Clin Orthop Surg.  2017 Mar;9(1):19-28. 10.4055/cios.2017.9.1.19.

Cementless Total Hip Arthroplasty Involving Trochanteric Osteotomy without Subtrochanteric Shortening for High Hip Dislocation

• Lee SJ
• Yoo JJ
• Kim HJ

• KMID: 2412299
• DOI: http://doi.org/10.4055/cios.2017.9.1.19

Abstract

BACKGROUND
Total hip arthroplasty with subtrochanteric shortening osteotomy is widely performed for high hip dislocation. However, suboptimal leg length discrepancy correction and nonunion of the osteotomy site remain concerns. Although total hip arthroplasty using trochanteric osteotomy without subtrochanteric osteotomy was introduced, cemented implants have been more commonly used than contemporary cementless implants in this procedure. We evaluated the long-term results of cementless total hip arthroplasty with trochanteric osteotomy without subtrochanteric osteotomy for high hip dislocation.
METHODS
From 1990 to 2002, 27 cementless total hip arthroplasties using trochanteric osteotomy without subtrochanteric osteotomy were performed in 26 patients with Crowe III or IV high hip dislocation and a mean age of 36.4 ± 12.9 years. Seven ceramic-on-ceramic, 8 ceramic-on-polyethylene, 10 metal-on-polyethylene, and 2 metal-on-metal bearings were inserted. Mean follow-up was 15.1 ± 3.7 years. We retrospectively reviewed medical records and radiographic data and evaluated the clinical and radiological results including the Harris hip score, implant survival, correction of leg length discrepancy, and occurrence of complications.
RESULTS
The mean Harris hip score and leg length discrepancy improved significantly from 73.3 to 94.9 points and from 4.3 cm to 1.0 cm, respectively. With revision for loosening set as the end point, implant survival rates at 10 and 15 years postoperatively were 96.0% and 90.9% for stems and 74.1% and 52.3% for cups. In 8 of 10 hips with the metal-on-polyethylene bearing and 4 of 8 hips with the ceramic-on-polyethylene bearing, revision surgery was performed for aseptic loosening. However, no revision was performed in hips with the ceramic-on-ceramic bearing or the metal-on-metal bearing. Implant survival was significantly different by the type of bearing surface. Two permanent neurologic complications occurred in patients with a limb lengthening over 3.5 cm.
CONCLUSIONS
With proper selection of the bearing surface coupled with adjustment of lengthening, cementless total hip arthroplasty using trochanteric osteotomy without subtrochanteric osteotomy might be a favorable treatment option for high hip dislocation.

Keyword

Congenital hip dislocation; Hip replacement; Dislocations; Osteotomy; Leg length inequality

MeSH Terms

Adolescent
Adult
Arthroplasty, Replacement, Hip/instrumentation/*methods
Ceramics
Female
Femur/diagnostic imaging/*surgery
Follow-Up Studies
Hip Dislocation/diagnostic imaging/*surgery
Hip Joint/diagnostic imaging/surgery
*Hip Prosthesis
Humans
Leg Length Inequality/diagnostic imaging/surgery
Male
Metal-on-Metal Joint Prostheses
Middle Aged
Osteotomy/*methods
Polyethylene
Prosthesis Design
Prosthesis Failure
Radiography
Reoperation
Survival Rate
Young Adult
Polyethylene

Figure

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  Fig. 1 Preoperative and postoperative radiographs and schematics of the operative technique. (A) The preoperative radiograph of a patient with Crowe type III high hip dislocation caused by developmental dysplasia shows a limb shortening of 3.5 cm. (B) The postoperative radiograph shows improved limb shortening to 1.4 cm. (C) Trochanteric osteotomy ① is performed and proximal femoral osteotomy ② is performed at the level between the upper border of the lesser trochanter and 1 cm proximal to the lesser trochanter. (D) Acetabular reaming ③ is performed and the structural bone graft for deficient acetabulum is obtained from the resected proximal femur or iliac crest and placed in the deficient acetabulum ④. (E) The cup ⑤ and stem ⑥ are inserted, and the greater trochanter is reattached with wire ⑦.

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  Fig. 2 Flowchart of the results of total hip arthroplasty involving trochanteric osteotomy without subtrochanteric shortening osteotomy for high hip dislocation. THA: total hip arthroplasty, CoC: ceramic-on-ceramic bearing.

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  Fig. 3 Kaplan-Meier survival analysis of cups and stems. CI: confidence interval.

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  Fig. 4 Preoperative and postoperative radiographs of a patient with Crowe type III high hip dislocation. (A) The preoperative radiograph shows a limb length discrepancy of 3.2 cm and acetabular dysplasia. (B) The postoperative radiograph shows stable implant fixation without osteolysis or loosening at 14.6 years after total hip arthroplasty using a ceramic-on-ceramic bearing.

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