Skip to main content
SpringerLink
Log in

Cemented Total Hip Arthroplasty With Subtrochanteric Osteotomy in Dysplastic Hips

  • Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Total hip arthroplasty (THA) in the presence of developmental dysplasia of the hip (DDH) can be technically challenging. Restoring the anatomic center of hip rotation may require femoral osteotomy. Techniques using cementless components are widely reported but less is known about using cemented components that may be more appropriate with osteopenic bone.

Questions/purposes

We therefore determined the rate of union, complications, and early functional score in a series of patients with DDH who underwent cemented THA and simultaneous subtrochanteric osteotomy.

Methods

We retrospectively reviewed 28 patients (35 hips) who underwent a cemented THA for DDH at a mean age of 47.3 years. Two patients (two hips) died within 12 months of surgery of unrelated conditions. The clinical notes and radiographs were reviewed with a minimum followup of 2 years (mean, 5.6 years; range, 2–14 years). Complications were noted. SF-12 and Oxford hip scores (OHS) were recorded for 18 patients preoperatively and after 6 and 12 months.

Results

Union occurred in 32 of 33 femora (97%); one patient had an infected nonunion. The overall revision rate was 20% (9% femoral revision rate). There were three dislocations, two of which had further surgery. Two patients had a transient neuropraxia. The mean SF-12 physical component score increased from 32 to 52 and mean SF-12 mental component score increased from 48 to 51. The mean OHS decreased from 40 to 27.

Conclusion

Combined subtrochanteric osteotomy and cemented THA is technically demanding with a higher complication rate than routine THA. The rate of union, complications, implant survival, and early OHS were comparable to those for similar techniques using cementless components.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Figs 3A–B

Similar content being viewed by others

References

  1. Becker DA, Gustilo RB. Double-chevron subtrochanteric shortening derotational femoral osteotomy combined with total hip arthroplasty for the treatment of complete congenital dislocation of the hip in the adult. J Arthroplasty. 1995;10:313–318.

    Article  CAS  PubMed  Google Scholar 

  2. Bernasek TL, Haidukewych G, Gustke K, Hill O, Levering M. Total hip arthroplasty requiring subtrochanteric osteotomy for developmental hip dysplasia: 5- to 14-year results. J Arthroplasty. 2007;22(Suppl 2):145–150.

    Article  PubMed  Google Scholar 

  3. Bruce WJM, Rizkallah SM, Kwon Y-M, Goldberg JA, Walsh WR. A new technique of subtrochanteric shortening in total hip arthroplasty. J Arthroplasty. 2000;15:617–626.

    Article  CAS  PubMed  Google Scholar 

  4. Carlsson A, Bjorkman A, Ringsberg K, von Schewelov T. Untreated congenital and posttraumatic high dislocation of the hip treated by replacement in adult age: 22 hips in 16 patients followed for 1–8 years. Acta Orthop Scand. 2003;74:389–396.

    Article  PubMed  Google Scholar 

  5. Chandler HP, Reineck FT, Wixson RL, McCarthy JC. Total hip replacement in patients younger than thirty years old: a five-year follow-up study. J Bone Joint Surg Am. 1981;63:1426–1434.

    CAS  PubMed  Google Scholar 

  6. Chareancholvanich K, Becker DA, Gustilo RB. Treatment of congenital dislocated hip by arthroplasty with femoral shortening. Clin Orthop Relat Res. 1999;360:127–135.

    Article  PubMed  Google Scholar 

  7. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am. 1979;61:15–23.

    CAS  PubMed  Google Scholar 

  8. Dawson R, Fitzpatrick J, Carr A, Murray D. Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br. 1996;78:185–190.

    CAS  PubMed  Google Scholar 

  9. Dorr LD, Takei GK, Conaty JP. Total hip arthroplasties in patients less than forty-five years old. J Bone Joint Surg Am. 1983;65:474–479.

    CAS  PubMed  Google Scholar 

  10. Dunn HK, Hess WE. Total hip reconstruction in chronically dislocated hips. J Bone Joint Surg Am. 1976;58:838–845.

    CAS  PubMed  Google Scholar 

  11. Edwards BN, Tullos HS, Nobel PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res. 1987;218:136–141.

    PubMed  Google Scholar 

  12. Eggli S, Hankemayer S, Müller ME. Nerve palsy after leg lengthening in total replacement arthroplasty for developmental dysplasia of the hip. J Bone Joint Surg Br. 1999;81:843–845.

    Article  CAS  PubMed  Google Scholar 

  13. Eskelinen A, Helenius I, Remes V, Ylinen P, Tallroth K, Paavilainen T. Cementless total hip arthroplasty in patients with high congenital hip dislocation. J Bone Joint Surg Am. 2006;88:80–91.

    Article  PubMed  Google Scholar 

  14. Gaston MS, Gaston P, Donaldson P, Howie CR. A new classification system for the adult dysplastic hip requiring total hip arthroplasty: a reliability study. Hip Int. 2009;19:96–101.

    PubMed  Google Scholar 

  15. Haddad FS, Masri BA, Garbuz DS, Duncan CP. Primary total replacement of the dysplastic hip. Instr Course Lect. 2000;49:23–39.

    CAS  PubMed  Google Scholar 

  16. Halley DK, Wroblewski BM. Long term results of low-friction arthroplasty in patients 30 years of age or younger. Clin Orthop Relat Res. 1986;211:43–50.

    PubMed  Google Scholar 

  17. Hartofilakidis G, Stamos K, Karachalios T, Ioannidis T, Zacharakis N. Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg Am. 1996;78:683–692.

