Hip Pelvis.  2014 Mar;26(1):22-28. 10.5371/hp.2014.26.1.22.

Cementless Total Hip Arthroplasty with Subtrochanteric Transverse Shortening Osteotomy in Patients with High Hip Dislocation

• Kim GW
• Lee KJ
• Min BW
• Bae KC
• Jang HG

• KMID: 2054158
• DOI: http://doi.org/10.5371/hp.2014.26.1.22

Abstract

PURPOSE
The purpose of this study was to evaluate the clinical and radiographic results of cementless total hip arthroplasty (THA) with subtrochanteric transverse shortening osteotomy in patients with high hip dislocation.
MATERIALS AND METHODS
Eighteen patients with high hip dislocation who underwent cementless THA combined with a subtrochanteric transverse shortening osteotomy, plate or cable fixation and bone graft on the osteotomy site between 2001 and 2012 were evaluated in this study. The mean duration of follow-up was 5.2 (2-8.3) years. We evaluated Harris hip score, limping, limb length discrepancy as a clinical parameter and osteolysis, loosening and union of the osteotomy site as a radiographic parameter.
RESULTS
Harris hip scores at the final follow-up showed improvement of limping and limb length discrepancy in all cases. And, with the exception of two cases of infection, there were no loosening and osteolysis. All cases showed union of the osteotomy site. There were two cases of infection and one case of dislocation as a complication. Infection occurred in two patients who underwent reoperation and one patient developed sciatic nerve palsy.
CONCLUSION
Cementless THA with subtrochanteric transverse shortening osteotomy showed relatively satisfactory clinical and radiologic results. However, the incidence of complications, such as infection, is relatively high, therefore, careful attention is needed.

Keyword

Congenital hip dislocation; Osteotomy; Hip replacement arthroplasty

MeSH Terms

Arthroplasty, Replacement, Hip*
Dislocations
Extremities
Follow-Up Studies
Hip
Hip Dislocation*
Hip Dislocation, Congenital
Humans
Incidence
Osteolysis
Osteotomy*
Reoperation
Sciatic Neuropathy
Transplants

Figure

• 

  Fig. 1 (A) A preoperative radiograph shows Crowe classification 4 high dislocation of the right hip with about 6 cm limb-length discrepancy. (B) A postoperative radiograph shows the hip after femoral shortening and total hip replacement on the right side. (C) A postoperative radiograph after 4.5 years shows healing of the osteotomy site and incorporation of the prosthesis.

• 

  Fig. 2 (A) A preoperative radiograph shows Crowe classification 4 high dislocation of the left hip. (B) A postoperative radiograph shows the hip after femoral shortening and total hip replacement on the left side. (C) A postoperative radiographs show after 6 months acetabular cup loosening caused by infection and after management of infected total hip replacement with PROSTALAC®. But, well-fixed femoral stem was retained. (D) A postoperative radiograph after the second stage revision shows no evidence of periprosthetic osteolysis and implant loosening.

Reference

1. Charnley J, Feagin JA. Low-friction arthroplasty in congenital subluxation of the hip. Clin Orthop Relat Res. 1973; (91):98–113.

2. Kim YH. Total arthroplasty of the hip after childhood sepsis. J Bone Joint Surg Br. 1991; 73:783–786.

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

4. 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.

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

6. 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.

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

8. Hartofilakidis G, Stamos K, Karachalios T, Ioannidis TT, Zacharakis N. Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg Am. 1996; 78:683–692.

9. Lim BH, Moon YW, Lim SJ, Lee HS, Park YS. Modular cementless total hip arthroplasty with subtrochanteric shortening osteotomy in patients with high hip dislocation. J Korean Hip Soc. 2010; 22:253–259.

10. Sponseller PD, McBeath AA. Subtrochanteric osteotomy with intramedullary fixation for arthroplasty of the dysplastic hip. A case report. J Arthroplasty. 1988; 3:351–354.

11. Cho CH, Yoo MC, Cho YJ, Lee YW, Kwon HG. Total hip replacement in unreduced hip dislocation. J Korean Orthop Assoc. 1999; 34:17–22.

12. Malchau H, Kärrholm 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.

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

14. 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.

15. 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.

16. Reikerås O, Haaland JE, Lereim P. Femoral shortening in total hip arthroplasty for high developmental dysplasia of the hip. Clin Orthop Relat Res. 2010; 468:1949–1955.

17. Takao M, Ohzono K, Nishii T, Miki H, Nakamura N, Sugano N. Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia. J Bone Joint Surg Am. 2011; 93:548–555.

18. 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.

19. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976; (121):20–32.

20. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990; (257):107–128.

21. Becker DA, Gustilo RB. 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 Arthroplasty. 1995; 10:313–318.

22. Kiliçoğlu Oİ, Türker M, Akgül T, Yazicioğlu O. Cementless total hip arthroplasty with modified oblique femoral shortening osteotomy in Crowe type IV congenital hip dislocation. J Arthroplasty. 2013; 28:117–125.

23. Lee SH, Kim BK, Ahn JY, Hwang JH, Lee DH. Short term results of cementless total hip arthroplasty with subtrochanteric shortening osteotomy in severe dysplasia of hip. J Korean Hip Soc. 2007; 19:136–143.

24. 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.

25. Sener N, Tözün IR, Aşik M. Femoral shortening and cementless arthroplasty in high congenital dislocation of the hip. J Arthroplasty. 2002; 17:41–48.

26. Fujishiro T, Nishiyama T, Hayashi S, Kurosaka M, Kanno T, Masuda T. Leg length change in total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe type IV developmental hip dysplasia. J Arthroplasty. 2012; 27:1019–1022.

27. Huo MH, Zatorski LE, Keggi KJ. Oblique femoral osteotomy in cementless total hip arthroplasty. Prospective consecutive series with a 3-year minimum follow-up period. J Arthroplasty. 1995; 10:319–327.