Becker V-SHAPED LATERAL ROTATION OSTEOTOMY IN TOTAL HIP ARTHROPLASTY FOR Crowe TYPE IV DEVELOPMENT DISLOCATION OF HIP_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

1The 3rd Department of Orthopaedics, the First Center Hospital of Baoding, Baoding Hebei, 071000, P.R.China;;
2Department of Orthopaedics, the First Affiliated Hospital of Soochow University. Corresponding author: MA Wenhai, E-mail: dyzxyygsk@163.com;

Corresponding author：

Keywords：

Development dislocation of the hip; Femoral neck anteversion angle; Osteotomy; Total hip arthroplasty

DOI：

10.7507/1002-1892.20130225

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Objective To summarize the surgical technique and the effectiveness of Becker V-shaped lateral rotation osteotomy in total hip arthroplasty (THA) for Crowe type IV development dislocation of the hip (DDH). Methods Between January 2000 and December 2009, 18 patients (22 hips) with Crowe type IV DDH underwent THA. There were 3 males and 15 females with an average age of 54 years (range, 41-75 years). The unilateral hip was involved in 14 cases and bilateral hips in 4 cases. All patients had over anteversion of the femoral neck, with the acetabular anteversion angle of (21.28 ± 4.87)°, the femoral neck anteversion angle of (59.06 ± 1.44)°, and combined anteversion angle of (80.33 ± 1.55)°. All the patients had limb-length discrepancy, ranged from 1.0 to 3.5 cm (mean, 2.5 cm). Before operation, gluteus medius muscle strength was grade 2 in 17 hips and grade 3 in 5 hips; severe or moderate claudication was observed in 13 and 5 patients, respectively. Trendelenburg sign was positive in all patients. Preoperative Harris score was 30.00 ± 6.32. Cementless prosthesis was used. Becker V-shaped lateral rotation osteotomy and subtrochanteric shortening with overlapping femoral resection were performed, and proximal femoral shaft splitting was performed on 21 hips having narrow bone marrow cavity. Results All the cases achieved primary healing of incision. No complication of anterior dislocation, deep infection, nerve traction injury, or femoral uncontrolled fracture occurred. All the cases were followed up 3-12 years (mean, 8 years). Postoperative X-ray films showed that the initial fixation result of femoral prosthesis was excellent in 18 hips and good in 4 hips. Bone healing of osteotomy stump was obtained at 3-6 months (mean, 5 months) after operation. Affected limb prolonged for 2.5-3.5 cm (mean, 3.0 cm ) at 1 year after operation; limb-length discrepancy was 0.5-1.5 cm (mean, 1.0 cm). The gluteus medius muscle strength was restored to grade 4 in 5 hips and grade 5 in 17 hips. At last follow-up, 13 patients had no claudication, and 5 patients had mild claudication; Trendelenburg sign was negative in 15 cases and was positive in 3 cases; the Harris score was significantly improved to 91.89 ± 3.22; all showing significant difference when compared with preoperative ones (P lt; 0.05). At last follow-up, the acetabular anteversion angle, the femoral neck anteversion angle, and combined anteversion angle were (19.33 ± 4.49), (13.33 ± 5.70), and (32.67 ± 5.35)°, respectively, all showing significant differences when compared with preoperative ones (P lt; 0.05). No aseptic loosening, osteolysis, or rediolucent line was found around the femoral component. No implant subsidence, stem varus, or revision occurred. Conclusion Becker V-shaped lateral rotation osteotomy is a safe and predictable method to treat type Crowe type IV DDH.

Citation： LI Yongwang,MA Wenhai,SUN Junying,SONG Xingjian,AN Ming ZHANG Qian. Becker V-SHAPED LATERAL ROTATION OSTEOTOMY IN TOTAL HIP ARTHROPLASTY FOR Crowe TYPE IV DEVELOPMENT DISLOCATION OF HIP. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(9): 1032-1036. doi: 10.7507/1002-1892.20130225 Copy

