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1.
Chinese Journal of Orthopaedics ; (12): 1362-1371, 2023.
Article de Chinois | WPRIM | ID: wpr-1027642

RÉSUMÉ

Objective:To investigate the difference in the efficacy of extended trochanteric osteotomy (ETO) and subtrochanteric shortening osteotomy (SSO) in total hip arthroplasty (THA) for Crowe type IV developmental dysplasia of the hip (DDH).Methods:Forty patients (51 hips) who underwent primary THA for Crowe type IV DDH from April 2012 to August 2020 at the First Affiliated Hospital of Soochow University and the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. The patients were classified into ETO (extended greater trochanteric osteotomy) group and SSO(subtrochanteric shortening osteotomy) group. There were 12 patients (14 hips) in the ETO group, with 3 males and 9 females, aged 49.9±16.7 years old (range, 22-75 years old) and 28 patients (37 hips) in the SSO group, with 7 males and 21 females, aged 50.3±14.0 years (range, 22-76 years). In both groups, Harris hip score (HHS), leg length discrepancy, limp, Trendelenburg sign were used to evaluate the functional results and anteroposterior radiographs of the pelvis were taken at each follow-up to assess bone healing at the osteotomy site, periprosthetic osteolysis, bone ingrowth and periprosthetic loosening. Complications were recorded and analyzed.Results:All 51 hips were followed up for at least 24 months. The operative time and total blood loss was 116.8±14.2 vs. 128.3±19.2 min and 650.8±191.4 vs. 808.3±151.3 ml in the ETO group and the SSO group with significant difference ( t=2.04, P=0.047; t=3.08, P=0.003) respectively. At the follow-up of 24 months the HHS of ETO and SSO groups were 94.8±6.3 vs. 93.9±4.9 points and the leg length discrepancy was 4.6±2.2 vs. 5.2±3.0 mm. The positive rate of Trendelenburg's sign was 7% vs. 16% and the incidence of limp was 17% vs. 29% in the ETO group and the SSO group with no significant difference ( t=0.54, P=0.591; t=0.68, P=0.499; P=0.657; P=0.693). The length of femoral shortening in the ETO group and SSO group was 30.8±4.1 vs 35.3±7.9 mm with significant difference ( t=2.02, P=0.049). Time for bone healing at the osteotomy site was 5.8±1.5 vs. 6.0±1.4 months and the incidence of intraoperative femoral fractures was 36% and vs. 65% with no significant difference ( t=0.45, P=0.657; χ 2=3.52, P=0.061). Bone in-growth (or bone on-growth) fixation was obtained for all acetabular and femoral prostheses, with no hips of prosthesis displacement, periprosthetic osteolysis, or dislocation. Conclusion:Total hip arthroplasty for Crowe type IV DDH can achieve satisfactory clinical efficacy with similar functional recovery and rate of complication in extended trochanteric osteotomy and subtrochanteric shortening osteotomy. However, the extended greater trochanter osteotomy can reduce the operation time, blood loss and length of femoral shortening.

2.
Article de Coréen | WPRIM | ID: wpr-656113

RÉSUMÉ

PURPOSE: To review the results and discuss the technique for an extended trochanteric osteotomy through the lateral approach in revision total hip arthroplasty. MATERIALS AND METHODS: Twenty patients were reviewed after an average follow-up of 30.4 months (range, 24-56 months) between 1999 and 2003. The indications for the extended trochanteric osteotomy included the removal of a well-fixed cemented or cementless stem in 12 hips, varus remodeling of the femur in 3 hips and trochanteric malposition in 5 hips. The length of the osteotomy, the proximal migration of the osteotomized fragment, the fixation status of the femoral stem, the union status of the osteotomy site and complications were evaluated at the last follow-up. RESULTS: The mean length of the osteotomy was 12 cm (range, 8-20 cm). Radiographic union of the osteotomy site was noted in all cases after an average of 3.8 months (range, 2.5-6.0 months). The mean migration of the osteotomized fragment was 2.4 mm (range, 0-8 mm). The complications included postoperative dislocation in 3 hips and fractures of the osteotomy fragment in 2 hips, which were treated at the last follow up. Fixation of the stem with bone ingrowth was noted in all patients. CONCLUSION: An extended trochanteric osteotomy through the lateral approach can be performed safely in complex revision total hip arthroplasty.


Sujet(s)
Humains , Arthroplastie , Arthroplastie prothétique de hanche , Luxations , Fémur , Études de suivi , Hanche , Ostéotomie
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