Total hip arthroplasty with Wagner Cone stem and subtrochanteric shortening osteotomy in treatment of Crowe Ⅳ developmental dysplasia of hip in adults / 中国修复重建外科杂志

Objective: To investigate the short-term effectiveness of total hip arthroplasty with Wagner Cone stem combined with subtrochanteric shortening osteotomy for adult patients with Crowe Ⅳ developmental dysplasia of the hip (DDH). Methods: A clinical data of 18 patients (20 hips) with Crowe Ⅳ DDH between January 2015 and June 2017 was retrospectively analyzed. There were 5 males (6 hips) and 13 females (14 hips), with an average age of 42 years (range, 20-67 years). There were 18 cases with unilateral DDH and 2 cases with bilateral DDHs. The "4" sign and Trendelenburg sign of affected hip were positive. Preoperative Harris score and visual analogue scale (VAS) score were 41.95±6.90 and 5.05±1.15, respectively. The length discrepancy was (4.76±2.59) cm in patients with unilateral DDH. And the lengths of bilateral lower limbs in patients with bilateral DDH were equal. The acetabular anteversion angle, femoral anteversion angle, and combined anteversion angle were (32.82±2.79), (46.18±6.80), and (79.01±7.54) °, respectively. All patients were treated by total hip arthroplasty with Wagner Cone stem and subtrochanteric shortening osteotomy. The length of osteotomy ranged from 2.0 to 3.5 cm (mean, 2.38 cm). Results: The operation time was 116-161 minutes (mean, 138.4 minutes); the volume of intraoperative blood loss was 600-1 200 mL (mean, 795 mL); the volume of drainage after operation was 100-630 mL (mean, 252 mL). All incisions healed by first intention. The symptom of sciatic nerve injury occurred in 1 case and relieved after symptomatic treatment. All patients were followed up 12-29 months (mean, 18.4 months). The "4" sign and Trendelenburg sign of affected hip were negative. The Harris score and VAS score at last follow-up were 87.50±5.06 and 0.75±0.85, respectively. The acetabular anteversion angle, femoral anteversion angle, and combined anteversion angle were (16.21±4.84), (18.99±2.55), and (35.20±5.80)°, respectively. There were significant differences in above indexes between pre- and post-operation ( P<0.05). The length discrepancy was (0.72±0.70) cm in patients with unilateral DDH, which was significant shorter than the preoperative value ( t=7.751, P=0.000). And the lengths of bilateral lower limbs in patients with bilateral DDH were equal. X-ray films showed that the osteotomy of femur healed at 3-6 months (mean, 4.1 months) without the signs of loosening, sinking, osteolysis, and dislocation. Conclusion: Total hip arthroplasty with Wagner Cone stem and subtrochanteric shortening osteotomy can obviously improve the hip joint function and restore the length of lower limb. The short-term effectiveness is satisfactory, but the long-term effectiveness and survival rate of prosthesis need to be further observed.

Updates on Ulnar Impaction Syndrome / 대한정형외과학회잡지

Ulnar impaction syndrome is one of the common causes of ulnar-sided wrist pain. The pain is usually aggravated by ulnar deviation during a power grip, especially when the forearm is in a pronated position. The most common predisposing factor of ulnar impaction syndrome is ulnar positive variance, which is an increased ulnar length relative to the radius of the radiocarpal joint. However, it can also occur in patients with ulnar neutral or negative variance because ulnar variance can increase during functional activities, including pronation and power gripping. In these patients, the triangular fibrocartilage complex (TFCC) may be thickened. If conservative treatments—lifestyle modification, medication, or wrist splinting—are unsuccessful, surgical treatments, such as wafer procedure or ulnar shortening osteotomy can be considered. The wafer procedure is an effective treatment for ulnar impaction syndrome. It removes the distal 2 to 4 mm of the ulnar head, while preserving the ulnar styloid process from fracturing via a limited open or an arthroscopic approach. The advantages of the wafer procedure are that it does not require bone healing or internal fixation and provides direct access to TFCC. However, it is a technically demanding procedure and is contraindicated in patients with distal radio-ulnar joint (DRUJ) instability, lunotriquetral instability, ulnar minus variance, and with an ulnar positive variance of more than 4 mm. Ulnar shortening osteotomy is the most popular method for the treatment of ulnar impaction syndrome. It can effectively relieve ulnar impaction symptoms and stabilize DRUJ. However, an excessive amount of shortening may increase the peak pressure at DRUJ, which results in DRUJ arthritis. There is also a possibility of delayed union or nonunion in the osteotomy site. To prevent delayed union or nonunion, we should make an effort to decrease the gap in the osteotomy site during surgery. A serial follow-up is also recommended to evaluate the occurrence of arthritis in DRUJ after ulnar shortening.

