SUBTROCHANTERIC SHORTENING WITH OVERLAPPING FEMORAL RESECTION IN TOTAL HIP ARTHROPLASTY FOR Crowe TYPE IV DEVELOPMENTAL DYSPLASIA OF HIP IN ADULTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Biao , GUO Shuanghong , GONG Yuekun , SU Qin , YANG Yi , BI Xin.

Department of Orthopaedics, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650031, P.R.China. Corresponding author: GUO Shuanghong, E-mail: Hubert_gsh@sina.com;

Corresponding author：

Keywords：

Developmental dysplasia of the hip; Subtrochanteric resection; Total hip arthroplasty; Adult

DOI：

10.7507/1002-1892.20130143

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Objective To investigate the effectiveness of subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip (DDH). Methods Between January 2004 and December 2010, 37 patients (44 hips) with Crowe type IV DDH underwent subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty with cementless prosthesis. There were 15 males (18 hips) and 22 females (26 hips) with an average age of 42 years (range, 24-46 years). Unilateral hip was involved in 30 cases and bilateral hips in 7 cases. Preoperative X-ray films showed complete dislocation of the femoral head and hypoplasia of the acetabulum and proximal femur. Before operation, the leg discrepancy was (5.5 ± 1.1) cm, and the Harris score was 32.1 ± 5.2. Results The mean operation time was 4.3 hours (range, 3-6 hours); the mean blood loss was 760 mL (range, 600-1 000 mL). All patients obtained primary healing of incision. The patients were followed up 1-8 years (mean, 6.7 years). Pain relief was achieved; 6 cases had mild claudication; 3 cases had femoral nerve palsy; and no stretch injury of sciatic nerve was observed. X-ray films showed that acetabular cups were in normal position. The healing time of fracture was 3-6 months (mean, 3.7 months). The leg discrepancy was (1.5 ± 1.0) cm at 1 day after operation, showing significant difference when compared with preoperative one (t=16.45, P=0.00). The Harris score was 94.3 ± 3.8 at 3 months after operation, showing significant difference when compared with preoperative score (t=59.15, P=0.00). No revision of acetabular and femoral prostheses was performed during follow-up. Conclusion Subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty is a safe method of restoring the anatomic hip center in Crowe type IV DDH in adults. It can avoid reduction difficulty caused by soft tissue contracture and injuries of sciatic nerve and femoral nerve caused by limb lengthening.

Citation： LI Biao,GUO Shuanghong,GONG Yuekun,SU Qin,YANG Yi,BI Xin.. SUBTROCHANTERIC SHORTENING WITH OVERLAPPING FEMORAL RESECTION IN TOTAL HIP ARTHROPLASTY FOR Crowe TYPE IV DEVELOPMENTAL DYSPLASIA OF HIP IN ADULTS. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(6): 645-648. doi: 10.7507/1002-1892.20130143 Copy

1.	Hartofilakidis G, Georgiades G, Babis GC, et al. Evaluation of two surgical techniques for acetabular reconstruction in total hip replacement for congenital hip disease: results after a minimum ten-year follow-up. J Bone Joint Surg (Br), 2008, 90(6): 724-730.
2.	李彪, 龚跃昆, 张磊, 等. 生物型全髋关节置换术治疗成人髋关节发育不良. 中国修复重建外科杂志, 2008, 22(6): 646-648.
3.	Starker M, Bischof F, Lindenfeld T. Total hip arthroplasty with shortening subtrochanteric osteotomy and custom-made prosthesis in Crowe type IV developmental dysplasia. Z Orthop Unfall, 2011, 149(5): 518-525.
4.	王皓宇, 黄明, 高明杰, 等. 后外侧入路高脱位髋关节假体重建软组织处理. 解剖与临床, 2011, 16(5): 412-414.
5.	Lai KA, Shen WJ, Huang LW, et al. Cementless total hip arthroplasty and limb-length equalization in patients with unilateral Crowe type-IV hip dislocation. J Bone Joint Surg (Am), 2005, 87(2): 339-345.
6.	Nakamura Y, Mitsui H, Kikuchi A, et al. Total hip arthroplasty using a cylindrical cementless stem in patients with a small physique. J Arthroplasty, 2011, 26(1): 77-81.
7.	Christie M, Brinson MF. Proximal/distal mismatch: type A and C femurs. Orthopedics, 2005, 28(9 Suppl): S1033-1036.
8.	Bruce WJ, Rizkallah SM, Kwon YM, et al. A new technique of subtrochanteric shortening in total hip arthroplasty: surgical technique and results of 9 cases. J Arthroplasty, 2000, 15(5): 617-626.
9.	Faldini C, Nanni M, Leonetti D, et al. Total hip arthroplasty in developmental hip dysplasia using cementless tapered stem. Results after a minimum 10-year follow-up. Hip Int, 2011, 21(4): 415-420.
10.	Fousek J, Indráková P. Total hip arthroplasty in post-dysplastic hip arthritis. Can type and position of the acetabular component influence longevity of the prosthesis? Acta Chir Orthop Traumatol Cech, 2007, 74(1): 47-54.
11.	Sun JY, Wei L. Subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty for Crowe type IV adult dislocation of the hip. Orthop Surg, 2009, 1(3): 207-211.
12.	Dallari D, Pignatti G, Stagni C, et al. Total hip arthroplasty with shortening osteotomy in congenital major hip dislocation sequelae. Orthopedics, 2011, 34(8): e328-333.
13.	Kim M, Kadowaki T. High long-term survival of bulk femoral head autograft for acetabular reconstruction in cementless THA for developmental hip dysplasia. Clin Orthop Relat Res, 2010, 468(6): 1611-1620.
14.	吴岳嵩, 汪滋民, 王志伟, 等. Crowe Ⅳ型髋关节发育不良的全髋关节置换术. 中华骨科杂志, 2010, 30(2): 129-136.
15.	Hendrich C, Mehling I, Sauer U, et al. Cementless acetabular reconstruction and structural bone-grafting in dysplastic hips. J Bone Joint Surg (Am), 2006, 88(2): 387-394.
16.	de Jong PT, Haverkamp D, van der Vis HM, et al. Total hip replacement with a superolateral bone graft for osteoarthritis secondary to dysplasia: a long-term follow-up. J Bone Joint Surg (Br), 2006, 88(2): 173-178.
17.	刘瑞宇, 王坤正, 王春生, 等. 三维表面遮盖法结合多平面重建在成人髋关节发育不良全髋关节置换术前髋臼评估中的应用. 中国修复重建外科杂志, 2008, 22(6): 643-645.
18.	高伟强, 陈经勇, 成俊, 等. 自体股骨头植骨生物型人工全髋关节置换治疗髋关节发育不良的疗效. 中国组织工程研究与临床康复, 2011, 15(26): 4785-4787.

