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Total hip arthroplasty with a monoblock conical stem and subtrochanteric transverse shortening osteotomy in Crowe type IV dysplastic hips

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Abstract

Purpose

This series assessed the clinical and radiographic outcomes of total hip arthroplasty (THA) with femoral shortening osteotomy for the management of patients with Crowe type IV hip dysplasia.

Methods

Only patients with Crowe type IV hip dysplasia who underwent primary THA combined with a subtrochanteric transverse osteotomy with an uncemented monoblock conical stem were included. The clinical and radiographic evaluations were performed before and immediately after surgery, and at last follow-up. The hip function was assessed with the Harris Hip Score (HHS).

Results

Seventy-four patients (102 hips) with a mean age of 53.9 (range, 20–83) were evaluated at an average follow-up of 11.3 years (range, 5–25). Stem revision occurred in two (1.9%) cases, with a survivorship of 95.9% (95%IC, 91.9–99.9%) at ten years. The average HHS increased from 44 (range, 15–78) pre-operatively to 90.3 (range, 62–100) at last follow-up (p < 0.001). Osteotomy site non-union and early dislocation were observed in 3.9 and 3.8%, respectively. No cases of nerve palsy were reported.

Conclusions

THA with a monoblock conical stem associated with subtrochanteric transverse osteotomy provides good long-term survival, clinical and radiographic results. It may be considered an effective management of patients with Crowe IV hip dysplasia.

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Authors and Affiliations

  1. Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy

    Guido Grappiolo, Francesco La Camera, Antonello Della Rocca, Giuseppe Mazziotta, Giuseppe Santoro & Mattia Loppini

  2. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy

    Mattia Loppini

Authors
  1. Guido Grappiolo
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  2. Francesco La Camera
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  3. Antonello Della Rocca
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  4. Giuseppe Mazziotta
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  5. Giuseppe Santoro
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  6. Mattia Loppini
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Corresponding author

Correspondence to Mattia Loppini.

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Conflict of interest

Guido Grappiolo received honoraria for speaking at symposia, financial support for attending symposia and educational programs from Zimmer Biomet, and royalties from Zimmer Biomet and Innomed. Giuseppe Mazziotta, Giuseppe Santoro, Mattia Loppini and Antonello Della Rocca received financial support for attending symposia and educational programs from Zimmer Biomet. Francesco La Camera has no conflict of interest.

Ethical approval

This was a retrospective and observational study with medical records of patients included in a registry of orthopaedic surgical procedures. The study protocol for the development of this registry was approved by the Ethical Committee of Humanitas Research Hospital (approval number 618/17) and in strict accordance with the Helsinki Declaration.

Informed consent

All individual participants signed a written informed consent before the surgical procedure and a written informed consent to be included in the registry of orthopaedic surgical procedures.

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Grappiolo, G., La Camera, F., Della Rocca, A. et al. Total hip arthroplasty with a monoblock conical stem and subtrochanteric transverse shortening osteotomy in Crowe type IV dysplastic hips. International Orthopaedics (SICOT) 43, 77–83 (2019). https://doi.org/10.1007/s00264-018-4122-5

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  • DOI: https://doi.org/10.1007/s00264-018-4122-5

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