Does restoration of hip center with subtrochanteric osteotomy provide preferable outcome for Crowe type III-IV irreducible development dysplasia of the hip??

Abstract

Background: Subtrochanteric osteotomy and proximal placement of acetabular components are two common procedures used to manage irreducible, high riding developmental dysplasia of the hip (DDH). Some common and specific complications are observed in both procedures. We aimed to compare both the outcomes and complications between these two procedures.

Methods: Twenty-one patients with unilateral, Crowe type III-IV DDH who were seen between 2002 and 2014 were included in this study. Subtrochanteric osteotomy with restoration of the hip center and proximal placement of the acetabular component were performed on 10 and 11 patients, respectively. Harris hip score (HHS) and radiographic images were used for outcome assessment. All patients completed a minimum of 2-year follow-up.

Results: The HHS in patients who had undergone subtrochanteric osteotomy and proximal placement of the acetabular component were 89.4 and 91.9 points, respectively. However, this difference was not significant. There were six complications, including transient sciatic nerve palsy in two patients, nonunion at the junction in two, an intra-operative fracture in one and cup loosening in another. The complication rates in the subtrochanteric osteotomy and proximal placement of the acetabular component group were 30% and 27.5%, respectively.

Conclusion: With regard to both clinical outcomes and complication rates, restoration of the hip center using subtrochanteric osteotomy may provide similar benefits to those patients with proximal placement of the acetabular component in treating Crowe type III-IV DDH.

Keywords: Crowe III–IV DDH; Subtrochanteric osteotomy; Total hip replacement.