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BMC Musculoskeletal Disorders

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Open Access 01-12-2014 | Research article

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

Authors: Changchuan Li, Chi Zhang, Maolin Zhang, Yue Ding

Published in: BMC Musculoskeletal Disorders | Issue 1/2014

Abstract

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.

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Dezateux C, Rosendahl K: Developmental dysplasia of the hip. Lancet. 2007, 369: 1541-1552. 10.1016/S0140-6736(07)60710-7.CrossRefPubMed

Peled E, Eidelman M, Katzman A, Bialik V: Neonatal incidence of hip dysplasia: ten years of experience. Clin Orthop Relat Res. 2008, 466: 771-775. 10.1007/s11999-008-0132-8.CrossRefPubMedPubMedCentral

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

Hartofilakidis G, Stamos K, Karachalios T, Ioannidis TT, Zacharakis N: Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg Am. 1996, 78: 683-692.PubMed

Sanchez-Sotelo J, Berry DJ, Trousdale RT, Cabanela ME: Surgical treatment of developmental dysplasia of the hip in adults: II. Arthroplasty options. J Am Acad Orthop Surg. 2002, 10: 334-344.CrossRefPubMed

Rosenstein AD, Diaz RJ: Challenges and solutions for total hip arthroplasty in treatment of patients with symptomatic sequelae of developmental dysplasia of the hip. Am J Orthop (Belle Mead NJ). 2011, 40: 87-91.

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: 2213-2221. 10.2106/JBJS.H.01024.CrossRefPubMed

Dunn HK, Hess WE: Total hip reconstruction in chronically dislocated hips. J Bone Joint Surg Am. 1976, 58: 838-845.PubMed

Kilicoglu OI, Turker M, Akgul T, Yazicioglu O: Cementless total hip arthroplasty with modified oblique femoral shortening osteotomy in Crowe type IV congenital hip dislocation. J Arthroplasty. 2013, 28: 117-125. 10.1016/j.arth.2012.06.014.CrossRefPubMed

10.

Yang S, Cui Q: Total hip arthroplasty in developmental dysplasia of the hip: review of anatomy, techniques and outcomes. World J Orthop. 2012, 3: 42-48. 10.5312/wjo.v3.i5.42.CrossRefPubMedPubMedCentral

11.

Zadeh HG, Hua J, Walker PS, Muirhead-Allwood SK: Uncemented total hip arthroplasty with subtrochanteric derotational osteotomy for severe femoral anteversion. J Arthroplasty. 1999, 14: 682-688. 10.1016/S0883-5403(99)90223-1.CrossRefPubMed

12.

Reikeras O, Haaland JE, Lereim P: Femoral shortening in total hip arthroplasty for high developmental dysplasia of the hip. Clin Orthop Relat Res. 2010, 468: 1949-1955. 10.1007/s11999-009-1218-7.CrossRefPubMedPubMedCentral

13.

Baz AB, Senol V, Akalin S, Kose O, Guler F, Turan A: Treatment of high hip dislocation with a cementless stem combined with a shortening osteotomy. Arch Orthop Trauma Surg. 2012, 132: 1481-1486. 10.1007/s00402-012-1560-1.CrossRefPubMed

14.

Dallari D, Pignatti G, Stagni C, Giavaresi G, Del Piccolo N, Rani N, Veronesi F, Fini M: Total hip arthroplasty with shortening osteotomy in congenital major hip dislocation sequelae. Orthopedics. 2011, 34: e328-e333.PubMed

15.

Decking J, Decking R, Schoellner C, Fuerderer S, Rompe JD, Eckardt A: Cementless total hip replacement with subtrochanteric femoral shortening for severe developmental dysplasia of the hip. Arch Orthop Trauma Surg. 2003, 123: 357-362. 10.1007/s00402-003-0554-4.CrossRefPubMed

16.

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: 313-318. 10.1016/S0883-5403(05)80180-9.CrossRefPubMed

17.

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: 32-38.CrossRefPubMed

18.

Strom L: Textbook of Pharmacoepidemiology. 2007, West Sussex: John Wiley & Sons

19.

Moher D, Liberati A, Tetzlaff J, Altman DG, Group P: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009, 339: b2535-10.1136/bmj.b2535.CrossRef

20.

Freeman M, Tukey J: Transformations related to the angular and the square root. Ann Math Stats. 1950, 21: 607-611. 10.1214/aoms/1177729756.CrossRef

21.

Higgins JP, Thompson SG: Quantifying heterogeneity in a meta-analysis. Stat Med. 2002, 21: 1539-1558. 10.1002/sim.1186.CrossRefPubMed

22.

