Total hip arthroplasty with Wagner Cone stem and subtrochanteric shortening osteotomy in treatment of Crowe <b>Ⅳ</b> developmental dysplasia of hip in adults_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LU Wei , ZENG Min , LEI Pengfei , XIE Jie ,  HU Yihe

Department of Orthopedics, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China;

Corresponding author：

HU Yihe, Email: huyh1964@163.com

Keywords：

Developmental dysplasia of the hip; Wagner Cone stem; subtrochanteric shortening osteotomy; total hip arthroplasty

DOI：

10.7507/1002-1892.201810062

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Objective To investigate the short-term effectiveness of total hip arthroplasty with Wagner Cone stem combined with subtrochanteric shortening osteotomy for adult patients with Crowe Ⅳ developmental dysplasia of the hip (DDH). Methods A clinical data of 18 patients (20 hips) with Crowe Ⅳ DDH between January 2015 and June 2017 was retrospectively analyzed. There were 5 males (6 hips) and 13 females (14 hips), with an average age of 42 years (range, 20-67 years). There were 18 cases with unilateral DDH and 2 cases with bilateral DDHs. The " 4” sign and Trendelenburg sign of affected hip were positive. Preoperative Harris score and visual analogue scale (VAS) score were 41.95±6.90 and 5.05±1.15, respectively. The length discrepancy was (4.76±2.59) cm in patients with unilateral DDH. And the lengths of bilateral lower limbs in patients with bilateral DDH were equal. The acetabular anteversion angle, femoral anteversion angle, and combined anteversion angle were (32.82±2.79), (46.18±6.80), and (79.01±7.54) °, respectively. All patients were treated by total hip arthroplasty with Wagner Cone stem and subtrochanteric shortening osteotomy. The length of osteotomy ranged from 2.0 to 3.5 cm (mean, 2.38 cm). Results The operation time was 116-161 minutes (mean, 138.4 minutes); the volume of intraoperative blood loss was 600-1 200 mL (mean, 795 mL); the volume of drainage after operation was 100-630 mL (mean, 252 mL). All incisions healed by first intention. The symptom of sciatic nerve injury occurred in 1 case and relieved after symptomatic treatment. All patients were followed up 12-29 months (mean, 18.4 months). The " 4” sign and Trendelenburg sign of affected hip were negative. The Harris score and VAS score at last follow-up were 87.50±5.06 and 0.75±0.85, respectively. The acetabular anteversion angle, femoral anteversion angle, and combined anteversion angle were (16.21±4.84), (18.99±2.55), and (35.20±5.80)°, respectively. There were significant differences in above indexes between pre- and post-operation (P<0.05). The length discrepancy was (0.72±0.70) cm in patients with unilateral DDH, which was significant shorter than the preoperative value (t=7.751, P=0.000). And the lengths of bilateral lower limbs in patients with bilateral DDH were equal. X-ray films showed that the osteotomy of femur healed at 3-6 months (mean, 4.1 months) without the signs of loosening, sinking, osteolysis, and dislocation. Conclusion Total hip arthroplasty with Wagner Cone stem and subtrochanteric shortening osteotomy can obviously improve the hip joint function and restore the length of lower limb. The short-term effectiveness is satisfactory, but the long-term effectiveness and survival rate of prosthesis need to be further observed.

Citation： LU Wei, ZENG Min, LEI Pengfei, XIE Jie, HU Yihe. Total hip arthroplasty with Wagner Cone stem and subtrochanteric shortening osteotomy in treatment of Crowe Ⅳ developmental dysplasia of hip in adults. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(8): 929-934. doi: 10.7507/1002-1892.201810062 Copy

