43 to postoperative 84.12±11.33. All patients’ G/L ratio were larger than1.50. Conclusions: The reverse sleeve of S-ROM was a simple and reliable method for patients with severe TVD, which brought satisfying clinical outcomes in mid-term follow-up. When G/L ratio is larger than 1.50, surgeons should consider this special surgical technique. Keywords: cementless modular stem; reverse sleeve; total hip arthroplasty; trochanter valgus deformity.