Total hip arthroplasty with a monoblock conical stem and subtrochanteric transverse shortening osteotomy in Crowe type IV dysplastic hips
- 137 Downloads
This series assessed the clinical and radiographic outcomes of total hip arthroplasty (THA) with femoral shortening osteotomy for the management of patients with Crowe type IV hip dysplasia.
Only patients with Crowe type IV hip dysplasia who underwent primary THA combined with a subtrochanteric transverse osteotomy with an uncemented monoblock conical stem were included. The clinical and radiographic evaluations were performed before and immediately after surgery, and at last follow-up. The hip function was assessed with the Harris Hip Score (HHS).
Seventy-four patients (102 hips) with a mean age of 53.9 (range, 20–83) were evaluated at an average follow-up of 11.3 years (range, 5–25). Stem revision occurred in two (1.9%) cases, with a survivorship of 95.9% (95%IC, 91.9–99.9%) at ten years. The average HHS increased from 44 (range, 15–78) pre-operatively to 90.3 (range, 62–100) at last follow-up (p < 0.001). Osteotomy site non-union and early dislocation were observed in 3.9 and 3.8%, respectively. No cases of nerve palsy were reported.
THA with a monoblock conical stem associated with subtrochanteric transverse osteotomy provides good long-term survival, clinical and radiographic results. It may be considered an effective management of patients with Crowe IV hip dysplasia.
KeywordsCrowe type IV dislocation Total hip arthroplasty Monoblock conical stem Transverse femoral shortening
Compliance with ethical standards
Conflict of interest
Guido Grappiolo received honoraria for speaking at symposia, financial support for attending symposia and educational programs from Zimmer Biomet, and royalties from Zimmer Biomet and Innomed. Giuseppe Mazziotta, Giuseppe Santoro, Mattia Loppini and Antonello Della Rocca received financial support for attending symposia and educational programs from Zimmer Biomet. Francesco La Camera has no conflict of interest.
This was a retrospective and observational study with medical records of patients included in a registry of orthopaedic surgical procedures. The study protocol for the development of this registry was approved by the Ethical Committee of Humanitas Research Hospital (approval number 618/17) and in strict accordance with the Helsinki Declaration.
All individual participants signed a written informed consent before the surgical procedure and a written informed consent to be included in the registry of orthopaedic surgical procedures.
- 5.Li X, Lu Y, Sun J, Lin X, Tang T (2017) Treatment of Crowe type-IV hip dysplasia using cementless total hip arthroplasty and double chevron subtrochanteric shortening osteotomy: a 5- to 10-year follow-up study. J Arthroplast 32:475–479. https://doi.org/10.1016/j.arth.2016.07.050 CrossRefGoogle Scholar
- 8.Ozden VE, Dikmen G, Beksac B, Tozun IR (2017) Tapered stems one-third proximally coated have higher complication rates than cylindrical two-third coated stems in patients with high hip dislocation undergoing total hip arthroplasty with step-cut shortening osteotomy. Orthop Traumatol Surg Res 103:569–577. https://doi.org/10.1016/j.otsr.2017.01.010 CrossRefGoogle Scholar
- 9.Akiyama H, Kawanabe K, Yamamoto K, Kuroda Y, So K, Goto K et al (2011) 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 16:270–277. https://doi.org/10.1007/s00776-011-0049-z CrossRefGoogle Scholar
- 14.DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 121:20–32Google Scholar
- 15.Gruen TA, McNeice GM, Amstutz HC (1979) “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 141:17–27Google Scholar
- 18.Loppini M, Longo UG, Caldarella E, Rocca AD, Denaro V, Grappiolo G (2017) Femur first surgical technique: a smart non-computer-based procedure to achieve the combined anteversion in primary total hip arthroplasty. BMC Musculoskelet Disord 18:331. https://doi.org/10.1186/s12891-017-1688-9 CrossRefGoogle Scholar
- 20.Oe K, Iida H, Kawamura H, Ueda N, Nakamura T, Okamoto N et al (2016) Long-term results of acetabular reconstruction using three bulk bone graft techniques in cemented total hip arthroplasty for developmental dysplasia. Int Orthop 40:1949–1954. https://doi.org/10.1007/s00264-015-3039-5 CrossRefGoogle Scholar
- 21.Liu S, Zuo J, Li Z, Yang Y, Liu T, Xiao J et al (2017) Study of three-dimensional morphology of the proximal femur in developmental adult dysplasia of the hip suggests that the on-shelf modular prosthesis may not be an ideal choice for patients with Crowe type IV hips. Int Orthop 41:707–713. https://doi.org/10.1007/s00264-016-3248-6 CrossRefGoogle Scholar
- 25.Ohishi M, Nakashima Y, Yamamoto T, Motomura G, Fukushi JI, Hamai S et al (2016) Cementless total hip arthroplasty for patients previously treated with femoral osteotomy for hip dysplasia: the incidence of periprosthetic fracture. Int Orthop 40:1601–1606. https://doi.org/10.1007/s00264-015-2992-3 CrossRefGoogle Scholar