1.	Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg (Am), 1979, 61(1): 15-23.
2.	Hasegawa Y, Iwata H. Natural history of unreduced congenital dislocation of the hip in adults. Arch Orthop Trauma Surg, 2000, 120(1-2): 17-22.
3.	Argenson JA, Flecher X, Parratte S, et al. Anatomy of the dysplastic hip and consequences for total hip arthroplasty. Clin Orthop Relat Res, 2007, (465): 40-45.
4.	Clohisy JC, Barrett SE, Gordon JE, et al. Periacetabular osteotomy in the treatment of severe acetabular dysplasia. J Bone Joint Surg (Am), 2005, 87(2): 254-259.
5.	Bernasek TL, Haidukewych GJ, Gustke KA, et al. Total hip arthroplasty requiring subtrochanteric osteotomy for developmental hip dysplasia. J Arthroplasty, 2007, 22(6 Suppl 2): 145-150.
6.	Reikerås O, Haaland JE, Lereim P. Femoral shortening in total hip arthroplasty for high developmental dysplasia of the hip. Clin Orthop Relat Res, 2010, 468(7): 1949-1955.
7.	Wang D, Li DH, Qi L, et al. Subtrochanteric shortening osteotomy during cementless total hip arthroplasty in young patients with severe developmental dysplasia of the hip. BMC Musculoskeletal Disorders, 2017, 18(1): 491.
8.	Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
9.	Bourne RB, Rorabeck CH. Soft tissue balancing: the hip. J Arthroplasty, 2002, 17(4 Suppl 1): 17-22.
10.	Mayeda BF, Haw JG, Battenberg AK, et al. Femoral-acetabular mating: the effect of femoral and combined anteversion on cross-linked polyethylene wear. J Arthroplasty, 2018, 33(10): 3320-3324.
11.	Liu S, Zuo J, Li Z, et al. Study of three-dimensional morphology of the proximal femur in developmental adult dysplasia of the hip suggests that the on-shelf modular prosthesis may not be an ideal choice for patients with Crowe type Ⅳ hips. Int Orthop, 2017, 41(4): 707-713.
12.	Sugano N, Noble PC, Kamaric E, et al. The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg (Br), 1998, 80(4): 711-719.
13.	Masonis JL, Patel JV, Miu A, et al. Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia: 5-year follow-up. J Arthroplasty, 2003, 18(3 Suppl 1): 68-73.
14.	Cameron HU, Eren OT, Solomon M. Nerve injury in the prosthetic management of the dysplastic hip. Orthopedics, 1998, 21(9): 980-981.
15.	Ollivier M, Abdel MP, Krych AJ, et al. Long-term results of total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe Ⅳ developmental dysplasia. J Arthroplasty, 2016, 31(8): 1756-1760.
16.	Klisic P, Jankovic L. Combined procedure of open reduction and shortening of the femur in treatment of congenital dislocation of the hips in older children. Clin Orthop Related Res, 1976, (119): 60-69.
17.	Yasgur DJ, Stuchin SA, Adler EM, et al. Subtrochanteric femoral shortening osteotomy in total hip arthroplasty for high-riding developmental dislocation of the hip. J Arthroplasty, 1997, 12(8): 880-888.
18.	Bruce WJ, Rizkallah SM, Kwon YM. A new technique of subtrochanteric shortening in total hip arthroplasty: surgical technique and results of 9 cases. J Arthroplasty, 2000, 15(5): 617-626.
19.	Sener N, Tözün IR, Aşik M. Femoral shortening and cementless arthroplasty in high congenital dislocation of the hip. J Arthroplasty, 2002, 17(1): 41-48.
20.	Park MS, Kim KH, Jeong WC. Transverse subtrochanteric shortening osteotomy in primary total hip arthroplasty for patients with severe hip developmental dysplasia. J Arthroplasty, 2007, 22(7): 1031-1036.
21.	Rollo G, Solarino G, Vicenti G, et al. Subtrochanteric femoral shortening osteotomy combined with cementless total hip replacement for Crowe type Ⅳ developmental dysplasia: a retrospective study. J Orthop Traumatol, 2017, 18(4): 407-413.
22.	Parisi T, Burroughs B, Kwon YM. Modular hip implant fracture at the stem-sleeve interface. Orthopedics, 2015, 38(3): e234-239.
23.	Li X, Lu Y, Sun J, et al. Treatment of Crowe type-Ⅳ hip dysplasia using cementless total hip arthroplasty and double chevron subtrochanteric shortening osteotomy: A 5- to 10-year follow-up study. J Arthroplasty, 2017, 32(2): 475-479.
24.	Kato T, Otani T, Sugiyama H, et al. Cementless total hip arthroplasty in hip dysplasia with an extensively porous-coated cylindrical stem modified for Asians: A 12-year follow-up study. J Arthroplasty, 2015, 30(6): 1014-1018.
25.	Hitz OF, Flecher X, Parratte S, et al. Minimum 10-year outcome of one-stage total hip arthroplasty without subtrochanteric osteotomy using a cementless custom stem for Crowe Ⅲ and Ⅳ hip dislocation. J Arthroplasty, 2018, 33(7): 2197-2202.
26.	Wagner H, Wagner M. Cone prosthesis for the hip joint. Arch Orthop Trauma Surg, 2000, 120(1-2): 88-95.
27.	Claramunt RT, Marqués F, León A, et al. Total hip replacement with an uncemented Wagner cone stem for patients with congenital hip dysplasia. Int Orthop, 2011, 35(12): 1767-1770.
28.	Schuh A, Schraml A, Hohenberger G. Long-term results of the Wagner cone prosthesis. Int Orthop, 2009, 33(1): 53-58.
29.	Parry MC, Vioreanu MH, Garbuz DS, et al. The Wagner cone stem for the management of the challenging femur in primary hip arthroplasty. J Arthroplasty, 2016, 31(8): 1767-1772.
30.	Zhen P, Liu J, Lu H, et al. Developmental hip dysplasia treated by total hip arthroplasty using a cementless Wagner cone stem in young adult patients with a small physique. BMC Musculoskeletal Disorders, 2017, 18(1): 192.

1. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg (Am), 1979, 61(1): 15-23.
2. Hasegawa Y, Iwata H. Natural history of unreduced congenital dislocation of the hip in adults. Arch Orthop Trauma Surg, 2000, 120(1-2): 17-22.
3. Argenson JA, Flecher X, Parratte S, et al. Anatomy of the dysplastic hip and consequences for total hip arthroplasty. Clin Orthop Relat Res, 2007, (465): 40-45.
4. Clohisy JC, Barrett SE, Gordon JE, et al. Periacetabular osteotomy in the treatment of severe acetabular dysplasia. J Bone Joint Surg (Am), 2005, 87(2): 254-259.
5. Bernasek TL, Haidukewych GJ, Gustke KA, et al. Total hip arthroplasty requiring subtrochanteric osteotomy for developmental hip dysplasia. J Arthroplasty, 2007, 22(6 Suppl 2): 145-150.
6. Reikerås O, Haaland JE, Lereim P. Femoral shortening in total hip arthroplasty for high developmental dysplasia of the hip. Clin Orthop Relat Res, 2010, 468(7): 1949-1955.
7. Wang D, Li DH, Qi L, et al. Subtrochanteric shortening osteotomy during cementless total hip arthroplasty in young patients with severe developmental dysplasia of the hip. BMC Musculoskeletal Disorders, 2017, 18(1): 491.
8. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
9. Bourne RB, Rorabeck CH. Soft tissue balancing: the hip. J Arthroplasty, 2002, 17(4 Suppl 1): 17-22.
10. Mayeda BF, Haw JG, Battenberg AK, et al. Femoral-acetabular mating: the effect of femoral and combined anteversion on cross-linked polyethylene wear. J Arthroplasty, 2018, 33(10): 3320-3324.
11. Liu S, Zuo J, Li Z, et al. Study of three-dimensional morphology of the proximal femur in developmental adult dysplasia of the hip suggests that the on-shelf modular prosthesis may not be an ideal choice for patients with Crowe type Ⅳ hips. Int Orthop, 2017, 41(4): 707-713.
12. Sugano N, Noble PC, Kamaric E, et al. The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg (Br), 1998, 80(4): 711-719.
13. Masonis JL, Patel JV, Miu A, et al. Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia: 5-year follow-up. J Arthroplasty, 2003, 18(3 Suppl 1): 68-73.
14. Cameron HU, Eren OT, Solomon M. Nerve injury in the prosthetic management of the dysplastic hip. Orthopedics, 1998, 21(9): 980-981.
15. Ollivier M, Abdel MP, Krych AJ, et al. Long-term results of total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe Ⅳ developmental dysplasia. J Arthroplasty, 2016, 31(8): 1756-1760.
16. Klisic P, Jankovic L. Combined procedure of open reduction and shortening of the femur in treatment of congenital dislocation of the hips in older children. Clin Orthop Related Res, 1976, (119): 60-69.
17. Yasgur DJ, Stuchin SA, Adler EM, et al. Subtrochanteric femoral shortening osteotomy in total hip arthroplasty for high-riding developmental dislocation of the hip. J Arthroplasty, 1997, 12(8): 880-888.
