Modular Cementless Total Hip Arthroplasty with Subtrochanteric Shortening Osteotomy in Patients with High Hip Dislocation

Byung-Ho Lim; Young-Wan Moon; Seung-Jae Lim; Hee-Soo Lee; Youn-Soo Park

doi:10.5371/jkhs.2010.22.4.253

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Lim, Moon, Lim, Lee, and Park: Modular Cementless Total Hip Arthroplasty with Subtrochanteric Shortening Osteotomy in Patients with High Hip Dislocation

Original Article

The Journal of the Korean Hip Society

The Journal of the Korean Hip Society 2010; 22(4): 253-259.

Published online: 31 December 2010

DOI: https://doi.org/10.5371/jkhs.2010.22.4.253

Modular Cementless Total Hip Arthroplasty with Subtrochanteric Shortening Osteotomy in Patients with High Hip Dislocation

Byung-Ho Lim, MD, Young-Wan Moon, MD, Seung-Jae Lim, MD, Hee-Soo Lee, MD, Youn-Soo Park, MD

Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Address reprint request to Youn-Soo Park, MD. Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul 135-710, Korea. TEL: +82-2-3410-3509 FAX: +82-2-3410-0061, ysp3504@skku.edu

Received 13 October 2010 Revised 2 December 2010 Accepted 6 December 2010

Abstract

Purpose

The purpose of this study was to report on the results of performing modular cementless total hip arthroplasty with a simultaneous subtrochanteric shortening osteotomy in patients with high hip dislocation.

Materials and Methods

We evaluated 23 patients (24 hips) with high hip dislocation and who had undergone total hip arthroplasty using a proximally modular cementless stem in combination with a subtrochanteric shortening osteotomy in order to place the acetabular cup at the level of the anatomic hip center between May 1996 and June 2008. There were 6 males and 17 females with a mean age of 44 years. The mean duration of follow-up was 5.6 years.

Results

The mean Harris hip score improved from 53 points preoperatively to 88 points at the time of final follow-up (P<0.001), and there were good or excellent results in 21 hips (87.5%). There was one instance of isolated loosening of the acetabular component. With the exception of one hip requiring revision surgery at 12 years postoperatively because of polyethylene wear and cup loosening, all the remaining components were well-fixed at the time of the last follow-up. A total of 4 hips (17%) had complications during follow-up; one dislocation, two transient femoral nerve palsies and one nonunion of the subtrochanteric osteotomy site.

Conclusion

Modular cementless total hip arthroplasty with a subtrochanteric shortening osteotomy in patients with high hip dislocation was associated with excellent clinical outcomes while it minimized additional fixation of the osteotomy site.

Keywords: High hip dislocation, Total hip arthroplasty, Modular cementless femoral stem, Subtrochanteric shortening osteotomy

Figures and Tables

Fig. 1

Case 23, a forty four-year-old woman with left hip pain and severe limping. (A) A preoperative anteroposterior radiograph of the left hip shows Crowe type-IV high developmental hip dislocation. The lines denote the planned subtrochanteric osteotomy and dotted line denote the planned extended trochanteric osteotomy. (B) A postoperative anteroposterior radiograph after 1 year show healing of the osteotomy and incorporation of the prosthesis. Cerclage wires were placed to secure the resected portion of osteotomized femur to the osteotomy site and to protect the femur from intraoperative fracture.

Fig. 2

Case 8, a fifty nine-year-old man with left hip pain. (A, B) A preoperative anteroposterior and lateral radiograph shows high dislocation due to septic hip sequelae. The lines denote the planned subtrochanteric osteotomy and dotted line denote the planned extended trochanteric osteotomy. (C, D) Postoperative anteroposterior and lateral radiograph after 6 months show nonunion with gap of the osteotomy site.(E, F) A reoperative anteroposterior and lateral radiograph after 3 years shows healing of the osteotomy site. Reoperation was performed with Dall-Miles hook, cable and onlay strut allograft for nonunion of the osteotomy site.

Table 1

Clinical Results

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