Total hip arthroplasty in neglected congenital high dislocation of the hip. A comparison of four different surgical techniques

An oblique osteotomy is better for subtrochanteric shortening in total hip arthroplasty for high hip dislocation: a mechanical comparison of four techniques

BACKGROUND

Subtrochanteric femoral shortening is used during total hip arthroplasty for high hip dislocation in developmental dysplasia of hip patients.

METHODS

We mechanically tested the stability of various commonly used subtrochanteric osteotomy techniques. As the equivalent of a femoral stem placed in a shortened femur without any stable fixation at the osteotomy line, 2 polyvinylchloride pipes were loosely intertwined. 4 different osteotomies (Z-subtrochanteric osteotomy, oblique-45° osteotomy, double Chevron-90° and 120° subtrochanteric osteotomy) were simulated. Torsional and axial loads were applied, and torsional stiffness was calculated for each test model.

RESULTS

Z, double Chevron-90° and 120° subtrochanteric osteotomy models demonstrated lower mean torsional stiffness than oblique-45° osteotomy. With the highest torsional stiffness oblique-45° provides the best stability for treatment of high dislocation hips when a subtrochanteric osteotomy is added.

CONCLUSIONS

This matches our previous clinical experience. Oblique osteotomy may also provide higher contact surfaces in the osteotomy lines to promote bone healing.

Operative and non-operative treatment options for dislocation of the hip following total hip arthroplasty

BACKGROUND

Dislocation following hip replacement is associated with significant morbidity and functional cost. The cause is usually multifactorial. A variety of treatment options are available which can broadly be classified into operative and non-operative.

OBJECTIVES

To determine the best methods of treatment of recurrent dislocation following total hip replacement.

SEARCH STRATEGY

The following databases were searched until August 2006: MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), Health Technology Assessment database (HTA), Database of Abstracts of Reviews of Effectiveness (DARE), International Standard Randomised Controlled Trial Number Register (ISRCTN), and MetaRegister of Controlled Trials (mRCT).

SELECTION CRITERIA

Randomised and quasi-randomised trials comparing operative and non-operative treatments for recurrent dislocation following total hip replacement.

DATA COLLECTION AND ANALYSIS

Two independent reviewers applied the inclusion criteria to identified studies.

MAIN RESULTS

Searches identified 269 studies. None fulfilled the inclusion criteria.

AUTHORS' CONCLUSIONS

The authors invite researchers to perform RCTs comparing different treatment options for recurrent dislocation of the hip. The heterogeneity of the population and variety of underlying causes would favour a multi-centre study to achieve an adequate sample size.