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.
Similar content being viewed by others
References
Rogers BA, Garbedian S, Kuchinad RA, Backstein D, Safir O, Gross AE (2012) Total hip arthroplasty for adult hip dysplasia. J Bone Joint Surg Am 94:1809–1821. https://doi.org/10.2106/JBJS.K.00779
Grappiolo G, Spotorno L, Burastero G (2007) Evolution of surgical techniques for the treatment of angular and torsional deviation in DDH: 20 years experience. Hip Int 17(Suppl 5):S105–S110
Free SA, Delp SL (1996) Trochanteric transfer in total hip replacement: effects on the moment arms and force-generating capacities of the hip abductors. J Orthop Res 14:245–250
Ahmed E, Ibrahim el G, Ayman B (2015) Total hip arthroplasty with subtrochanteric osteotomy in neglected dysplastic hip. Int Orthop 39:27–33. https://doi.org/10.1007/s00264-014-2554-0
Li X, Lu Y, Sun J, Lin X, Tang T (2017) Treatment of Crowe type-IV hip dysplasia using cementless total hip arthroplasty and double chevron subtrochanteric shortening osteotomy: a 5- to 10-year follow-up study. J Arthroplast 32:475–479. https://doi.org/10.1016/j.arth.2016.07.050
Tozun IR, Akgul T, Sensoy V, Kilicoglu OI (2016) The results of monoblock stem with step-cut femoral shortening osteotomy for developmentally dislocated hips. Hip Int 26:270–277. https://doi.org/10.5301/hipint.5000338
Takao M, Ohzono K, Nishii T, Miki H, Nakamura N, Sugano N (2011) Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia. J Bone Joint Surg Am 93:548–555. https://doi.org/10.2106/JBJS.I.01619
Ozden VE, Dikmen G, Beksac B, Tozun IR (2017) Tapered stems one-third proximally coated have higher complication rates than cylindrical two-third coated stems in patients with high hip dislocation undergoing total hip arthroplasty with step-cut shortening osteotomy. Orthop Traumatol Surg Res 103:569–577. https://doi.org/10.1016/j.otsr.2017.01.010
Akiyama H, Kawanabe K, Yamamoto K, Kuroda Y, So K, Goto K et al (2011) Cemented total hip arthroplasty with subtrochanteric femoral shortening transverse osteotomy for severely dislocated hips: outcome with a 3- to 10-year follow-up period. J Orthop Sci 16:270–277. https://doi.org/10.1007/s00776-011-0049-z
Zhu J, Shen C, Chen X, Cui Y, Peng J, Cai G (2015) Total hip arthroplasty with a non-modular conical stem and transverse subtrochanteric osteotomy in treatment of high dislocated hips. J Arthroplast 30:611–614. https://doi.org/10.1016/j.arth.2014.11.002
Zini R, Longo UG, de Benedetto M, Loppini M, Carraro A, Maffulli N et al (2013) Arthroscopic management of primary synovial chondromatosis of the hip. Arthroscopy 29:420–426. https://doi.org/10.1016/j.arthro.2012.10.014
Makita H, Inaba Y, Hirakawa K, Saito T (2007) Results on total hip arthroplasties with femoral shortening for Crowe’s group IV dislocated hips. J Arthroplast 22:32–38
Grappiolo G, Loppini M, Longo UG, Traverso F, Mazziotta G, Denaro V (2015) Trabecular metal augments for the management of Paprosky type III defects without pelvic discontinuity. J Arthroplast 30:1024–1029. https://doi.org/10.1016/j.arth.2015.01.001
DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 121:20–32
Gruen TA, McNeice GM, Amstutz HC (1979) “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 141:17–27
Kim YH, Kim JS, Oh SH, Kim JM (2003) Comparison of porous-coated titanium femoral stems with and without hydroxyapatite coating. J Bone Joint Surg Am 85:1682–1688
Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification J Bone Joint Surg Am 55:1629–1632
Loppini M, Longo UG, Caldarella E, Rocca AD, Denaro V, Grappiolo G (2017) Femur first surgical technique: a smart non-computer-based procedure to achieve the combined anteversion in primary total hip arthroplasty. BMC Musculoskelet Disord 18:331. https://doi.org/10.1186/s12891-017-1688-9
Traina F, De Fine M, Biondi F, Tassinari E, Galvani A, Toni A (2009) The influence of the centre of rotation on implant survival using a modular stem hip prosthesis. Int Orthop 33:1513–1518. https://doi.org/10.1007/s00264-008-0710-0
Oe K, Iida H, Kawamura H, Ueda N, Nakamura T, Okamoto N et al (2016) Long-term results of acetabular reconstruction using three bulk bone graft techniques in cemented total hip arthroplasty for developmental dysplasia. Int Orthop 40:1949–1954. https://doi.org/10.1007/s00264-015-3039-5
Liu S, Zuo J, Li Z, Yang Y, Liu T, Xiao J et al (2017) Study of three-dimensional morphology of the proximal femur in developmental adult dysplasia of the hip suggests that the on-shelf modular prosthesis may not be an ideal choice for patients with Crowe type IV hips. Int Orthop 41:707–713. https://doi.org/10.1007/s00264-016-3248-6
Catma MF, Unlu S, Ozturk A, Aksekili AM, Ersan O, Ates Y (2016) Femoral shortening osteotomy in total hip arthroplasty for severe dysplasia: a comparison of two fixation techniques. Int Orthop 40:2271–2276
Hasegawa Y, Iwase T, Kanoh T, Seki T, Matsuoka A (2012) Total hip arthroplasty for Crowe type developmental dysplasia. J Arthroplast 27:1629–1635. https://doi.org/10.1016/j.arth.2012.02.026
Rojas J, Bautista M, Bonilla G, Amado O, Huerfano E, Monsalvo D et al (2018) A retrospective study on the relationship between altered native acetabular angle and vertical implant malpositioning. Int Orthop 42:769–775. https://doi.org/10.1007/s00264-017-3584-1
Ohishi M, Nakashima Y, Yamamoto T, Motomura G, Fukushi JI, Hamai S et al (2016) Cementless total hip arthroplasty for patients previously treated with femoral osteotomy for hip dysplasia: the incidence of periprosthetic fracture. Int Orthop 40:1601–1606. https://doi.org/10.1007/s00264-015-2992-3
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-018-4122-5