The short-term efficacy of Crowe Ⅳ developmental dysplasia treated by total hiparthroplasty with subtrochanteric shortening osteotomy / 重庆医学

Objective To evaluate the short-term efficacy of total hip arthroplasty combined with subcutaneous osteotomy in the treatment of CroweⅣ hip dysplasia (DDH).Methods From March 2012 to March 2015,14 patients (16 hips) underwent total hip arthroplasty with femoral distraction osteotomy S-ROM femoral stem prosthesis.And we observed its recent efficacy.Results All patients underwent S-ROM prosthesis.The patients underwent transverse osteotomy of the femoral trochanter.The osteotomy length was 2.0-3.5 cm.The average follow-up time was 19 months.And no complications such as dislocation,vascular nerve injury,deep vein thrombosis and infection were observed during the follow-up.The average Harris scores improved from 42.3 preoperatively to 90.4 postoperatively at 9 months after the operation.The average lengths of preoperative limb shortening and postoperative limb shortening were 6.4 cm and 4.3 cm respectively.The X-ray films showed no dislocation of acetabulum and femoral prosthesis.Bone healing was achieved at 6 months after osteotomy.Conclusion This method could be a good choice for Crowe Ⅳ developmental dysplasia.The short-term efficacy is satisfactory.

Treatment of Acute Tuberculous Spondylitis by the Spinal Shortening Osteotomy: A Technical Notes and Case Illustrations

Surgical treatment for spinal tuberculosis is necessary in particular cases that a large amount of necrotic tissue is encountered and there is spinal cord compression. A spinal shortening osteotomy procedure has previously been described for the correction of the sagittal balance in a late kyphotic deformity, but there have been no reports on this as a surgical treatment in the acute stage. Thus, the aim of this report is to present the surgical techniques and clinical results of 3 patients who were treated with this procedure. Three patients with tuberculous spondylitis at the thoracic spine were surgically treated with this procedure. All the patients presented with severe progressive back pain, kyphotic deformity and neurological deficit. The patients recovered uneventfully from surgery without further neurological deterioration. Their pain was improved and the patients remained free of pain during the follow-up period. In conclusion, posterior spinal shortening osteotomy is an alternative method for the management of tuberculous spondylitis.

A Comparison of Ulnar Shortening Osteotomy Alone Versus Combined Arthroscopic Triangular Fibrocartilage Complex Debridement and Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome

BACKGROUND: This study compared the results of patients treated for ulnar impaction syndrome using an ulnar shortening osteotomy (USO) alone with those treated with combined arthroscopic debridement and USO. METHODS: The results of 27 wrists were reviewed retrospectively. They were divided into three groups: group A (USO alone, 10 cases), group B (combined arthroscopic debridement and USO, 9 cases), and group C (arthroscopic triangular fibrocartilage complex [TFCC] debridement alone, 8 cases). The wrist function was evaluated using the modified Mayo wrist score, disabilities of the arm, shoulder and hand (DASH) score and Chun and Palmer grading system. RESULTS: The modified Mayo wrist score in groups A, B, and C was 74.5 +/- 8.9, 73.9 +/- 11.6, and 61.3 +/- 10.2, respectively (p 0.05). CONCLUSIONS: Both USO alone and combined arthroscopic TFCC debridement with USO improved the wrist function and reduced the level of pain in the patients treated for ulnar impaction syndrome. USO alone may be the preferred method of treatment in patients if the torn flap of TFCC is not unstable.

Long-term Outcomes of Ulnar Shortening Osteotomy for Idiopathic Ulnar Impaction Syndrome: At Least 5-Years Follow-up

