Top

Journal of Orthopaedic Science

Published in:

01-05-2011 | Original article

Cemented total hip arthroplasty with subtrochanteric femoral shortening transverse osteotomy for severely dislocated hips: outcome with a 3- to 10-year follow-up period

Authors: Haruhiko Akiyama, Keiichi Kawanabe, Koji Yamamoto, Yutaka Kuroda, Kazutaka So, Koji Goto, Takashi Nakamura

Published in: Journal of Orthopaedic Science | Issue 3/2011

Abstract

Background

Total hip arthroplasty (THA) for the treatment of severe dislocation of the hip is a technically demanding procedure. In most previous reports, techniques and clinical outcomes using cementless prostheses are widely reported, but there have been few reports on the technique and outcomes using cemented prostheses. The purpose of this study was to evaluate the outcomes of a cemented THA with a simultaneous subtrochanteric femoral shortening transverse osteotomy in patients with Crowe type III or IV developmental dysplasia of the hip.

Methods

We retrospectively reviewed 15 hips in 11 patients who underwent cemented THA with subtrochanteric femoral shortening transverse osteotomy and with placement of the acetabular component at the level of the anatomic hip center. Patients were evaluated preoperatively and postoperatively with the Merle d’Aubigné and Postel hip score. Radiographic examination was performed to evaluate the level of the femoral osteotomy site, of the radiographic leg lengthening, and of bone union.

Results

The clinical evaluation by the Merle d’Aubigné and Postel hip score was improved from 8.1 ± 2.5 preoperatively to 15.1 ± 1.3 at the time of final follow-up. Radiographic evidence of bone union at the osteotomy site appeared at more than 6 months after operation. Moreover, there were 3 (20%) nonunions that needed reoperation. No acetabular and femoral components exhibited radiological loosening at the time of final follow-up. In addition, one delayed union causing thigh pain was treated with low-intensity pulsed ultrasound that accelerated bone formation.

Conclusion

Our results in this study indicate that we should prevent instability at the transverse osteotomy site and an adequate intercalary cortical bone graft is needed to prevent nonunion in cemented THA combined with a subtrochanteric femoral shortening transverse osteotomy. We should apply this procedure with caution in patients, especially those who show less potential bone formation activity.

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

Harris WH. Total hip replacement for congenital dysplasia of hip: technique. St. Louis: C. V. Mosby; 1974. p. 251–65.

Dunn HK, Hess WE. Total hip reconstruction in chronically dislocated hips. J Bone Joint Surg Am. 1976;58:838–45.PubMed

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.PubMed

Harris WH, Crothers O, Oh I. Total hip replacement and femoral-head bone-grafting for severe acetabular deficiency in adults. J Bone Joint Surg Am. 1977;59:752–9.PubMed

Hartofilakidis G, Stamos K, Ioannidis TT. Low friction arthroplasty for old untreated congenital dislocation of the hip. J Bone Joint Surg Br. 1988;70:182–6.PubMed

MacKenzie JR, Kelley SS, Johnston RC. Total hip replacement for coxarthrosis secondary to congenital dysplasia and dislocation of the hip. Long-term results. J Bone Joint Surg Am. 1996;78:55–61.PubMed

Davlin LB, Amstutz HC, Tooke SM, Dorey FJ, Nasser S. Treatment of osteoarthrosis secondary to congenital dislocation of the hip. Primary cemented surface replacement compared with conventional total hip replacement. J Bone Joint Surg Am. 1990;72:1035–42.PubMed

Paavilainen T, Hoikka V, Solonen KA. Cementless total replacement for severely dysplastic or dislocated hips. J Bone Joint Surg Br. 1990;72:205–11.PubMed

10.

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;10:319–27.PubMedCrossRef

11.

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;10:313–8.PubMedCrossRef

12.

Hotokebuchi T, Sonohata M, Shigematsu M, Mawatari M. A new device for a V-shaped subtrochanteric osteotomy combined with total hip arthroplasty. J Arthroplasty. 2006;21:135–7.PubMedCrossRef

13.

Kawai T, Tanaka C, Ikegawa M, Kanoe H. Cemented total hip arthroplasty with transverse subtrochanteric shortening osteotomy for Crowe group IV dislocated hip. J Arthroplasty. 2011;26(2):229–35.PubMedCrossRef

14.

