What Is the Impact of a Previous Femoral Osteotomy on THA? A Systematic Review

Abstract

Background Femoral osteotomies have been widely used to treat a wide range of developmental and degenerative hip diseases. For this purpose, different types of proximal femur osteotomies were developed: at the neck as well as at the trochanteric, intertrochanteric, or subtrochanteric levels. Few studies have evaluated the impact of a previous femoral osteotomy on a THA; thus, whether and how a previous femoral osteotomy affects the outcome of THA remains controversial. Each author certifies that neither he or she, nor any member of his or her immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his or her institution approved the reporting of this investigation and that all investigations were conducted in conformity with ethical principles of research.

Medium-term outcomes of total hip arthroplasty in juvenile patients

“…The medical literature reports increased operative time and complication rates when the removal of previously implanted hardware is performed at the same time of THA [38]. This supports routine implant removal in children with a high likelihood of future THA [39]. In most of these patients, the choice of the appropriate surgical approach requires an understanding of the local anatomy to optimize joint visualization [28].…”

“…The second factor is the severity of osteoarthritis. An osteotomy performed on an already osteoarthritic bone would at best result in only a short-term improvement of symptoms and could represent a complicating factor for the future THA surgery [39]. Furthermore, regardless of whether the osteotomy fixation hardware is removed at another surgery, or during the index THA, thus prolonging the surgical times, the risk of subsequent periprosthetic joint infection is theoretically increased [44].…”

“…Furthermore, regardless of whether the osteotomy fixation hardware is removed at another surgery, or during the index THA, thus prolonging the surgical times, the risk of subsequent periprosthetic joint infection is theoretically increased [44]. In general, we prefer to remove the metalwork, if previous surgery has been undertaken, well before the arthroplasty is performed [39]. Further studies are necessary to answer these legitimate questions and assess the safest surgical approach for these young patients.…”

Total Hip Replacement in Developmental Hip Dysplasia: A Narrative Review

“…However, Fukuri et al reported similar functional results to patients who underwent THA in the presence of a rotational acetabular osteotomy [21]. Even in the case of the Bernese osteotomy, Parvizi et al concluded that subsequent THA for DDH was not compromised [22] . On the other hand, poorer functional outcomes have been reported after combined periacetabular osteotomy (PO) and intertrochanteric valgus osteotomy [4].…”

“…The articular capsule is thickened and upwards elongated, while the function of the abductors is impaired. With the possible exception of the abductors, all the muscles around the hip joint are shortened in both low and high dislocations [22,23]. In most cases, brave intraoperative soft tissue release and tenotomies are advocated [24,25,26,27].…”