BACKGROUND: There have been few outcomes studies with follow-up after performing ulnar shortening osteotomy for ulnar impaction syndrome. We investigated the long-term clinical and radiological outcomes of ulnar shortening osteotomy for the treatment of idiopathic ulnar impaction syndrome. METHODS: We retrospectively reviewed 36 patients who had undergone ulnar shortening osteotomy for idiopathic ulnar impaction syndrome for a mean follow-up of 79.1 months (range, 62 to 132 months). The modified Gartland and Werley scores were measured pre- and postoperatively. The radiographic parameters for the assessment of the distal radioulnar joint (DRUJ) as well as the relationship between these radiographic parameters and the clinical and radiological outcomes were determined. RESULTS: The average modified Gartland and Werley wrist score improved from 65.5 +/- 8.1 preoperatively to 93.4 +/- 5.8 at the last follow-up visit. The average preoperative ulnar variance of 4.7 +/- 2.0 mm was reduced to an average of -0.6 +/- 1.4 mm postoperatively. Osteoarthritic changes of the DRUJ were first seen at 34.8 +/- 11.1 months follow-up in 6 of 36 wrists (16.7%). Those who had osteoarthritic changes in the DRUJ had significantly wider preoperative ulnar variance, a longer distal radioulnar distance and a greater length of ulnar shortening, but the wrist scores of the patients who had osteoarthritic changes in the DRUJ were comparable to those who did not have osteoarthritic changes in the DRUJ. CONCLUSIONS: The clinical outcomes are satisfactory for even more than 5 years after ulnar shortening osteotomy for treating idiopathic ulnar impaction syndrome despite the osteoarthritic changes of the DRUJ. The patients who need a larger degree of ulnar shortening may develop DRUJ arthritis.

Modular Cementless Total Hip Arthroplasty with Subtrochanteric Shortening Osteotomy in Patients with High Hip Dislocation

PURPOSE: The purpose of this study was to report on the results of performing modular cementless total hip arthroplasty with a simultaneous subtrochanteric shortening osteotomy in patients with high hip dislocation. MATERIALS AND METHODS: We evaluated 23 patients (24 hips) with high hip dislocation and who had undergone total hip arthroplasty using a proximally modular cementless stem in combination with a subtrochanteric shortening osteotomy in order to place the acetabular cup at the level of the anatomic hip center between May 1996 and June 2008. There were 6 males and 17 females with a mean age of 44 years. The mean duration of follow-up was 5.6 years. RESULTS: The mean Harris hip score improved from 53 points preoperatively to 88 points at the time of final follow-up (P<0.001), and there were good or excellent results in 21 hips (87.5%). There was one instance of isolated loosening of the acetabular component. With the exception of one hip requiring revision surgery at 12 years postoperatively because of polyethylene wear and cup loosening, all the remaining components were well-fixed at the time of the last follow-up. A total of 4 hips (17%) had complications during follow-up; one dislocation, two transient femoral nerve palsies and one nonunion of the subtrochanteric osteotomy site. CONCLUSION: Modular cementless total hip arthroplasty with a subtrochanteric shortening osteotomy in patients with high hip dislocation was associated with excellent clinical outcomes while it minimized additional fixation of the osteotomy site.

The Results of Radial Shortening Osteotomy for Kienbock Disease Stage III

PURPOSE: Radial shortening osteotomy and ulnar lengthening osteotomy for decreasing axial loading have been known to treatment for avascular necrosis of lunate bone. The purpose of this study was to evaluate the clinical outcomes of radial shortening osteotomy for Lichtman stage III Kienbock disease. MATERIALS AND METHODS: Between December 2001 and October 2008, thirteen patients with Kienbock disease underwent a radial shortening osteotomy at our institution. On the basis of Lichtman classification, six had stage IIIA and seven had stage IIIB. Radiographic measurement of the ulnar variance and the carpal height ratio were assessed preoperatively and at the follow-up. Patients were examined for wrist pain, range of motion at flexion and extension and grip strength both preoperatively and postoperatively. The clinical outcomes was evaluated through the modification of Evans scoring system. RESULTS: All thirteen had maintained the preoperative stage at the follow-up. In ulnar variance, negative variance was seven. The carpal height ratio was increased mean 0.018 at the follw-up. Pain in VAS was improved mean 3.6 at the follow-up. In range of motion of wrist flexion-extension, in the eleven which had limitation of motion preoperatively, all eleven showed improvement. In grip strength, among the ten which had decreased preoperatively, eight showed improvement and two showed no change at the follw-up. The clinical outcomes were good in eight, fair in three and poor in two. Among the five, negative ulnar variance of stage IIIB, three had good, two had fair clinical outcomes. CONCLUSIONS: We found that radial shortening osteotomy can prevent disease progression, also show good clinical results for stage IIIB Kienbock disease as well as stage IIIA.

