Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2019

Open Access 01-12-2019 | Hip Dysplasia | Case report

The causes and management of nonunion of femoral subtrochanteric shortening osteotomy in a THA patient: a case report

Authors: Song Gong, Weihua Xu, Ruoyu Wang, Shaokai Liu, Lizhi Han, Guo Chen, Bo Wang

Published in: BMC Musculoskeletal Disorders | Issue 1/2019

Login to get access

Abstract

Background

Total hip arthroplasty (THA) is considerably difficult to perform in patients with Crowe type IV developmental dysplasia of the hip (DDH). Some Crowe type IV DDH patients require a femoral subtrochanteric shortening osteotomy to equalize the length of the lower extremities and decrease the difficulty of intraoperative reduction. Subtrochanteric transverse osteotomy has been proven to have superior clinical efficacy, but some cases of nonunion occur.

Case presentation

We present the case of a 62-year-old male patient who underwent right THA with femoral subtrochanteric transverse osteotomy due to Crowe type IV DDH. Nonunion of the osteotomy occurred during the follow-up period. In July 2017, the patient underwent right THA and femoral subtrochanteric transverse osteotomy due to Crowe type IV DDH. In November 2017, a slight feeling of bone rubbing and slight pain in the hip were reported. The ends of the osteotomy had rotated and united poorly. However, the patient requested to undergo continued observation. In December 2017, the patient reported an obvious sensation of bone rubbing and aggravated hip pain. The ends of the osteotomy had rotated and continued to exhibit nonunion. On December 26, 2017, the patient was treated with plate and screw internal fixation with bone morphogenetic protein (BMP) following our suggestion. In August 2018, the ends of the osteotomy had united after internal fixation was applied.

