Femoral shortening in total hip arthroplasty for high developmental dysplasia of the hip.

BACKGROUND: When reconstructing a hip with developmental dysplasia with a high dislocation, placing the acetabular component in the anatomic position can result in a prosthetic hip that is difficult to reduce. Subtrochanteric femoral osteotomy and shortening makes reduction easier but can be associated with complications (eg, limp, sciatic nerve injury, nonunion of the osteotomy) or compromise long-term stem survival. QUESTIONS/PURPOSES: We therefore evaluated (1) the short-term complication rate, (2) functional scores, and (3) survivorship of prostheses in patients with high developmental dysplasia of the hip reconstructed with femoral shortening. PATIENTS AND METHODS: We prospectively followed 46 patients (65 hips) operated on from 1990 to 2000. There were 34 females and 12 males with a mean age of 48 years (range, 16-79 years). Before surgery, all patients had a positive Trendelenburg test. The minimum followup was 8 years (mean, 13 years; range, 8-18 years). RESULTS: One patient experienced recurrent dislocation and two peroneal nerve palsies, one of which partially recovered and one of which was permanent. In one patient, the stem subsided and after 8 months was replaced by a larger stem that stabilized. One patient had a nonunion but was functioning well and did not have additional surgery. At followup, 12 of the 65 hips (18%) had a positive Trendelenburg test. The mean muscle strength of the abductors was 4 (range, 3-5). The mean Harris hip score was 87 (range, 59-100) and the mean visual analog scale pain score 81 (range, 35-100). At followup, all stems were well fixed with no obvious signs of radiographic loosening. Ten cups were revised because of aseptic loosening. CONCLUSIONS: Our data suggest femoral osteotomy and shortening at the subtrochanteric level predictably allows a stable reduction in patients with high developmental dysplasia of the hip and does not lead to any reduction in long-term survival. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Conversion of knee fusion to total arthroplasty: complications in 8 patients.

BACKGROUND: There are no clear indications for conversion of knee fusion to total arthroplasty. In this paper we report outcome and complications in 8 patients. PATIENTS AND METHODS: We reviewed 8 total knee arthroplasties after takedown of previous fusion 24-55 months after the conversion. The original diagnoses were complications following injury in 3 patients, rheumatoid arthritis in 3, complication after chondromalacia in 1 patient and tuberculous arthritis in 1 patient. The age at operation ranged from 31 to 67 years. The time since arthrodesis ranged from 1 to 49 years. RESULTS: 5 patients had to undergo reoperation for postoperative complications. 2 patients experienced recurrence of previous deep infection, which led to thigh amputation in one and chronic fistulation in the other. Only 1 patient had an uneventful course after the conversion procedure, but he died later on due to a heart attack. As another patient also died of cardiovascular disease, 5 of the 8 patients were available for evaluation of knee function. In these patients the knee flexion ranged from 90 to 120 degrees, extension lag ranged from 10 to 40 degrees, and all knees were aligned at 6 to 8 degrees of valgus. The Knee Society clinical scores ranged from 47 to 74, the Womac scores ranged from 9 to 47, and EuroQol ranged from 0.1 to 0.8. INTERPRETATION: Our findings indicate that conversion of knee arthrodesis to total arthroplasty should only be performed in selected cases, and after giving the patient extensive information about the high risk of rather serious complications.

Satisfactory long-term results after Eden-Hybbinette-Alvik operation for recurrent anterior dislocation of the shoulder: 6-20 years' follow-up of 52 patients.

We studied the outcome after the Eden-Hybbinette-Alvik operation for recurrent anterior shoulder dislocation in 52 patients after a mean of 14 (6-20) years. Their mean age at operation was 26 years. Redislocation occurred in 2/52 patients. The success rate was 49/52, when rated by the patients, and 38/45, using the Carter-Rowe shoulder score. 44/52 reported no pain, 48/52 no limitations at work and 37/51 no limitations in sports. Mild and moderate arthrosis were found in 24/45 on the operated side and 9/45 on the uninvolved side. None (0/21) of the patients without arthrosis and 5/24 of those with arthrosis in the operated shoulder reported mild or moderate pain.

Radiographic classification of glenohumeral arthrosis.

We studied the interobserver agreement of two radiographic classification systems for evaluation of glenohumeral arthrosis in 40 patients at long-term follow-up after the Eden Hybbinette operation for habitual dislocation of the anterior shoulder. Both observers agreed that none of the patients had severe arthrosis. The Samilson-Prieto system showed agreement using the classification in 35 of 40 operated shoulders (kappa 0.76). The Kellgren-Lawrence system showed agreement using the classification in 23 of 40 operated shoulders (kappa 0.36). The rate of arthrosis in the operated shoulder ranged from 0.2 to 0.6, depending on the classification system and the observer. None of the patients without arthrosis, but one fifth of those with arthrosis reported pain. The Samilson-Prieto classification is preferable because it is simple to use and has excellent interobserver agreement.