Howie CR, Ohly NE, Miller B. Cemented total hip arthroplasty with subtrochanteric osteotomy in dysplastic hips. Clin Orthop Relat Res. 2010;468(12):3240–7.PubMedCrossRef

15.

Dall D. Exposure of the hip by anterior osteotomy of the greater trochanter. A modified anterolateral approach. J Bone Joint Surg Br. 1986;68:382–6.PubMed

16.

Symeonides PP, Pournaras J, Petsatodes G, Christoforides J, Hatzokos I, Pantazis E. Total hip arthroplasty in neglected congenital dislocation of the hip. Clin Orthop Relat Res. 1997;341:55–61.PubMedCrossRef

17.

Merle d’Aubigné R, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am. 1954;36:451–75.

18.

Makita H, Inaba Y, Hirakawa K, Saito T. Results on total hip arthroplasties with femoral shortening for Crowe’s group IV dislocated hips. J Arthroplasty. 2007;22:32–8.PubMedCrossRef

19.

Akiyama H, Kawanabe K, Iida H, Pan H, Goto K, Nakamura T. Long-term results of cemented total hip arthroplasty in developmental dysplasia with acetabular bulk bone grafts after improving operative techniques. J Arthroplasty. 2010;25(5):716–20.PubMedCrossRef

20.

Mulroy RD Jr, Harris WH. Failure of acetabular autogenous grafts in total hip arthroplasty. Increasing incidence: a follow-up note. J Bone Joint Surg Am. 1990;72:1536–40.PubMed

21.

Rodriguez JA, Huk OL, Pellicci PM, Wilson PD Jr. Autogenous bone grafts from the femoral head for the treatment of acetabular deficiency in primary total hip arthroplasty with cement. Long-term results. J Bone Joint Surg Am. 1995;77:1227–33.PubMed

22.

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 Arthroplasty. 2003;18:68–73.PubMedCrossRef

23.

Sener N, Tozun IR, Asik M. Femoral shortening and cementless arthroplasty in high congenital dislocation of the hip. J Arthroplasty. 2002;17:41–8.PubMed

24.

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 Arthroplasty. 1997;12:880–8.PubMedCrossRef

25.

Chareancholvanich K, Becker DA, Gustilo RB. Treatment of congenital dislocated hip by arthroplasty with femoral shortening. Clin Orthop Relat Res. 1999;360:127–35.PubMedCrossRef

26.

Duarte LR. The stimulation of bone growth by ultrasound. Arch Orthop Trauma Surg. 1983;101:153–9.PubMedCrossRef

27.

Heckman JD, Ryaby JP, McCabe J, Frey JJ, Kilcoyne RF. Acceleration of tibial fracture-healing by non-invasive, low-intensity pulsed ultrasound. J Bone Joint Surg Am. 1994;76:26–34.PubMed

28.

Rubin C, Bolander M, Ryaby JP, Hadjiargyrou M. The use of low-intensity ultrasound to accelerate the healing of fractures. J Bone Joint Surg Am. 2001;83:259–70.PubMedCrossRef

Title: Cemented total hip arthroplasty with subtrochanteric femoral shortening transverse osteotomy for severely dislocated hips: outcome with a 3- to 10-year follow-up period
Authors: Haruhiko Akiyama
Keiichi Kawanabe
Koji Yamamoto
Yutaka Kuroda
Kazutaka So
Koji Goto
Takashi Nakamura
Publication date: 01-05-2011
Publisher: Springer Japan
Published in: Journal of Orthopaedic Science / Issue 3/2011
Print ISSN: 0949-2658
Electronic ISSN: 1436-2023
DOI: https://doi.org/10.1007/s00776-011-0049-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cemented total hip arthroplasty with subtrochanteric femoral shortening transverse osteotomy for severely dislocated hips: outcome with a 3- to 10-year follow-up period

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2011

Activation of glial cells in the spinal cord of a model of lumbar radiculopathy

Safe zone for the approach to the posterior sole (heel): a cadaver study

Aquaporin-1: a potential membrane channel for facilitating the adaptability of rabbit nucleus pulposus cells to an extracellular matrix environment

Short-term after-effect of forearm cast removal in children

Arthroscopic removal of intra-articular osteoid osteoma in the knee: case report and review of the literature

Extent and contraindications for sacral amputation in patients with recurrent rectal cancer: a systematic literature review