Skip to main content
SpringerLink
Log in

Total hip arthroplasty with subtrochanteric osteotomy in neglected dysplastic hip

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Total hip arthroplasty (THA) in the presence of developmental dysplasia of the hip (DDH) presents many challenges to the reconstructive surgeon. The complexity of femoral and acetabular anatomy in these cases makes standard reconstruction technically challenging. Restoring the anatomic centre of hip rotation may require femoral osteotomy. The aim of this study was to determine the rate of union, complications and functional results in a series of patients with Crowe IV dysplastic hips who underwent cementless THA and simultaneous subtrochanteric oblique osteotomy.

Methods

A retrospective study was designed in a series of 13 patients (14 hips) with Crowe IV DDH who underwent cementless THA and simultaneous subtrochanteric oblique osteotomy at a mean age of 37 years. Patients were reviewed clinically and radiographically with a minimum follow-up of two years. Complications were noted. Harris Hip Score (HHS) was recorded pre-operatively and at six and 12 months postoperatively.

Results

Union occurred in 14 of 14 femora (100 %). The overall revision rate was 14 % (7 % femoral, 7 % acetabular). No dislocations necessitated further surgery. No patient had intraoperative femoral fracture, sciatic nerve injury, infection or deep venous thrombosis. Mean HHS improved from 42 preoperatively to 79 at 6 months and 86 at 12 months.

Conclusion

Combined subtrochanteric femoral osteotomy and cementless THA is technically demanding and proved to be safe and effective in femoral shortening for treatment of Crowe IV DDH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Sanchez-Sotelo J, Berry DJ, Trousdale RT, Cabanela ME (2002) Surgical treatment of developmental dysplasia of the hip in adults: II Arthroplasty options. J Am Acad Orthop Surg 10:334–344

    PubMed  Google Scholar 

  2. Crowe JF, Mani VJ, Ranawat CS (1979) Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am 61:15–23

    CAS  PubMed  Google Scholar 

  3. Dunn HK, Hess WE (1976) Total hip reconstruction in chronically dislocated hips. J Bone Joint Surg Am 58:838–845

    CAS  PubMed  Google Scholar 

  4. Eskelinen A, Helenius I, Remes V, Ylinen P, Tallroth K, Paavilainen T (2006) Cementless total hip arthroplasty in patients with high congenital hip dislocation. J Bone Joint Surg Am 88:80–91

    Article  PubMed  Google Scholar 

  5. Halley DK, Wroblewski BM (1986) Long term results of low-friction arthroplasty in patients 30 years of age or younger. Clin Orthop Relat Res 211:43–50

    PubMed  Google Scholar 

  6. Papagelopoulos PJ, Trousdale RT, Lewallen DG (1996) Total hip arthroplasty with femoral osteotomy for proximal femoral deformity. Clin Orthop Relat Res 332:151–162

    Article  PubMed  Google Scholar 

  7. Bicanic G, Delimar D, Delimar M et al (2009) Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop 33:397–402. doi:10.1007/s00264-008-0683-z

    Article  PubMed Central  PubMed  Google Scholar 

  8. Linde F, Jensen J, Pilgaard S (1988) Charnley arthroplasty in osteoarthritis secondary to congenital dislocation or subluxation. Clin Orthop Relat Res 227:164–171

    CAS  PubMed  Google Scholar 

  9. Pagnano MW, Hanssen AD, Lewallen DG, Shaughnessy WJ (1996) The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty: long-term results of patients who have Crowe type II congenital dysplasia of the hip. J Bone Joint Surg Am 78:1004–1014

    CAS  PubMed  Google Scholar 

  10. Yoder SA, Brand RA, Pederson DR et al (1988) Total hip acetabular component position affects acetabular loosening rates. Clin Orthop Relat Res 228:79–87

    PubMed  Google Scholar 

  11. Eggli S, Hankemayer S, Muller ME (1999) Nerve palsy after leg lengthening in total replacement arthroplasty for developmental dysplasia of the hip. J Bone Joint Surg (Br) 81:843–845

    Article  CAS  Google Scholar 

  12. Lai KA, Shen WJ, Huang LW et al (2005) Cementless total hip arthroplasty and limb-length equalization in patients with unilateral Crowe type-IV hip dislocation. J Bone Joint Surg Am 87:339–345. doi:10.2106/JBJS.D.02097

    Article  PubMed  Google Scholar 

  13. Noble PC, Kamaric E, Sugano N, Matsubara M, Harada Y, Ohzono K, Paravic V (2003) Three-dimensional shape of the dysplastic femur: implications for THR. Clin Orthop Relat Res 417:27–40

