COMPARISON OF CEMENTLESS TOTAL HIP ARTHROPLASTY BETWEEN WITH AND WITHOUT SUBTROCHANTERIC FEMORAL SHORTENING OSTEOTOMY IN Crowe TYPE IV DEVELOPMENTAL DYSPLASIA OF HIP_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGZhendong , CHAIWei , SONGJunlei , YANGFan , LIHeng , ZHANGQingmeng , XUChi ,  CHENJiying

Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P. R. China;

Corresponding author：

CHENJiying, Email: chenjiying_301@163.com

Keywords：

Crowe type IV developmental dysplasia of the hip; Total hip arthroplasty; Subtrochanteric shortening osteotomy; Cementless prosthesis

DOI：

10.7507/1002-1892.20150033

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Objective To investigate the clinical characteristic differences of cementless total hip arthroplasty (THA) between with and without subtrochanteric femoral shortening osteostomy in Crowe type IV developmental dysplasia of the hip (DDH). Methods Between January 2006 and March 2012, 21 patients (21 hips) with Crowe type IV DDH who underwent primary THA were enrolled according to inclusion criteria. According to whether subtrochanteric femoral shortening osteostomy was performed during THA or not, the patients were divided into 2 groups: THA with osteostomy group (n=9) and THA without osteotomy group (n=12). There was no significant difference in gender, age, body mass index, and hip Harris score between 2 groups (P>0.05) except leg length discrepancy (t=-3.170, P=0.005). The operation time, blood loss, postoperative drainage, complications, and radiography data were compared to evaluate the clinical characteristics. Results The operation time, blood loss, and postoperative drainage of osteotomy group were all significantly greater than those of no osteotomy group (P<0.05). All patients achieved primary healing of incision; 1 patient (1 hip) had transient sciatic nerve symptom in osteotomy group. The average follow-up time was 53 months (range, 28-88 months). The X-ray films showed good fracture healing at 3-6 months after operation in osteostomy group. No prosthetic loosening or dislocation was found. The hip Harris score was 90.67±4.06 in osteostomy group and 92.17±3.27 in no osteostomy group, showing no significant difference between 2 groups (t=-0.938, P=0.360). The leg length discrepancy was (0.22±0.26) cm in osteostomy group and (0.18±0.27) cm in no osteostomy group, showing no significant difference (t=107.000, P=0.546). The leg length discrepancy was found in 6 patients of osteotomy group and 5 patients of no osteotomy group. One patient complained of thigh pain in osteotomy group; 2 patients had slight limp (Trendelenburg +) in no osteotomy group. Conclusion THA can improve joint function and increase limb length in the treatment of Crowe type IV DDH. Subtrochanteric shortening osteotomy is an effective treatment which can be performed according to preoperative template measurement, leg length shortening, and the soft tissue tension.

Citation： ZHANGZhendong, CHAIWei, SONGJunlei, YANGFan, LIHeng, ZHANGQingmeng, XUChi, CHENJiying. COMPARISON OF CEMENTLESS TOTAL HIP ARTHROPLASTY BETWEEN WITH AND WITHOUT SUBTROCHANTERIC FEMORAL SHORTENING OSTEOTOMY IN Crowe TYPE IV DEVELOPMENTAL DYSPLASIA OF HIP. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(2): 154-159. doi: 10.7507/1002-1892.20150033 Copy