18. Bruce WJ, Rizkallah SM, Kwon YM. A new technique of subtrochanteric shortening in total hip arthroplasty: surgical technique and results of 9 cases. J Arthroplasty, 2000, 15(5): 617-626.
19. Sener N, Tözün IR, Aşik M. Femoral shortening and cementless arthroplasty in high congenital dislocation of the hip. J Arthroplasty, 2002, 17(1): 41-48.
20. Park MS, Kim KH, Jeong WC. Transverse subtrochanteric shortening osteotomy in primary total hip arthroplasty for patients with severe hip developmental dysplasia. J Arthroplasty, 2007, 22(7): 1031-1036.
21. Rollo G, Solarino G, Vicenti G, et al. Subtrochanteric femoral shortening osteotomy combined with cementless total hip replacement for Crowe type Ⅳ developmental dysplasia: a retrospective study. J Orthop Traumatol, 2017, 18(4): 407-413.
22. Parisi T, Burroughs B, Kwon YM. Modular hip implant fracture at the stem-sleeve interface. Orthopedics, 2015, 38(3): e234-239.
23. Li X, Lu Y, Sun J, et al. Treatment of Crowe type-Ⅳ hip dysplasia using cementless total hip arthroplasty and double chevron subtrochanteric shortening osteotomy: A 5- to 10-year follow-up study. J Arthroplasty, 2017, 32(2): 475-479.
24. Kato T, Otani T, Sugiyama H, et al. Cementless total hip arthroplasty in hip dysplasia with an extensively porous-coated cylindrical stem modified for Asians: A 12-year follow-up study. J Arthroplasty, 2015, 30(6): 1014-1018.
25. Hitz OF, Flecher X, Parratte S, et al. Minimum 10-year outcome of one-stage total hip arthroplasty without subtrochanteric osteotomy using a cementless custom stem for Crowe Ⅲ and Ⅳ hip dislocation. J Arthroplasty, 2018, 33(7): 2197-2202.
26. Wagner H, Wagner M. Cone prosthesis for the hip joint. Arch Orthop Trauma Surg, 2000, 120(1-2): 88-95.
27. Claramunt RT, Marqués F, León A, et al. Total hip replacement with an uncemented Wagner cone stem for patients with congenital hip dysplasia. Int Orthop, 2011, 35(12): 1767-1770.
28. Schuh A, Schraml A, Hohenberger G. Long-term results of the Wagner cone prosthesis. Int Orthop, 2009, 33(1): 53-58.
29. Parry MC, Vioreanu MH, Garbuz DS, et al. The Wagner cone stem for the management of the challenging femur in primary hip arthroplasty. J Arthroplasty, 2016, 31(8): 1767-1772.
30. Zhen P, Liu J, Lu H, et al. Developmental hip dysplasia treated by total hip arthroplasty using a cementless Wagner cone stem in young adult patients with a small physique. BMC Musculoskeletal Disorders, 2017, 18(1): 192.

Chinese Journal of Reparative and Reconstructive Surgery

Total hip arthroplasty with Wagner Cone stem and subtrochanteric shortening osteotomy in treatment of Crowe Ⅳ developmental dysplasia of hip in adults

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