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

Gyo-Wook Kim; Kyung-Jae Lee; Byung-Woo Min; Ki-Cheor Bae; Hyung-Gyu Jang

doi:10.5371/hp.2014.26.1.22

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Kim, Lee, Min, Bae, and Jang: Cementless Total Hip Arthroplasty with Subtrochanteric Transverse Shortening Osteotomy in Patients with High Hip Dislocation

Original Article

Hip & Pelvis 2014; 26(1): 22-28.

Published online: 31 March 2014

DOI: https://doi.org/10.5371/hp.2014.26.1.22

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

Gyo-Wook Kim, MD, Kyung-Jae Lee, MD, Byung-Woo Min, MD, Ki-Cheor Bae, MD, Hyung-Gyu Jang, MD

Department of Orthopedic Surgery, Keimyung University School of Medicine, Daegu, Korea.

Address reprint request to Gyo-Wook Kim, MD. Department of Orthopedic Surgery, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Korea. TEL: +82-53-250-8161, FAX: +82-53-250-7205, wuk0605@gmail.com

Received 31 December 2013 Revised 26 February 2014 Accepted 27 February 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to evaluate the clinical and radiographic results of cementless total hip arthroplasty (THA) with subtrochanteric transverse shortening osteotomy in patients with high hip dislocation.

Materials and Methods

Eighteen patients with high hip dislocation who underwent cementless THA combined with a subtrochanteric transverse shortening osteotomy, plate or cable fixation and bone graft on the osteotomy site between 2001 and 2012 were evaluated in this study. The mean duration of follow-up was 5.2 (2-8.3) years. We evaluated Harris hip score, limping, limb length discrepancy as a clinical parameter and osteolysis, loosening and union of the osteotomy site as a radiographic parameter.

Results

Harris hip scores at the final follow-up showed improvement of limping and limb length discrepancy in all cases. And, with the exception of two cases of infection, there were no loosening and osteolysis. All cases showed union of the osteotomy site. There were two cases of infection and one case of dislocation as a complication. Infection occurred in two patients who underwent reoperation and one patient developed sciatic nerve palsy.

Conclusion

Cementless THA with subtrochanteric transverse shortening osteotomy showed relatively satisfactory clinical and radiologic results. However, the incidence of complications, such as infection, is relatively high, therefore, careful attention is needed.

Keywords: Congenital hip dislocation, Osteotomy, Hip replacement arthroplasty

Figures and Tables

Fig. 1

(A) A preoperative radiograph shows Crowe classification 4 high dislocation of the right hip with about 6 cm limb-length discrepancy. (B) A postoperative radiograph shows the hip after femoral shortening and total hip replacement on the right side. (C) A postoperative radiograph after 4.5 years shows healing of the osteotomy site and incorporation of the prosthesis.

Fig. 2

(A) A preoperative radiograph shows Crowe classification 4 high dislocation of the left hip. (B) A postoperative radiograph shows the hip after femoral shortening and total hip replacement on the left side. (C) A postoperative radiographs show after 6 months acetabular cup loosening caused by infection and after management of infected total hip replacement with PROSTALAC®. But, well-fixed femoral stem was retained. (D) A postoperative radiograph after the second stage revision shows no evidence of periprosthetic osteolysis and implant loosening.

Table 1

Clinical Results

Values are presented as data (range) or data only.

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