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KMID : 0386720040160010010
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Journal of the Korean Hip Society
2004 Volume.16 No. 1 p.10 ~ p.16
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Arthroplasty for High-riding Development Dislocation of the Hip
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Park Myung-Sik
Suh Dong-Ju
Park Jong-Hyuk
Oh Sang-Soo
Hwang Byung
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Abstract
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Purpose: This study evaluated the mid-term results following subtrochanteric transverse-femoral shortening osteotomy in total hip arthroplasty for high-riding developmental dislocation of the hip (Crowe IV) and its results.
Materials and Methods: Twelve patients with 13 subtrochanteric transverse femoral shortening osteotomy with total hip arthroplasties were followed from 1995 to 2000 for an average of 43 months (range, 24-83 months). Clinical assessment was scored according to the d’ Aubigne and Postel scale and leg length was measured before and after surgery. Radiologically, consolidation of the osteotomy site and stability were evaluated. Non-cemented femoral components and non-cemented cups were used in all cases. Stabilization was obtained in 5 cases by using a plate, which was managed with a conventional stem and in 7 cases by wiring which was managed with a fluted stem.
Results: Eleven of the 13 osteotomies (84.6%) demonstrated radiologic evidence of union, one had a nonunion and one had a delayed union in the osteotomy site. Clinical scores of d´ Aubigne and Postel were improved 11 of 12 patients (11-14-5). Leg length inequalities were restored to an average postsurgery discrepancy of 1.5 cm (range, 1-3.5), from their poeoperative discrepancy. One patient had an early dislocation and was treated with abduction orthosis after closed reduction. Another patient experienced sinking of the femoral component, which was managed by total hip revision with autogenous bone graft, and new femoral component (long fluted stem).
Conclusion: Subtrochanteric femoral shortening transverse osteotomy in total hip arthroplasty for developmental dislocation of the hip permits acetabular fixation in the anatomical region without lengthening or tension of the sciatic nerve. The non-cemented, distal fluted, femoral stem showed a superior result than conventional stem.
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KEYWORD
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Developmental dysplasia of the hip, Total hip arthroplasty, Subtrochanteric osteotomy
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