    PubMed  Google Scholar 

  14. Perka C, Fischer U, Taylor WR, Matziolis G (2004) Developmental hip dysplasia treated with total hip arthroplasty with a straight stem and a threaded cup. J Bone Joint Surg Am 86-A:312–319

    PubMed  Google Scholar 

  15. Koulouvaris P, Stafylas K, Sculco T, Xenakis T (2008) Distal femoral shortening in total hip arthroplasty for complex primary hip reconstruction A new surgical technique. J Arthroplast 23:992–998

    Article  Google Scholar 

  16. Paavilainen T, Hoikka V, Solonen KA (1990) Cementless total repacement for severely dysplastic or dislocated hips. J Bone Joint Surg (Br) 72:205–211

    CAS  Google Scholar 

  17. Woolson ST, Harris WH (1983) Complex total hip replacement for dysplastic or hypoplastic hips using miniature or microminiature components. J Bone Joint Surg Am 65:1099–1108

    CAS  PubMed  Google Scholar 

  18. Krych AJ, Howard JL, Trousdale RT, Cabanela ME, Berry DJ (2009) Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-IV developmental dysplasia. J Bone Joint Surg Am 91:2213–2221

    Article  PubMed  Google Scholar 

  19. Reikeras O, Haaland JE, Lereim P (2010) Femoral shortening in total hip arthroplasty for high developmental dysplasia of the hip. Clin Orthop Relat Res 468:1949–1955. doi:10.1007/s11999-009-1218-7

    Article  PubMed Central  PubMed  Google Scholar 

  20. Becker DA, Gustilo RB (1995) Double-chevron subtrochanteric shortening derotational femoral osteotomy combined with total hip arthroplasty for the treatment of complete congenital dislocation of the hip in the adult Preliminary report and description of a new surgical technique. J Arthroplast 10:313–318

    Article  CAS  Google Scholar 

  21. Hotokebuchi T, Sonohata M, Shigematsu M et al (2006) A new device for a V-shaped subtrochanteric osteotomy combined with total hip arthroplasty. J Arthroplasty 21:135–137. doi:10.1016/j.arth.2005.10.009

    Article  PubMed  Google Scholar 

  22. Kilicoglu OI, Turker M, Akgul T et al (2013) Cementless total hip arthroplasty with modified oblique femoral shortening osteotomy in Crowe type IV congenital hip dislocation. J Arthroplasty 28:117–125. doi:10.1016/j.arth.2012.06.014

    Article  PubMed  Google Scholar 

  23. Fujishiro T, Nishiyama T, Hayashi S et al (2012) Leg length change in total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe type IV developmental hip dysplasia. Arthroplast 27:1019–1022. doi:10.1016/j.arth.2012.01.032

    Article  Google Scholar 

  24. Paavilainen T1, Hoikka V, Solonen KA (1990) Cementless total replacement for severely dysplastic or dislocated hips. J Bone Joint Surg Br.72(2):205–11. http://www.ncbi.nlm.nih.gov/pubmed/2312556

  25. Delimar D1, Bicanic G, Korzinek K (2008) Femoral shortening during hip arthroplasty through a modified lateral approach. Clin Orthop Relat Res. 466(8):1954–8. doi: 10.1007/s11999-008-0292-6. Epub 2008 May 16. http://www.ncbi.nlm.nih.gov/pubmed/18483836

  26. Zhao X, Zhu ZA, Xie YZ et al (2011) Total hip replacement for high dislocated hips without femoral shortening osteotomy. J Bone Joint Surg (Br) 93:1189–1193. doi:10.1302/0301-620X.93B9.25914

    Article  CAS  Google Scholar 

  27. Hartofilakidis G, Karachalios T (2004) Total hip arthroplasty for congenital hip disease. J Bone Joint Surg Am 86-A:242–250

    PubMed  Google Scholar 

  28. Bao N, Meng J, Zhou L, Guo T, Zeng X, Zhao J (2013) Lesser trochanteric osteotomy in total hip arthroplasty for treating Crowe type IV developmental dysplasia of hip. Int Orthop (SICOT) 37:385–390

    Article  Google Scholar 

  29. Bruce WJM, Rizkallah SM, Kwon Y-M, Goldberg JA, Walsh WR (2000) A new technique of subtrochanteric shortening in total hip arthroplasty. J Arthroplasty 15:617–626

    Article  CAS  PubMed  Google Scholar 

  30. Sener N, Tozun I, Asik M (2002) Femoral shortening and cementless arthroplasty in high congenital dislocation of the hip. J Arthroplasty 17:41–48