1.	Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg (Am), 1979, 61(1):15-23.
2.	Terjesen T, Horn J, Gunderson RB. Fifty-year follow-up of late-detected hip dislocation:clinical and radiographic. J Bone Joint Surg (Am), 2014, 96(4):e28.
3.	Zahar A, Papik K, Lakatos J, et al. Total hip arthroplasty with acetabular reconstruction using a bulk autograft for patients with developmental dysplasia of the hip results in high loosening rates at mid-term follow-up. Int Orthop, 2014, 38(5):947-951.
4.	Yan F, Chen G, Yang L, et al. A reduction technique of arthroplasty without subtrochanteric femoral shortening osteotomy for the treatment of developmental high dislocation of hip:a case series of 28 hips. J Arthroplasty, 2014, 29(12):2289-2293.
5.	Fukui K, Kaneuji A, Sugimori T, et al. How far above the true anatomic position can the acetabular cup be placed in total hip arthroplasty? Hip Int, 2013, 23(2):129-134.
6.	Erdemli B, Yilmaz C, Atalar H, et al. Total hip arthroplasty in developmental high dislocation of the hip. J Arthroplasty, 2005, 20(8):1021-1028.
7.	Gustke K. The dysplastic hip:not for the shallow surgeon. Bone Joint J, 2013, 95-B(11 Suppl A):31-36.
8.	Masonis JL, Patel JV, Miu A, et al. Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia:5-year follow-up. J Arthroplasty, 2003, 18(3 Suppl 1):68-73.
9.	Park MS, Kim KH, Jeong WC. Transverse subtrochanteric shortening osteotomy in primary total hip arthroplasty. J Arthroplasty, 2007, 22(7):1031-1036.
10.	Oe K, Iida H, Nakamura T, et al. Subtrochanteric shortening osteotomy combined with cemented total hip arthroplasty for Crowe group IV hips. Arch Orthop Trauma Surg, 2013, 133(12):1763-1770.
11.	Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty. J Bone Joint Surg (Am), 1969, 51(4):737-755.
12.	Imarisio D, Trecci A, Sabatini L, et al. Cementless total hip replacement for severe developmental dysplasia of the hip:our experience in Crowe's group IV. Musculoskelet Surg, 2013, 97(1):25-30.
13.	Kirschner S, Goronzy J, Storch A, et al. Avoidance, diagnostics and therapy of nerve lesions after total hip arthroplasty. Orthopade, 2011, 40(6):491-499.
14.	Biant LC, Bruce WJ, Assini JB, et al. Primary total hip arthroplasty in severe developmental dysplasia of the hip. Ten-year results using a cementless modular stem. J Arthroplasty, 2009, 24(1):27-32.
15.	孙启才, 王祥华, 宋柏杉, 等. S-ROM假体全髋关节置换治疗CroweⅣ型髋关节发育不良. 中国骨伤, 2013, 26(2):153-157.
16.	Krych AJ, Howard JL, Trousdale RT, et al. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-IV developmental dysplasia. J Bone Joint Surg (Am), 2009, 91(9):2213-2221.
17.	唐竞, 邵宏翊, 唐杞衡, 等. 髋臼重建治疗CroweⅢ型髋臼发育不良. 中华外科杂志, 2008, 46(17):1303-1306.
18.	Togrul E, Ozkan C, Kalaci A, et al. A new technique of subtrochanteric shortening in total hip replacement for Crowe type 3 to 4 dysplasia of the hip. J Arthroplasty, 2010, 25(3):465-470.
19.	Lai KA, Shen WJ, Huang LW, et al. Cementless total hip arthroplasty and limb-length equalization in patients with unilateral Crowe type-IV hip dislocation. J Bone Joint Surg (Am), 2005, 87(2):339-345.
20.	Fujishiro T, Nishiyama T, Hayashi S, et al. Leg length change in total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe type IV developmental hip dysplasia. J Arthroplasty, 2012, 27(6):1019-1022.
21.	Russotti GM, Harris WH. Proximal placement of the acetabular component in total hip arthroplasty. A long-term follow-up study. J Bone Joint Surg (Am), 1991, 73(4):587-592.
22.	Hasegawa Y, Iwase T, Kanoh T, et al. Total hip arthroplasty for Crowe type IV developmental dysplasia. J Arthroplasty, 2012, 27(9):1629-1635.
23.	Reikerås O, Haaland JE, Lereim P. Femoral shortening in total hip arthroplasty for high developmental dysplasia of the hip. Clin Orthop Relat Res, 2010, 468(7):1949-1455.
24.	Yang S, Cui Q. Total hip arthroplasty in developmental dysplasia of the hip:Review of anatomy, techniques and outcomes. World J Orthop, 2012, 3(5):42-48.
25.	Hartofilakidis G, Karachalios T. Total hip arthroplasty for congenital hip disease. J Bone Joint Surg (Am), 2004, 86-A(2):242-250.
26.	DiFazion F, Shon WY, Salvati EA, et al. Long-term results of total hip arthroplasty with a cemented custom-designed Swan-neck femoral component for congenital dislocation of severe dysplasia:a follow-up note. J Bone Joint Surg (Am), 2002, 84-A(2):204-207.
27.	Makita H, Inaba Y, Hirakawa K, et al. Results on total hip arthroplasties with femoral shortening for Crow's group IV dislocated hips. J Arthrolasty, 2007, 22(1):32-38.

1. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg (Am), 1979, 61(1):15-23.
2. Terjesen T, Horn J, Gunderson RB. Fifty-year follow-up of late-detected hip dislocation:clinical and radiographic. J Bone Joint Surg (Am), 2014, 96(4):e28.
3. Zahar A, Papik K, Lakatos J, et al. Total hip arthroplasty with acetabular reconstruction using a bulk autograft for patients with developmental dysplasia of the hip results in high loosening rates at mid-term follow-up. Int Orthop, 2014, 38(5):947-951.
4. Yan F, Chen G, Yang L, et al. A reduction technique of arthroplasty without subtrochanteric femoral shortening osteotomy for the treatment of developmental high dislocation of hip:a case series of 28 hips. J Arthroplasty, 2014, 29(12):2289-2293.
5. Fukui K, Kaneuji A, Sugimori T, et al. How far above the true anatomic position can the acetabular cup be placed in total hip arthroplasty? Hip Int, 2013, 23(2):129-134.
6. Erdemli B, Yilmaz C, Atalar H, et al. Total hip arthroplasty in developmental high dislocation of the hip. J Arthroplasty, 2005, 20(8):1021-1028.
7. Gustke K. The dysplastic hip:not for the shallow surgeon. Bone Joint J, 2013, 95-B(11 Suppl A):31-36.
8. Masonis JL, Patel JV, Miu A, et al. Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia:5-year follow-up. J Arthroplasty, 2003, 18(3 Suppl 1):68-73.
9. Park MS, Kim KH, Jeong WC. Transverse subtrochanteric shortening osteotomy in primary total hip arthroplasty. J Arthroplasty, 2007, 22(7):1031-1036.
10. Oe K, Iida H, Nakamura T, et al. Subtrochanteric shortening osteotomy combined with cemented total hip arthroplasty for Crowe group IV hips. Arch Orthop Trauma Surg, 2013, 133(12):1763-1770.
11. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty. J Bone Joint Surg (Am), 1969, 51(4):737-755.
12. Imarisio D, Trecci A, Sabatini L, et al. Cementless total hip replacement for severe developmental dysplasia of the hip:our experience in Crowe's group IV. Musculoskelet Surg, 2013, 97(1):25-30.
13. Kirschner S, Goronzy J, Storch A, et al. Avoidance, diagnostics and therapy of nerve lesions after total hip arthroplasty. Orthopade, 2011, 40(6):491-499.
14. Biant LC, Bruce WJ, Assini JB, et al. Primary total hip arthroplasty in severe developmental dysplasia of the hip. Ten-year results using a cementless modular stem. J Arthroplasty, 2009, 24(1):27-32.
15. 孙启才, 王祥华, 宋柏杉, 等. S-ROM假体全髋关节置换治疗CroweⅣ型髋关节发育不良. 中国骨伤, 2013, 26(2):153-157.
16. Krych AJ, Howard JL, Trousdale RT, et al. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-IV developmental dysplasia. J Bone Joint Surg (Am), 2009, 91(9):2213-2221.
17. 唐竞, 邵宏翊, 唐杞衡, 等. 髋臼重建治疗CroweⅢ型髋臼发育不良. 中华外科杂志, 2008, 46(17):1303-1306.
18. Togrul E, Ozkan C, Kalaci A, et al. A new technique of subtrochanteric shortening in total hip replacement for Crowe type 3 to 4 dysplasia of the hip. J Arthroplasty, 2010, 25(3):465-470.
19. Lai KA, Shen WJ, Huang LW, et al. Cementless total hip arthroplasty and limb-length equalization in patients with unilateral Crowe type-IV hip dislocation. J Bone Joint Surg (Am), 2005, 87(2):339-345.
20. Fujishiro T, Nishiyama T, Hayashi S, et al. Leg length change in total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe type IV developmental hip dysplasia. J Arthroplasty, 2012, 27(6):1019-1022.
21. Russotti GM, Harris WH. Proximal placement of the acetabular component in total hip arthroplasty. A long-term follow-up study. J Bone Joint Surg (Am), 1991, 73(4):587-592.
22. Hasegawa Y, Iwase T, Kanoh T, et al. Total hip arthroplasty for Crowe type IV developmental dysplasia. J Arthroplasty, 2012, 27(9):1629-1635.
23. Reikerås O, Haaland JE, Lereim P. Femoral shortening in total hip arthroplasty for high developmental dysplasia of the hip. Clin Orthop Relat Res, 2010, 468(7):1949-1455.
24. Yang S, Cui Q. Total hip arthroplasty in developmental dysplasia of the hip:Review of anatomy, techniques and outcomes. World J Orthop, 2012, 3(5):42-48.
25. Hartofilakidis G, Karachalios T. Total hip arthroplasty for congenital hip disease. J Bone Joint Surg (Am), 2004, 86-A(2):242-250.
26. DiFazion F, Shon WY, Salvati EA, et al. Long-term results of total hip arthroplasty with a cemented custom-designed Swan-neck femoral component for congenital dislocation of severe dysplasia:a follow-up note. J Bone Joint Surg (Am), 2002, 84-A(2):204-207.
27. Makita H, Inaba Y, Hirakawa K, et al. Results on total hip arthroplasties with femoral shortening for Crow's group IV dislocated hips. J Arthrolasty, 2007, 22(1):32-38.

Chinese Journal of Reparative and Reconstructive Surgery

COMPARISON OF CEMENTLESS TOTAL HIP ARTHROPLASTY BETWEEN WITH AND WITHOUT SUBTROCHANTERIC FEMORAL SHORTENING OSTEOTOMY IN Crowe TYPE IV DEVELOPMENTAL DYSPLASIA OF HIP

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