Subtrochanteric femoral shortening osteotomy combined with cementless total hip replacement for Crowe type IV developmental dysplasia: a retrospective study

Abstract

Background: Total hip replacement for high dislocation of the hip presents some difficulties, considering patients' young ages, the abnormal hip anatomy and the high rate of complications. In this study, we present our experience in terms of clinical and radiological results in the treatment of Crowe type IV hips with subtrochanteric femoral shortening osteotomy and cementless total hip replacement.

Materials and methods: We retrospectively reviewed 15 patients with Crowe type IV hip dysplasia (two bilateral cases for a total of 17 hips) treated with cementless total hip replacement associated with shortening subtrochanteric osteotomies (nine transversal and eight Z-shape osteotomies) between March 2000 to February 2006. The mean follow-up was 88 months (range 63-133). Harris hip score, leg length discrepancy, neurological status, union status of the osteotomy and the component stability were the criteria of the evaluation. All complications were noted.

Results: The mean HHS improved from 38.3 (range 32-52) to 85.6 (range 69-90). The mean preoperative leg length discrepancy was of 45 mm (range 38-70) and reduced to a mean of 12 mm (range 9-1.6) postoperatively. All osteotomies resulted healed at an average of 12.3 weeks (range 10-15). No cases of delayed union or nonunion were detected. Two patients (11%) showed early symptoms of sciatic nerve palsy which resolved uneventfully in 6 months. There was no migrations and none of the implants required revision.

Conclusions: Cementless THA with shortening subtrochanteric osteotomy is an effective method in the treatment of patients with Crowe type IV development dysplasia of the hip.

Level of evidence: IV.

Keywords: Hip dysplasia; Hip replacement; Shortening osteotomy.

Fig. 1

44-year-old female patient with bilateral DDH. a Pre-operative planning with the Z-shaped osteotomy. b X-ray at 2-year follow-up right hip surgery (1-year; left hip). Note the intra-op fracture on the left hip treated with an additional cerclage. c1–4 Clinical images at 5-year follow-up right hip surgery (4-year; left hip)

Fig. 2

39-year-old male patient with unilateral Crowe type IV DDH. a Pre-operative planning with cementless THA and transverse shortening osteotomy. b Quadrangular cross-section CSR Japan stem (Sulzer^®, Switzerland). c Post-operative X-ray