    CAS  PubMed  Google Scholar 

  18. Koulouvaris P, Stafylas K, Sculco T, Xenakis T. Distal femoral shortening in total hip arthroplasty for complex primary hip reconstruction. A new surgical technique. J Arthroplasty. 2008;23:992–998.

    Article  PubMed  Google Scholar 

  19. Krych AJ, Howard JL, Trousdale RT, Cabanela ME, Berry DJ. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-IV developmental dysplasia. J Bone Joint Surg Am. 2009;91:2213–2221.

    Article  PubMed  Google Scholar 

  20. Linde F, Jensen J, Pilgaard S. Charnley arthroplasty in osteoarthritis secondary to congenital dislocation or subluxation. Clin Orthop Relat Res. 1988;227:164–171.

    CAS  PubMed  Google Scholar 

  21. Masonis JL, Patel JV, Miu A, Bourne RB, McCalden R, Macdonald SJ, Rorabeck CH. Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia 5-year follow-up. J Arthroplasty. 2003;18(1):68–73.

    Article  PubMed  Google Scholar 

  22. Nagoya S, Kaya M, Sasaki M, Tateda K, Kosukegawa I, Yamashita T. Cementless total hip replacement with subtrochanteric femoral shortening for severe developmental dysplasia of the hip. J Bone Joint Surg Br. 2009;91:1142–1147.

    Article  CAS  PubMed  Google Scholar 

  23. Nercessian OA, Macaulay W, Stinchfield FE. Peripheral neuropathies following total hip arthroplasty. J Arthroplasty. 1994;9:645–651.

    Article  CAS  PubMed  Google Scholar 

  24. Onodera S, Majima T, Ito H, Matsuno T, Kishimoto T, Minami A. Cementless total hip arthroplasty using the modular S-ROM prosthesis combined with corrective proximal femoral osteotomy. J Arthroplasty. 2006;21:664–669.

    Article  PubMed  Google Scholar 

  25. Paavilainen T, Hoikka V, Paavolainen P. Cementless total hip arthroplasty for congenitally dislocated or dysplastic hips. Technique for replacement with a straight femoral component. Clin Orthop Relat Res. 1993;297:71–81.

    PubMed  Google Scholar 

  26. Paavilainen T, Hoikka V, Solonen KA. Cementless total replacement for severely dysplastic or dislocated hips. J Bone Joint Surg Br. 1990;72:205–211.

    CAS  PubMed  Google Scholar 

  27. Pagnano MW, Hanssen AD, Lewallen DG, Shaughnessy WJ. The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty: long-term results of patients who have Crowe type II congenital dysplasia of the hip. J Bone Joint Surg Am. 1996;78:1004–1014.

    CAS  PubMed  Google Scholar 

  28. Papagelopoulos PJ, Trousdale RT, Lewallen DG. Total hip arthroplasty with femoral osteotomy for proximal femoral deformity. Clin Orthop Relat Res. 1996;332:151–162.

    Article  PubMed  Google Scholar 

  29. Park M-S, Kim K-H, Jeong W-C. Transverse subtrochanteric shortening osteotomy in primary total hip arthroplasty for patients with severe hip developmental dysplasia. J Arthroplasty. 2007;22:1031–1036.

    Article  PubMed  Google Scholar 

  30. Reikeraas O, Lereim P, Gabor I, Gunderson R, Bjerkreim I. Femoral shortening in total arthroplasty for completely dislocated hips: 3-7 year results in 25 cases. Acta Orthop Scand. 1996;67:33–36.

    Article  CAS  PubMed  Google Scholar 

  31. Sener N, Tozun I, Asik M. Femoral shortening and cementless arthroplasty in high congenital dislocation of the hip. J Arthroplasty. 2002;17:41–48.

    PubMed  Google Scholar 

  32. Symeonides PP, Pournaras J, Petsatodes G, Christoforides J, Hatzokos I, Pantazis E. Total hip arthroplasty in neglected congenital dislocation of the hip. Clin Orthop Relat Res. 1997;341:55–61.

    Article  PubMed  Google Scholar 

  33. Ware JE, Kosinski M, Keller SD. A 12-item Short-Form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–233.

    Article  PubMed  Google Scholar 

  34. Woolson ST, Harris WH. Complex total hip replacement for dysplastic or hypoplastic hips using miniature or microminiature components. J Bone Joint Surg Am. 1983;65:1099–1108.

    CAS  PubMed  Google Scholar 

  35. Yasgur DJ, Stuchin SA, Adler EM, DiCesare PE. Subtrochanteric femoral shortening osteotomy in total hip arthroplasty for high-riding developmental dislocation of the hip. J Arthroplasty. 1997;12:880–888.

    Article  CAS  PubMed  Google Scholar 

  36. Yoder SA, Brand RA, Pederson DR, et al. Total hip acetabular component position affects acetabular loosening rates. Clin Orthop Relat Res. 1988;228:79–87.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK

    Colin R. Howie FRCSEd, Nicholas E. Ohly MRCSEd & Ben Miller FRACS

Authors
  1. Colin R. Howie FRCSEd
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicholas E. Ohly MRCSEd
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ben Miller FRACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Colin R. Howie FRCSEd.

Additional information

One or more of the authors (BM) or a member of his or her immediate family received, in any 1 year, payments or benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Stryker Australia).

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

About this article

Cite this article

Howie, C.R., Ohly, N.E. & Miller, B. Cemented Total Hip Arthroplasty With Subtrochanteric Osteotomy in Dysplastic Hips. Clin Orthop Relat Res 468, 3240–3247 (2010). https://doi.org/10.1007/s11999-010-1367-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-010-1367-8

Keywords

Search

Navigation