Miller J: The inverse of the freeman-Tukey double arcsine transformation. Am Stat. 1978, 32: 138-138.

23.

Higghins J, Green S: Cochrane Handbook for Systematic Reviews of Interventions. 2008CrossRef

24.

Reikeraas O, Lereim P, Gabor I, Gunderson R, Bjerkreim I: Femoral shortening in total arthroplasty for completely dislocated hips: 3–7 year results in 25 cases. Acta Orthop Scand. 1996, 67: 33-36. 10.3109/17453679608995605.CrossRefPubMed

25.

Gotze C, Winkelmann W, Gosheger G, Rodl R: Is there a need of an additional extramedullary fixation in transverse subtrochanteric shortening in primary total hip arthroplasty for patients with severe hip dysplasia? Short-term experience in seven patients with congenital dislocation. Z Orthop Unfall. 2007, 145: 568-573.CrossRefPubMed

26.

Howie CR, Ohly NE, Miller B: Cemented total hip arthroplasty with subtrochanteric osteotomy in dysplastic hips. Clin Orthop Relat Res. 2010, 468: 3240-3247. 10.1007/s11999-010-1367-8.CrossRefPubMedPubMedCentral

27.

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: 34-38.CrossRefPubMed

28.

Starker M, Bischof F, Lindenfeld T: Total hip arthroplasty with shortening subtrochanteric osteotomy and custom-made prosthesis in Crowe type IV developmental dysplasia. Z Orthop Unfall. 2011, 149: 518-525.CrossRefPubMed

29.

Semenowicz J, Szymanski S, Walo R, Czuma P, Pijet B: Total hip arthroplasty with shortening subtrochanteric Z osteotomy in the treatment of developmental dysplasia with high hip dislocation. Ortop Traumatol Rehabil. 2012, 14: 341-349.CrossRefPubMed

30.

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: 880-888. 10.1016/S0883-5403(97)90157-1.CrossRefPubMed

31.

Chareancholvanich K, Becker DA, Gustilo RB: Treatment of congenital dislocated hip by arthroplasty with femoral shortening. Clin Orthop Relat Res. 1999, 360: 127-135.CrossRefPubMed

32.

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.CrossRefPubMed

33.

Bernasek TL, Haidukewych GJ, Gustke KA, Hill O, Levering M: Total hip arthroplasty requiring subtrochanteric osteotomy for developmental hip dysplasia: 5- to 14-year results. J Arthroplasty. 2007, 22: 145-150. 10.1016/j.arth.2007.05.014.CrossRefPubMed

34.

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 Arthroplasty. 2000, 15: 617-626. 10.1054/arth.2000.4335.CrossRefPubMed

35.

Erdemli B, Yilmaz C, Atalar H, Guzel B, Cetin I: Total hip arthroplasty in developmental high dislocation of the hip. J Arthroplasty. 2005, 20: 1021-1028. 10.1016/j.arth.2005.02.003.CrossRefPubMed

36.

Ozturkmen Y, Karli M, Dogrul C: Cemented total hip arthroplasty for severe dysplasia or congenital dislocation of the hip. Acta Orthop Traumatol Turc. 2002, 36: 195-202.PubMed

37.

Sener N, Tozun IR, Asik M: Femoral shortening and cementless arthroplasty in high congenital dislocation of the hip. J Arthroplasty. 2002, 17: 41-48.PubMed

38.

Park MS, Kim KH, Jeong WC: Transverse subtrochanteric shortening osteotomy in primary total hip arthroplasty for patients with severe hip developmental dysplasia. J Arthroplasty. 2007, 22: 1031-1036. 10.1016/j.arth.2007.05.011.CrossRefPubMed

39.

Nagoya S, Kaya M, Sasaki M, Tateda K, Kosukegawa I, Yamashita T: Cementless total hip replacement with subtrochanteric femoral shortening for severe developmental dysplasia of the hip. J Bone Joint Surg Br. 2009, 91: 1142-1147.CrossRefPubMed

40.

Togrul E, Ozkan C, Kalaci A, Gulsen M: A new technique of subtrochanteric shortening in total hip replacement for Crowe type 3 to 4 dysplasia of the hip. J Arthroplasty. 2010, 25: 465-470. 10.1016/j.arth.2009.02.023.CrossRefPubMed

41.

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: 270-277. 10.1007/s00776-011-0049-z.CrossRefPubMed

42.