Conclusions

THA with femoral subtrochanteric transverse osteotomy exhibits good efficacy for the treatment of patients with Crowe type IV DDH. However, postoperative nonunion occurs in a small number of cases. The causes of nonunion should be analysed, and effective measures should be taken to prevent this situation. Plate and screw internal fixation with BMP is an effective treatment for nonunion of the ends of an osteotomy.
Literature
1.
Yang S, Cui Q. Total hip arthroplasty in developmental dysplasia of the hip: Review of anatomy, techniques and outcomes. World J Orthop. 2012;3(5):42–8.CrossRef
2.
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(9):2213–21.CrossRef
3.
Ollivier M, Abdel MP, Krych AJ, Trousdale RT, Berry DJ. Long-Term Results of Total Hip Arthroplasty with Shortening Subtrochanteric Osteotomy in Crowe IV Developmental Dysplasia. J Arthroplast. 2016;31(8):1756–60.CrossRef
4.
Wang D, Li LL, Wang HY, Pei FX, Zhou ZK. Long-Term Results of Cementless Total Hip Arthroplasty with Subtrochanteric Shortening Osteotomy in Crowe Type IV Developmental Dysplasia. J Arthroplast. 2017;32(4):1211–9.CrossRef
5.
Muratli KS, Karatosun V, Uzun B, Celik S. Subtrochanteric shortening in total hip arthroplasty: biomechanical comparison of four techniques. J Arthroplast. 2014;29(4):836–42.CrossRef
6.
Park MS, Kim KH, Jeong WC. Transverse subtrochanteric shortening osteotomy in primary total hip arthroplasty for patients with severe hip developmental dysplasia. J Arthroplast. 2007;22(7):1031–6.CrossRef
7.
Zeng WN, Liu JL, Wang FY, Zhang X, Fan HQ, Chen GX, Guo L, Duan XJ, Zhou Q, Yang L. Total hip arthroplasty for patients with Crowe type IV developmental dysplasia of the hip: Ten years results. Int J Surg. 2017;42:17–21.CrossRef
8.
Greber EM, Pelt CE, Gililland JM, Anderson MB, Erickson JA, Peters CL. Challenges in Total Hip Arthroplasty in the Setting of Developmental Dysplasia of the Hip. J Arthroplast. 2017;32(9S):S38–44.CrossRef
9.
Hua WB, Yang SH, Xu WH, Ye SN, Liu XZ, Wang J, Feng Y. Total hip arthroplasty with subtrochanteric femoral shortening osteotomy for high hip dislocation. Orthop Surg. 2015;7(2):112–8.CrossRef
10.
Sonohata M, Kitajima M, Kawano S, Mawatari M. Nerve Palsy after Total Hip Arthroplasty without Subtrochanteric Femoral Shortening Osteotomy for a Completely Dislocated Hip Joint. Open Orthop J. 2016;10:785–92.CrossRef
11.
Akiyama H, Kawanabe K, Yamamoto K, Kuroda Y, So K, Goto K, Nakamura T. Cemented total hip arthroplasty with subtrochanteric femoral shortening transverse osteotomy for severely dislocated hips: outcome with a 3- to 10-year follow-up period. J Orthop Sci. 2011;16(3):270–7.CrossRef
12.
Charity JA, Tsiridis E, Sheeraz A, Howell JR, Hubble MJ, Timperley AJ, Gie GA. Treatment of Crowe IV high hip dysplasia with total hip replacement using the Exeter stem and shortening derotational subtrochanteric osteotomy. J Bone Joint Surg Br. 2011;93(1):34–8.CrossRef
13.
Wang D, Li DH, Li Q, Wang HY, Luo ZY, Yang Y, Pei FX, Zhou ZK. Subtrochanteric shortening osteotomy during cementless total hip arthroplasty in young patients with severe developmental dysplasia of the hip. BMC Musculoskelet Disord. 2017;18(1):491.CrossRef
14.
Sofu H, Kockara N, Gursu S, Issin A, Oner A, Sahin V. Transverse Subtrochanteric Shortening Osteotomy During Cementless Total Hip Arthroplasty in Crowe Type-III or IV Developmental Dysplasia. J Arthroplast. 2015;30(6):1019–23.CrossRef
15.
Mu W, Yang D, Xu B, Mamtimin A, Guo W, Cao L. Midterm Outcome of Cementless Total Hip Arthroplasty in Crowe IV-Hartofilakidis Type III Developmental Dysplasia of the Hip. J Arthroplast. 2016;31(3):668–75.CrossRef
16.
Masonis JL, Patel JV, Miu A, Bourne RB, McCalden R, Macdonald SJ, Rorabeck CH. Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia: 5-year follow-up. J Arthroplast. 2003;18(3 Suppl 1):68–73.CrossRef
17.
Yalcin N, Kilicarslan K, Karatas F, Mutlu T, Yildirim H. Cementless total hip arthroplasty with subtrochanteric transverse shortening osteotomy for severely dysplastic or dislocated hips. Hip Int. 2010;20(1):87–93.CrossRef
18.
Onodera S, Majima T, Ito H, Matsuno T, Kishimoto T, Minami A. Cementless total hip arthroplasty using the modular S-ROM prosthesis combined with corrective proximal femoral osteotomy. J Arthroplast. 2006;21(5):664–9.CrossRef
19.
Yasgur DJ, Stuchin SA, Adler EM, DiCesare PE. Subtrochanteric femoral shortening osteotomy in total hip arthroplasty for high-riding developmental dislocation of the hip. J Arthroplast. 1997;12:880.CrossRef
20.
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 Arthroplast. 2000;15:617.CrossRef
Metadata
Title
The causes and management of nonunion of femoral subtrochanteric shortening osteotomy in a THA patient: a case report
Authors
Song Gong
Weihua Xu
Ruoyu Wang
Shaokai Liu
Lizhi Han
Guo Chen
Bo Wang
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2019
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-019-2612-2

Other articles of this Issue 1/2019

BMC Musculoskeletal Disorders 1/2019 Go to the issue

Case report

Stress fracture of the posterior talar process in a female long-distance runner treated by osteosynthesis with screw fixation via two-portal hindfoot endoscopy: a case report

Research article

Loading capacity of dynamic knee spacers: a comparison between hand-moulded and COPAL spacers

Research article

Different suture anchor fixation techniques affect contact properties in humeral greater tuberosity fracture: a biomechanical study

Study protocol

Effect of a short message service (SMS) intervention on adherence to a physiotherapist-prescribed home exercise program for people with knee osteoarthritis and obesity: protocol for the ADHERE randomised controlled trial

Research article

Exercise-induced pain changes associate with changes in muscle perfusion in knee osteoarthritis: exploratory outcome analyses of a randomised controlled trial

Research article

Chronic widespread pain and its associations with quality of life and function at a 20- year follow-up of individuals with chronic knee pain at inclusion