Abstract
Background
When reconstructing a hip with developmental dysplasia with a high dislocation, placing the acetabular component in the anatomic position can result in a prosthetic hip that is difficult to reduce. Subtrochanteric femoral osteotomy and shortening makes reduction easier but can be associated with complications (eg, limp, sciatic nerve injury, nonunion of the osteotomy) or compromise long-term stem survival.
Questions/purposes
We therefore evaluated (1) the short-term complication rate, (2) functional scores, and (3) survivorship of prostheses in patients with high developmental dysplasia of the hip reconstructed with femoral shortening.
Patients and Methods
We prospectively followed 46 patients (65 hips) operated on from 1990 to 2000. There were 34 females and 12 males with a mean age of 48 years (range, 16–79 years). Before surgery, all patients had a positive Trendelenburg test. The minimum followup was 8 years (mean, 13 years; range, 8–18 years).
Results
One patient experienced recurrent dislocation and two peroneal nerve palsies, one of which partially recovered and one of which was permanent. In one patient, the stem subsided and after 8 months was replaced by a larger stem that stabilized. One patient had a nonunion but was functioning well and did not have additional surgery. At followup, 12 of the 65 hips (18%) had a positive Trendelenburg test. The mean muscle strength of the abductors was 4 (range, 3–5). The mean Harris hip score was 87 (range, 59–100) and the mean visual analog scale pain score 81 (range, 35–100). At followup, all stems were well fixed with no obvious signs of radiographic loosening. Ten cups were revised because of aseptic loosening.
Conclusions
Our data suggest femoral osteotomy and shortening at the subtrochanteric level predictably allows a stable reduction in patients with high developmental dysplasia of the hip and does not lead to any reduction in long-term survival.
Level of Evidence
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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References
Argenson JN, Flecher X, Parratte S, Aubaniac JM. Anatomy of the dysplastic hip and consequences for total hip arthroplasty. Clin Orthop Relat Res. 2007;465:40–45.
Bruce WJ, Rizkallah SM, Kwon YM, Goldberg JA, Walsh WR. A new technique of subtrochanteric shortening in total hip arthroplasty: surgical technique and results of 9 cases. J Arthroplasty. 2000;15:617–626.
Callaghan JJ, Forest EE, Sporer SM, Goetz DD, Johnston RC. Total hip arthroplasty in the young adult. Clin Orthop Relat Res. 1997;344:257–262.
DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.
Dorr LD, Kane TJ III, Conaty JP. Long-term results of cemented total hip arthroplasty in patients 45 years old or younger: a 16-year follow-up study. J Arthroplasty. 1994;9:453–456.
Edwards BN, Tullos HS, Nobel PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res. 1987;218:136–141.
Emery DF, Clarke HJ, Grover ML. Stanmore total hip replacement in younger patients: review of a group of patients under 50 years of age at operation. J Bone Joint Surg Br. 1997;79:240–246.
Erdemli B, Yilmaz C, Atalar H, Güzel B, Cetin I. Total hip arthroplasty in developmental high dislocation of the hip. J Arthroplasty. 2005;20:1021–1028.
Eskelinen A, Helenius I, Remes V, Ylinen P, Tallroth K, Paavilainen T. Cementless total hip arthroplasty in patients with high congenital hip dislocation. J Bone Joint Surg Am. 2006;88:80–91.
Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am. 2005; 87:2619–2625.
Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.
Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.
Hartofilakidis G, Karachalios T. Total hip arthroplasty for congenital hip disease. J Bone Joint Surg Am. 2004;86:242–250.
Hartofilakidis G, Stamos K, Ioannidis TT. Low friction arthroplasty for old untreated congenital dislocation of the hip. J Bone Joint Surg Br. 1988;70:182–186.
Hess WE, Umber JS. Total hip arthroplasty in chronically dislocated hips: follow-up study on the protrusio socket technique. J Bone Joint Surg Am. 1978;60:948–954.
Joshi AB, Porter ML, Trail IA, Hunt LP, Murphy JC, Hardinge K. Long-term results of Charnley low-friction arthroplasty in young patients. J Bone Joint Surg Br. 1993;75:616–623.
Kaplan E, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–481.
Kim YH, Seo HS, Kim JS. Outcomes after THA in patients with high hip dislocation after childhood sepsis. Clin Orthop Relat Res. 2009;467:2371–2378.
Koulouvaris P, Stafylas K, Sculco T, Xenakis T. Distal femoral shortening in total hip arthroplasty for complex primary hip reconstruction: a new surgical technique. J Arthroplasty. 2008;23:992–998.
Krych AJ, Howard JL, Trousdale RT, Cabanela ME, Berry DJ. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-IV developmental dysplasia. J Bone Joint Surg Am. 2009;91:2213–2221.
Linde F, Jensen J, Pilgaard S. Charnley arthroplasty in osteoarthritis secondary to congenital dislocation or subluxation of the hip. Clin Orthop Relat Res. 1988;227:164–171.
Livermore J, Ilstrup D, Morrey B. Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am. 1990;72:518–528.
Makita H, Inaba Y, Hirakawa K, Saito T. Results on total hip arthroplasties with femoral shortening for Crowe’s group IV dislocated hips. J Arthroplasty 2007;22:32–38.
Malchau H, Karrholm J, Wang YX, Herberts P. Accuracy of migration analysis in hip arthroplasty: digitized and conventional radiography, compared to radiostereometry in 51 patients. Acta Orthop Scand. 1995;66:418–424.
Massin P, Schmidt L, Engh CA. Evaluation of cementless acetabular component migration: an experimental study. J Arthroplasty. 1989;4:245–251.
Pagnano W, Hanssen AD, Lewallen DG, Shaughnessy WJ. The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty. J Bone Joint Surg Am. 1996;78:1004–1014.
Park MS, Kim KH, Jeong WC. Transverse subtrochanteric shortening osteotomy in primary total hip arthroplasty for patients with severe hip developmental dysplasia. J Arthroplasty. 2007;22:1031–1036.
Reikerås O, Gunderson RB. Long-term results of HA coated threaded versus HA coated hemispheric press fit cups: 287 hips followed for 11 to 16 years. Arch Orthop Trauma Surg. 2006;126:503–508.
Seddon HJ, ed. Peripheral Nerve Injuries. Medical Research Council Special Report Series Number 282. London, UK: Her Majesty’s Stationery Office; 1954.
Symeonides PP, Pournaras J, Petsatodes G, Christoforides J, Hatzokos I, Pantazis E. Total hip arthroplasty in neglected congenital dislocation of the hip. Clin Orthop Relat Res. 1997;341:55–61.
Wangen H, Lereim P, Holm I, Gunderson R, Reikerås O. Hip arthroplasty in patients younger than 30 years: excellent ten to 16-year follow-up results with a HA-coated stem. Int Orthop. 2008;32:203–208.
Zicat B, Engh CA, Gokcen E. Patterns of osteolysis around total hip components inserted with and without cement. J Bone Joint Surg Am. 1995;77:432–439.
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Reikerås, O., Haaland, J.E. & Lereim, P. Femoral Shortening in Total Hip Arthroplasty for High Developmental Dysplasia of the Hip. Clin Orthop Relat Res 468, 1949–1955 (2010). https://doi.org/10.1007/s11999-009-1218-7
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DOI: https://doi.org/10.1007/s11999-009-1218-7