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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.
ABSTRACT
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.
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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.
Subject(s)
Female , Humans , Male , Arthroplasty , Joint Dislocations , Femoral Nerve , Follow-Up Studies , Hip , Hip Dislocation , Hypogonadism , Mitochondrial Diseases , Ophthalmoplegia , Osteotomy , Paralysis , PolyethyleneABSTRACT
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.
Subject(s)
Acetabulum , Allografts , Arthroplasty, Replacement, Hip , Follow-Up Studies , Gait , Hip , Leg , OsteotomyABSTRACT
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.