Ulnar Shortening Osteotomy for the Treatment of Ulnar Impaction Syndrome

PURPOSE: To compare the clinical outcomes of the ulnar shortening osteotomy alone and the ulnar shortening osteotomy with arthroscopic debridement in the idiopathic ulnar impaction syndrome with positive ulnar variance. MATERIALS AND METHODS: Twenty seven cases, who underwent the ulnar shortening osteotomy with or without arthroscopic debridement for treatment of the idiopathic ulnar impaction syndrome with positive ulnar variance, were included. The mean age was 40.3 years (range, 21 to 63 years) and the mean follow-up period was 20.6 months (range, 12 to 60 months). The ulnar shortening osteotomy alone and the ulnar shortening osteotomy with arthroscopic debridement were performed in 14 and 13 cases respectively. Pre- and postoperative functional results of the wrist were evaluated by the modified Mayo wrist score. RESULTS: The ulnar variance was corrected from 4.61 mm (range, 1.8~10 mm) to -0.06 mm (range, -3.3~3.1 mm) in the ulnar shortening osteotomy alone group and from 3.01 mm (range, 1.2~7.6 mm) to -0.74 mm (range, -1.8~0 mm) in the ulnar shortening osteotomy with arthroscopic debridement group. The final results of the ulnar shortening osteotomy alone were excellent in 4 cases, good in 5 cases, and fair in 5 cases. Those of the ulnar shortening osteotomy with arthroscopic debridement group were excellent in 6 cases, good in 2 cases, fair in 1 case, and poor in 2 cases. The modified Mayo wrist score at the last follow-up were 83.57(range, 75~100) in the ulnar shortening osteotomy alone group and 83.35(range, 40~100) in the ulnar shortening osteotomy with arthroscopic debirdement group. No statistically significant difference was demonstrated between two groups (p=0.43). CONCLUSION: The ulnar shortening osteotomy is valuable treatment for the idiopathic ulnar impaction syndrome with positive ulnar variance. The combined arthroscopic debridment does not appear to have positive influence to the final results.

Total Hip Arthroplasty without a Femoral Shortening Procedure for Treating a Highly Dislocated Hip

PURPOSE: This study evaluated the results of total hip arthroplasty (THA) without a femoral shortening procedure for the treatment of a highly dislocated hip. MATERIALS AND METHODS: A total of 11 hips of 11 patients who underwent THA between April 1996 and February 2001 were clinically and radiologically evaluated. Among these 11 hips, 5 hips were sequelae of developmental dysplasia of the hip and 6 hips were sequelae of pyogenic or tuberculous infection. The mean follow-up period was 98 months (range: 88~121 months). RESULTS: In all cases, the hip center was restored to the anatomic hip center. The mean Harris hip score increased from 56.2 preoperatively to 86.3 at the end of follow-up and the mean difference of the spino-malleolar distance decreased from 5.6 cm preoperatively to 1.4cm postoperatively. Non-union in the greater trochanter osteotomy site was encountered in two patients. Two cases of sciatic nerve palsy and one cases of heterotopic ossification occurred, but one case of sciatic nerve palsy recovered within 6 months. CONCLUSION: After enough soft tissue release, if reduction to the original hip center is difficult, then performing femoral osteotomy or shortening osteotomy should be considered during the THA for a highly dislocated hip.

Treatment of Ulnar Impaction Syndrome using Arthroscopy and Ulnar Shortening Osteotomy / 대한정형외과학회잡지

PURPOSE: To retrospectively analyze the follow-up results of patients with ulnar impaction syndrome, who were treated with arthroscopic debridement, thermal shrinkage and a simultaneous ulnar shortening osteotomy. MATERIALS AND METHODS: Eleven wrists from ten patients with ulnar impaction syndrome, which were diagnosed by the clinical history, physical examination, radiological evaluation and arthroscopic findings, and were treated by arthroscopic debridement, thermal shrinkage and ulnar shortening osteotomy were enrolled in this study. The minimum duration of the follow-up was one year. The ulnar variance was measured using Kreder's method, and the follow-up results were analyzed radiographically as well as clinically using the Chun and Palmer wrist score. RESULTS: According to the wrist scoring system, seven wrists were fair and four poor preoperatively. However, after surgery, eight wrists were excellent and three good. The average wrist score increased from 62 preoperatively to 93 at the last follow-up. The mean ulnar variance decreased from +3.3 mm (+0.4-+6.4 mm) preoperatively to +0.1 mm (-0.8-+1.3 mm) at the last follow-up. Radiological union of the osteotomy site was achieved after an average of 12 weeks. There were no cases of nonunion or malunion. CONCLUSION: When ulnar impaction syndrome is diagnosed by the clinical, radiological and arthroscopic findings, arthroscopic debridement, thermal shrinkage and simultaneous ulnar shortening osteotomy are useful treatments for relieving the patients symptoms.

