[Total hip arthroplasty with shortening subtrochanteric osteotomy and custom-made prosthesis in Crowe type IV developmental dysplasia]

Reduction of High Hip Dislocation With a Distraction Nail and Arthroplasty (Preliminary Results of a Novel Technique)

A novel distraction technique is described for total hip arthroplasty in symptomatic high hip dislocation (Crowe IV) combining an intramedullary motorized lengthening nail with a pelvic support plate to gradually stretch hip soft tissues (distalization) and performing total hip arthroplasty with the cup in the primary acetabulum. Twelve patients (15 hips) were identified in a retrospective study via chart review. Medical records and radiographs were reviewed for details of the initial case parameters, surgical details, magnitude of distalization, duration of treatment, outcomes, and complications. Followed by an average of 67.4 mm of distalization, nearly anatomical cup placement, and equal leg length were achieved in all patients. During distalization, pain level was low with acceptable range of motion. One unplanned surgery and no complications with long-term sequelae occurred.

Comparison of transverse and modified subtrochanteric femoral shortening osteotomy in total hip arthroplasty for developmental dysplasia of hip: a meta-analysis

BACKGROUND

Subtrochanteric femoral shortening osteotomy is a crucial procedure to prevent nerve injury in total hip arthroplasty for severe developmental dysplasia of the hip. Transverse osteotomy was first applied, and other modified methods have also been reported. Each has its own advantages and limitations, but no definitive conclusions regarding differences in outcomes have been reached to date.

METHODS

We therefore performed a comprehensive meta-analysis to compare the outcomes of different approaches. 37 studies (795 hips) were included in the final analysis. Meta-analysis, subgroup analysis and meta-regression were performed.

RESULTS

Meta-analysis and subgroup analysis showed no significant difference between transverse and modified method. This is further confirmed by meta-regression. Method of osteotomy was found to be not associated with nonunion rate (P = 0.472), as well as other post-operative outcomes including nerve palsy (P = 0.240), dislocation (P = 0.735), revision (P = 0.653) and Harris hip score improvement (P = 0.562). In addition, western countries (P = 0.010) and duration of follow-up more than 5 years (P = 0.014) were associated with higher revision rate.

CONCLUSIONS

Transverse osteotomy and modified osteotomy appear to be equivalent in terms of nonunion, safety and efficacy. Transverse osteotomy may be recommended, due to its simplicity and convenience in adjusting the anteversion angle. Well-designed and large-sample-size randomized controlled trials are expected to confirm and update the findings of this analysis.

Greater trochanter osteotomy with cementless THA for Crowe type IV DDH

This study explored the surgical method and short-term clinical effect of a greater trochanter osteotomy along with cementless artificial total hip arthroplasty in the treatment of Crowe type IV developmental dysplasia of the hip. The authors conducted a retrospective analysis of 18 patients (22 hips) with Crowe type IV dysplasia who were seen between June 2008 and August 2010. After undergoing cementless artificial total hip arthroplasty using a posterolateral approach, a greater trochanter osteotomy was used to adjust the tension of the gluteal muscle, and an acetabular cup was placed. Average preoperative length shortening of the affected limb was 4.5 cm (range, 3.4-6 cm), and average postoperative length increase was 4.0 cm (range, 3.2-4.8 cm). Average postoperative Harris Hip Score was 87 (range, 79-91), which was higher than the average preoperative score of 38 (range, 32-51). Intraoperatively, 3 hips (3 patients) sustained a proximal femur fracture. Due to the stability of the femoral prosthesis, either no treatment or wire fixation only was given; by 2 months postoperatively, radiographs indicated that all fractures had healed. One patient had symptoms of sciatic nerve paralysis that resolved 3 months postoperatively. Performing a greater trochanter osteotomy after cementless artificial total hip arthroplasty is effective for the treatment of Crowe type IV dysplasia and can rebuild the complex biology and biomechanics of hip dysplasia without increasing the complication risk.