Kilicarslan K, Yalcin N, Karatas F, Catma F, Yildirim H: Cementless total hip arthroplasty for dysplastic and dislocated hips. Eklem Hastalik Cerrahisi. 2011, 22: 8-15.PubMed

43.

Takao M, Ohzono K, Nishii T, Miki H, Nakamura N, Sugano N: Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia. J Bone Joint Surg Am. 2011, 93: 548-555. 10.2106/JBJS.I.01619.CrossRefPubMed

44.

Zhong C, Cai XZ, Yan SG, He RX: S-ROM modular arthroplasty combined with transverse subtrochanteric shortening for Crowe type IV congenital dislocation of hip. Chin Med J (Engl). 2011, 124: 3891-3895.

45.

Hasegawa Y, Iwase T, Kanoh T, Seki T, Matsuoka A: Total hip arthroplasty for Crowe type developmental dysplasia. J Arthroplasty. 2012, 27: 1629-1635. 10.1016/j.arth.2012.02.026.CrossRefPubMed

46.

Sun QC, Wang XH, Song BS, Zhu FB, Yan SG: Total hip arthroplasty for crowe type IV developmental dysplasia of the hip with S-ROM prosthesis. Zhongguo Gu Shang. 2013, 26: 153-157.PubMed

47.

Kawai T, Tanaka C, Ikenaga M, Kanoe H: Cemented total hip arthroplasty with transverse subtrochanteric shortening osteotomy for Crowe group IV dislocated hip. J Arthroplasty. 2011, 26: 229-235. 10.1016/j.arth.2010.03.029.CrossRefPubMed

48.

Li W, Zhang W, Bai G, Huang Z, Shen R: Total hip arthroplasty for treatment of Crowe type IV congenital dysplasia of hip with dislocation in adults. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013, 27: 1153-1156.PubMed

49.

Li Y, Ma W, Sun J, Song X, An M, Zhang Q: Becker V-shaped lateral rotation osteotomy in total hip arthroplasty for Crowe type IV development dislocation of hip. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013, 27: 1032-1036.PubMed

50.

Oe K, Iida H, Nakamura T, Okamoto N, Wada T: Subtrochanteric shortening osteotomy combined with cemented total hip arthroplasty for Crowe group IV hips. Arch Orthop Trauma Surg. 2013, 133: 1763-1770. 10.1007/s00402-013-1869-4.CrossRefPubMedPubMedCentral

51.

Oinuma K, Tamaki T, Miura Y, Kaneyama R, Shiratsuchi H: Total hip arthroplasty with subtrochanteric shortening osteotomy for Crowe grade 4 dysplasia using the direct anterior approach. J Arthroplasty. 2014, 29: 626-629. 10.1016/j.arth.2013.07.038.CrossRefPubMed

52.

Brooks PJ: Dislocation following total hip replacement: causes and cures. Bone Joint J. 2013, 95-B: 67-69. 10.1302/0301-620X.95B11.32645.CrossRefPubMed

53.

Jamsen E, Varonen M, Huhtala H, Lehto MU, Lumio J, Konttinen YT, Moilanen T: Incidence of prosthetic joint infections after primary knee arthroplasty. J Arthroplasty. 2010, 25: 87-92.CrossRefPubMed

54.

Dale H, Hallan G, Hallan G, Espehaug B, Havelin LI, Engesaeter LB: Increasing risk of revision due to deep infection after hip arthroplasty. Acta Orthop. 2009, 80: 639-645. 10.3109/17453670903506658.CrossRefPubMedPubMedCentral

55.

Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J: Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res. 2008, 466: 1710-1715. 10.1007/s11999-008-0209-4.CrossRefPubMedPubMedCentral

56.

Harrison T, Robinson P, Cook A, Parker MJ: Factors affecting the incidence of deep wound infection after hip fracture surgery. J Bone Joint Surg Br. 2012, 94: 237-240.CrossRefPubMed

57.

Edwards C, Counsell A, Boulton C, Moran CG: Early infection after hip fracture surgery: risk factors, costs and outcome. J Bone Joint Surg Br. 2008, 90: 770-777.CrossRefPubMed

58.

Bracken J, Tran T, Ditchfield M: Developmental dysplasia of the hip: controversies and current concepts. J Paediatr Child Health. 2012, 48: 963-972. 10.1111/j.1440-1754.2012.02601.x. quiz 972–963CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/15/331/prepub

Title: Comparison of transverse and modified subtrochanteric femoral shortening osteotomy in total hip arthroplasty for developmental dysplasia of hip: a meta-analysis
Authors: Changchuan Li
Chi Zhang
Maolin Zhang
Yue Ding
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2014
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/1471-2474-15-331

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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