Short Term Results of Cementless Total Hip Arthroplasty with Subtrochanteric Shortening Osteotomy in Severe Dysplasia of Hip

PURPOSE: This study examined the clinical, functional and radiological results of total hip arthroplasty with subtrochanteric shortening osteotomy in severe dysplasia of hip. MATERIALS AND METHODS: Seventeen cases of severe dysplasia of the hip, which were treated with total hip arthroplasty with subtrochanteric shortening osteotomy from August 1997 to September 2004, were evaluated. The mean follow-up duration was 52.9 months (range: 26~106). Harris hip score (HHS), leg length discrepancy (LLD) and complication were assessed clinically. Gait analysis (7 cases) and Cybex study (8 cases) for the abductor muscle power were assessed functionally. Bony union and stability around the osteotomy site of the femoral and acetabular components was assessed radiologically. RESULTS: The mean HHS improved from 65.1 (range: 23~87) points preoperatively to 88.2 (range: 72~100) points at the last follow-up. The mean LLD improved from 3.7 (range: 1~7) cm preoperatively to 1.6 (range: 0.5~3.3) cm postoperatively. All cases showed complete bony union of the allograft in the acetabulum and osteotomy site at a mean time of 6 months postoperatively. Gait analysis improved in all cases but there was some limping gait remaining. On the Cybex study, 6 out of 8 cases showed improved abductor muscle peak toque, postoperatively. CONCLUSION: A cementless total hip arthroplasty with subtrochanteric shortening osteotomy is believed to be a useful treatment for severe dysplasia of hip. Despite the improving HHS, the abductor power can be decreased. In these points, gait analysis and the Cybex study are helpful on the follow-up.

Cementless Total Hip Replacement Arthroplasty with Subtrochanteric Shortening Osteotomy in Crowe IV Developmental Dysplasia of the Hip / 대한정형외과학회잡지

PURPOSE: The purpose of the current study is to introduce a surgical technique of total hip arthroplasty, by which a postsurgical neurologic deficit can be prevented and excellent clinical and radiological outcome can be obtained in patients with Crowe IV developmental dysplasia of the hip. MATERIALS AND METHODS: Twelve hip joints underwent hip joint arthroplasty at our hospital between October 1995 and November 1997 due to hip joint arthritis secondary to developmental dysplasia of the hip. Among them six hip joints of five patients which belonged to the Crowe Classification IV were operated using cementless total hip arthroplasty with subtrochanteric shortening osteotomy. The medical records and radiographs of these five patients were reviewed. The average follow up period was 61.2 months (range of 40 to 77 months). Preoperative Harris hip score ranged from 61 to 71 (average, 66.2) points. Leg length discrepancy ranged from 2.0 to 5.5 (average, 4.1) cm. RESULTS: Harris Hip Score was improved to 95.3 (87 to 100) points at the last follow-up examination. The postoperative leg length was same bilaterally in five cases except for one case. Bone union in the osteotomy site was obtained three months after surgery. The radiolucent area and findings of movement of the acetabular cup were not observed. Subcidence of the femoral stem or pedestal formation was not observed in five cases. In one case, revision was done for the subcidence of 5 mm or more with radiolucent line around the entire stem and pedestal formation at 48 months postoperatively. One case showed femoral nerve paralysis immediately after the surgery, which recovered completely in six months after the surgery. CONCLUSION: This surgical technique is a useful method in total hip arthroplasty for the Crowe IV developmental dysplasia of the hip without permanent neurologic deficit.

Arthroscopy of the Wrist and Ulnar Shortening Osteotomy for the Treatment of the Ulnar Impaction Syndrome / 대한정형외과학회잡지

PURPOSE: This is a retrospective analysis of patients with ulnar impaction syndrome, who were diagnosed by wrist arthroscopy and treated by simultaneous ulnar shortening osteotomy. MATERIALS AND METHODS: Six patients with ulnar impaction syndrome, in whom there was an arthroscopic diagnostic confirmation of the disease had an arthroscopic debridement and ulnar shortening osteotomy. Conservative treatment over a period of more than six months had failed in each patient. The minimum duration of the follow up was one year. The ulnar variance was measured using Kreder's method, and the results were clinically analysed using Chun and Palmer's wrist score as well as radiographically. RESULTS: The Palmer's stages of TFCC injury were 2A (one), 2B (four), 2C (one) on arthroscpic finding. The results were excellent in 4 and good in 2 (preoperative: 3 were fair, and 3 were poor). The wrist score increased from 63 to 94. The ulnar variance changed from +3 mm to -1 mm. CONCLUSION: When an ulnar impaction syndrome is suspected on clinical grounds and by radiographic findings, the pathoanantomy should be assessed arthroscopically. If the arthroscopy reveals Palmer's stages 2A, 2B, 2C, arthroscopic debridement and ulnar shortening osteotomy is a useful method for the treatment of ulnar impaction syndrome.