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. 2014 Sep 4:15:293.
doi: 10.1186/1471-2474-15-293.

Partial greater trochanter osteotomy for hip reduction in total hip arthroplasty for high dislocated hip: a preliminary report

Rui Yu Liu, Chuan Yi Bai, Qi Chun Song, Xiao Qian Dang, Yao Jun Wu, Kun Zheng Wang  1
Affiliations

Partial greater trochanter osteotomy for hip reduction in total hip arthroplasty for high dislocated hip: a preliminary report

Rui Yu Liu et al. BMC Musculoskelet Disord. .

Abstract

Background: Hip reduction in total hip arthroplasty for high dislocated hips is difficult. Various femur osteotomy procedures have been used for hip reduction, but these methods increase operative time and risk of nonunion. We investigated the efficacy of a novel partial greater trochanter osteotomy technique for hip reduction in total hip arthroplasty for patients with high hip dislocation.

Methods: Twenty-one patients (23 hips) with high dislocated hip were treated with total hip arthroplasty that included partial greater trochanter osteotomy, i.e., the upper 2/3 greater trochanter was resected, and the gluteus medius muscle attachment was spared. The clinical outcome was evaluated by comparing the Harris hip scores and radiographic exam results, obtained before surgery and at follow-ups.

Results: Follow-ups of 21 patients ranged from 13 to 56 months. The mean Harris hip score increased from preoperative 55.0 (36-69) to postoperative 86.1 (71-93; P = 0.00). The average preoperative leg length discrepancy in patients with unilateral high hip dislocation was 46 mm (28-65 mm); postoperatively leg length discrepancy was less than 1 cm in 11 patients, between 1 and 2 cm in 8 patients, and more than 2 cm in 2 patients. The average leg lengthening at the time of surgery was 36 mm (24-54 mm). Trendelenburg's gait changed from positive to negative in 20 hips by the last follow-up. No nerve injury occurred postoperative.

Conclusion: Partial greater trochanter osteotomy is an effective method to render hip reduction in total hip arthroplasty for patients with high dislocation of the hip.

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Figures

Figure 1
Figure 1
Illustration of partial greater trochanter osteotomy. (A) Before surgery. (B) After surgery. Intraoperative steps: 1) peel off the gluteus medius muscle attachment in the upper 2/3 of the greater trochanter; 2) partial greater trochanter osteotomy; 3) femoral neck osteotomy line.
Figure 2
Figure 2
Total hip arthroplasty performed in a 51-year-old woman with left hip high dislocation using partial greater trochanter osteotomy. (A) Preoperative. (B) Four years after THA.
Figure 3
Figure 3
Total hip arthroplasty performed in a 48-year-old woman with left high pathological hip dislocation using partial greater trochanter osteotomy. (A) Preoperative. (B) Immediately postoperative.
See this image and copyright information in PMC

References

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Pre-publication history
    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/15/293/prepub

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