1. Hartofilakidis G, Georgiades G, Babis GC, et al. Evaluation of two surgical techniques for acetabular reconstruction in total hip replacement for congenital hip disease: results after a minimum ten-year follow-up. J Bone Joint Surg (Br), 2008, 90(6): 724-730.
2. 李彪, 龚跃昆, 张磊, 等. 生物型全髋关节置换术治疗成人髋关节发育不良. 中国修复重建外科杂志, 2008, 22(6): 646-648.
3. Starker M, Bischof F, Lindenfeld T. Total hip arthroplasty with shortening subtrochanteric osteotomy and custom-made prosthesis in Crowe type IV developmental dysplasia. Z Orthop Unfall, 2011, 149(5): 518-525.
4. 王皓宇, 黄明, 高明杰, 等. 后外侧入路高脱位髋关节假体重建软组织处理. 解剖与临床, 2011, 16(5): 412-414.
5. Lai KA, Shen WJ, Huang LW, et al. Cementless total hip arthroplasty and limb-length equalization in patients with unilateral Crowe type-IV hip dislocation. J Bone Joint Surg (Am), 2005, 87(2): 339-345.
6. Nakamura Y, Mitsui H, Kikuchi A, et al. Total hip arthroplasty using a cylindrical cementless stem in patients with a small physique. J Arthroplasty, 2011, 26(1): 77-81.
7. Christie M, Brinson MF. Proximal/distal mismatch: type A and C femurs. Orthopedics, 2005, 28(9 Suppl): S1033-1036.
8. Bruce WJ, Rizkallah SM, Kwon YM, et al. A new technique of subtrochanteric shortening in total hip arthroplasty: surgical technique and results of 9 cases. J Arthroplasty, 2000, 15(5): 617-626.
9. Faldini C, Nanni M, Leonetti D, et al. Total hip arthroplasty in developmental hip dysplasia using cementless tapered stem. Results after a minimum 10-year follow-up. Hip Int, 2011, 21(4): 415-420.
10. Fousek J, Indráková P. Total hip arthroplasty in post-dysplastic hip arthritis. Can type and position of the acetabular component influence longevity of the prosthesis? Acta Chir Orthop Traumatol Cech, 2007, 74(1): 47-54.
11. Sun JY, Wei L. Subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty for Crowe type IV adult dislocation of the hip. Orthop Surg, 2009, 1(3): 207-211.
12. Dallari D, Pignatti G, Stagni C, et al. Total hip arthroplasty with shortening osteotomy in congenital major hip dislocation sequelae. Orthopedics, 2011, 34(8): e328-333.
13. Kim M, Kadowaki T. High long-term survival of bulk femoral head autograft for acetabular reconstruction in cementless THA for developmental hip dysplasia. Clin Orthop Relat Res, 2010, 468(6): 1611-1620.
14. 吴岳嵩, 汪滋民, 王志伟, 等. Crowe Ⅳ型髋关节发育不良的全髋关节置换术. 中华骨科杂志, 2010, 30(2): 129-136.
15. Hendrich C, Mehling I, Sauer U, et al. Cementless acetabular reconstruction and structural bone-grafting in dysplastic hips. J Bone Joint Surg (Am), 2006, 88(2): 387-394.
16. de Jong PT, Haverkamp D, van der Vis HM, et al. Total hip replacement with a superolateral bone graft for osteoarthritis secondary to dysplasia: a long-term follow-up. J Bone Joint Surg (Br), 2006, 88(2): 173-178.
17. 刘瑞宇, 王坤正, 王春生, 等. 三维表面遮盖法结合多平面重建在成人髋关节发育不良全髋关节置换术前髋臼评估中的应用. 中国修复重建外科杂志, 2008, 22(6): 643-645.
18. 高伟强, 陈经勇, 成俊, 等. 自体股骨头植骨生物型人工全髋关节置换治疗髋关节发育不良的疗效. 中国组织工程研究与临床康复, 2011, 15(26): 4785-4787.

Chinese Journal of Reparative and Reconstructive Surgery

SUBTROCHANTERIC SHORTENING WITH OVERLAPPING FEMORAL RESECTION IN TOTAL HIP ARTHROPLASTY FOR Crowe TYPE IV DEVELOPMENTAL DYSPLASIA OF HIP IN ADULTS

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