    PubMed  Google Scholar 

  31. Carlsson A, Bjorkman A, Ringsberg K, von Schewelov T (2003) Untreated congenital and posttraumatic high dislocation of the hip treated by replacement in adult age: 22 hips in 16 patients followed for 1–8 years. Acta Orthop Scand 74:389–396

    Article  PubMed  Google Scholar 

  32. Onodera S, Majima T, Ito H, Matsuno T, Kishimoto T, Minami A (2006) Cementless total hip arthroplasty using the modular S-ROM prosthesis combined with corrective proximal femoral osteotomy. J Arthroplasty 21:664–669

    Article  PubMed  Google Scholar 

  33. Park M-S, Kim K-H, Jeong W-C (2007) Transverse subtrochanteric shortening osteotomy in primary total hip arthroplasty for patients with severe hip developmental dysplasia. J Arthroplasty 22:1031–1036

    Article  PubMed  Google Scholar 

  34. Bernasek TL, Haidukewych G, Gustke K, Hill O, Levering M (2007) Total hip arthroplasty requiring subtrochanteric osteotomy for developmental hip dysplasia: 5- to 14-year results. J Arthroplasty 22(Suppl 2):145–150

    Article  PubMed  Google Scholar 

  35. Nagoya S, Kaya M, Sasaki M, Tateda K, Kosukegawa I, Yamashita T (2009) Cementless total hip replacement with subtrochanteric femoral shortening for severe developmental dysplasia of the hip. J Bone Joint Surg (Br) 91:1142–1147

    Article  CAS  Google Scholar 

  36. Reikeraas O, Lereim P, Gabor I, Gunderson R, Bjerkreim I (1996) Femoral shortening in total arthroplasty for completely dislocated hips: 3–7 year results in 25 cases. Acta Orthop Scand 67:33–36

    Article  CAS  PubMed  Google Scholar 

  37. Yasgur DJ, Stuchin SA, Adler EM, DiCesare PE (1997) Subtrochanteric femoral shortening osteotomy in total hip arthroplasty for highriding developmental dislocation of the hip. J Arthroplasty 12:880–888

    Article  CAS  PubMed  Google Scholar 

  38. Chareancholvanich K, Becker DA, Gustilo RB (1999) Treatment of congenital dislocated hip by arthroplasty with femoral shortening. Clin Orthop Relat Res 360:127–135

    Article  PubMed  Google Scholar 

  39. Masonis JL, Patel JV, Miu A, Bourne RB, McCalden R, Macdonald SJ, Rorabeck CH (2003) Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia 5-year follow-up. J Arthroplasty 18(1):68–73

    Article  PubMed  Google Scholar 

  40. Howie CR, Ohly NE, Miller B (2010) Cemented Total Hip Arthroplasty With Subtrochanteric Osteotomy in Dysplastic Hips. Clin Orthop Relat Res 468:3240–3247

    Article  PubMed Central  PubMed  Google Scholar 

  41. Gaston MS, Gaston P, Donaldson P, Howie CR (2009) A new classification system for the adult dysplastic hip requiring total hip arthroplasty: a reliability study. Hip Int 19:96–101

    PubMed  Google Scholar 

  42. Edwards BN, Tullos HS, Nobel PC (1987) Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res 218:136–141

    PubMed  Google Scholar 

  43. Nercessian OA, Macaulay W, Stinchfield FE (1994) Peripheral neuropathies following total hip arthroplasty. J Arthroplasty 9:645–651

    Article  CAS  PubMed  Google Scholar 

  44. Dunn HK, Hess WE (1976) Total hip reconstruction in chronically dislocated hips. J Bone Joint Surg Am 58:838–845

    CAS  PubMed  Google Scholar 

  45. Dorr LD, Takei GK, Conaty JP (1983) Total hip arthroplasties in patients less than forty-five years old. J Bone Joint Surg Am 65:474–479

    CAS  PubMed  Google Scholar 

  46. Halley DK, Wroblewski BM (1986) Long term results of low-friction arthroplasty in patients 30 years of age or younger. Clin Orthop Relat Res 211:43–50

    PubMed  Google Scholar 

Download references

Conflict of interests

None.

Author information

Authors and Affiliations

  1. Orthopaedic Surgery, Ain Shams University, Cairo, Egypt

    Eid Ahmed, El-Ganzoury Ibrahim & Bassiony Ayman

Authors
  1. Eid Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. El-Ganzoury Ibrahim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bassiony Ayman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eid Ahmed.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ahmed, E., Ibrahim, EG. & Ayman, B. Total hip arthroplasty with subtrochanteric osteotomy in neglected dysplastic hip. International Orthopaedics (SICOT) 39, 27–33 (2015). https://doi.org/10.1007/s00264-014-2554-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-014-2554-0

Keywords

Search

Navigation