Cementless Total Hip Replacement Arthroplasty with Subtrochanteric Shortening Osteotomy in Crowe IV Developmental Dysplasia of the Hip

Moon, Kyoung Ho; Lee, Tong Joo; Cha, Seung Do; Park, Young Ha

Abstract

PURPOSE
The purpose of the current study is to introduce a surgical technique of total hip arthroplasty, by which a postsurgical neurologic deficit can be prevented and excellent clinical and radiological outcome can be obtained in patients with Crowe IV developmental dysplasia of the hip. MATERIALS AND METHODS: Twelve hip joints underwent hip joint arthroplasty at our hospital between October 1995 and November 1997 due to hip joint arthritis secondary to developmental dysplasia of the hip. Among them six hip joints of five patients which belonged to the Crowe Classification IV were operated using cementless total hip arthroplasty with subtrochanteric shortening osteotomy. The medical records and radiographs of these five patients were reviewed. The average follow up period was 61.2 months (range of 40 to 77 months). Preoperative Harris hip score ranged from 61 to 71 (average, 66.2) points. Leg length discrepancy ranged from 2.0 to 5.5 (average, 4.1) cm. RESULTS: Harris Hip Score was improved to 95.3 (87 to 100) points at the last follow-up examination. The postoperative leg length was same bilaterally in five cases except for one case. Bone union in the osteotomy site was obtained three months after surgery. The radiolucent area and findings of movement of the acetabular cup were not observed. Subcidence of the femoral stem or pedestal formation was not observed in five cases. In one case, revision was done for the subcidence of 5 mm or more with radiolucent line around the entire stem and pedestal formation at 48 months postoperatively. One case showed femoral nerve paralysis immediately after the surgery, which recovered completely in six months after the surgery. CONCLUSION: This surgical technique is a useful method in total hip arthroplasty for the Crowe IV developmental dysplasia of the hip without permanent neurologic deficit.