1.	Kiliçoğlu O, Türker M, Akgül T, et al. Cementless total hip arthroplasty with modified oblique femoral shortening osteotomy in Crowe type IV congenital hip dislocation. J Arthroplasty, 2013, 28(1): 117-125.
2.	Dunn HK, Hess WE. Total hip reconstruction in chronically dislocated hips. J Bone Joint Surg (Am), 1976, 58(6): 838-845.
3.	Mallory TH, Lombardi AV Jr, Fada RA, et al. Dislocation after total hip arthroplasty using the anterolateral abductor split approach. Clin Orthop Relat Res, 1999, (358): 166-172．.
4.	Paavilainen T, Hoikka V, Paavolainen P. Cementless total hip arthroplasty for congenitally dislocated or dysplastic hips: technique for replacement with a straight femoral component. Clin Orthop Relat Res, 1993, (297): 71-81.
5.	Anwar M, Sugano N, Masuhara K, et al. Total hip arthroplasty in the neglected congenital dislocation of the hip: a five-to 14-year follow-up study. Clin Orthop Relat Res, 1993, (295): 127-134.
6.	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.
7.	Mendes DG. The role of computerized tomography scan in preoperative evaluation of the adult dislocated hip. Clin Orthop Relat Res, 1981, (161): 198-202.
8.	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 Supple 1): 68-73.
9.	孙俊英, 郝跃峰, 杨沛彦, 等. 股骨转子下叠加缩短截骨在Crowe Ⅳ型成人髋脱位全髋置换术的应用. 中华骨科杂志, 2008, 28(1): 9-13.
10.	Mulliken BD, Bourne RB, Rorabeck CH, et al. A tapered titanium femoral stem inserted without cement in a total hip arthroplasty. Radiographic evaluation and stability. J Bone Joint Surg (Am), 1996, 78(8): 1214-1225.
11.	Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral component: a radiographic analysis of loosening. Clin Orthop Relat Res, 1979, (141): 17-27.
12.	DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 20-32.
13.	Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg (Br), 1987, 69(1): 45-55.
14.	Latimer HA, Lachiewicz PF. Porous coated acetabular components with screw fixation. Five to ten-year results. J Bone Joint Surg (Am), 1996, 78(7): 975-981.
15.	Dorr LD. Acetabular cup position: the imperative of getting it right. Orthopedics, 2008, 31(9): 898-899.
16.	Argenson JN, Ryembault E, Flecher X, et al. Three-dimensional anatomy of the hip in osteoarthritis after developmental dysplasia. J Bone Joint Surg (Br), 2005, 87(9): 1192-1196.
17.	Togrul E, Özkan C, Kalaci A, et al. A new technique of subtrochanteric shortening in total hi replacement for Crowe type 3 to 4 dysplasia of the hip. J Arthroplasty, 2010, 25(3): 465-470．.
18.	Reikeraas O, Lereim P, Gabor I, et al. Femoral shortening in total arthroplasty for completely dislocated hips: 3-7 year results in 25 cases. Acta Orthop Scand, 1996, 67(1): 33-36.
19.	张洪. 髋关节发育不良诊断和治疗中的问题与对策. 中华外科杂志, 2008, 46(17): 1284-1287.
20.	Unnanuntana A, Wagner D, Goodman SB. The accuracy of preoperative templating in cementless total hip arthroplasty. J Arthroplasty, 2009, 24(2): 180-186.

1. Kiliçoğlu O, Türker M, Akgül T, et al. Cementless total hip arthroplasty with modified oblique femoral shortening osteotomy in Crowe type IV congenital hip dislocation. J Arthroplasty, 2013, 28(1): 117-125.
2. Dunn HK, Hess WE. Total hip reconstruction in chronically dislocated hips. J Bone Joint Surg (Am), 1976, 58(6): 838-845.
3. Mallory TH, Lombardi AV Jr, Fada RA, et al. Dislocation after total hip arthroplasty using the anterolateral abductor split approach. Clin Orthop Relat Res, 1999, (358): 166-172．.
4. Paavilainen T, Hoikka V, Paavolainen P. Cementless total hip arthroplasty for congenitally dislocated or dysplastic hips: technique for replacement with a straight femoral component. Clin Orthop Relat Res, 1993, (297): 71-81.
5. Anwar M, Sugano N, Masuhara K, et al. Total hip arthroplasty in the neglected congenital dislocation of the hip: a five-to 14-year follow-up study. Clin Orthop Relat Res, 1993, (295): 127-134.
6. 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.
7. Mendes DG. The role of computerized tomography scan in preoperative evaluation of the adult dislocated hip. Clin Orthop Relat Res, 1981, (161): 198-202.
8. 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 Supple 1): 68-73.
9. 孙俊英, 郝跃峰, 杨沛彦, 等. 股骨转子下叠加缩短截骨在Crowe Ⅳ型成人髋脱位全髋置换术的应用. 中华骨科杂志, 2008, 28(1): 9-13.
10. Mulliken BD, Bourne RB, Rorabeck CH, et al. A tapered titanium femoral stem inserted without cement in a total hip arthroplasty. Radiographic evaluation and stability. J Bone Joint Surg (Am), 1996, 78(8): 1214-1225.
11. Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral component: a radiographic analysis of loosening. Clin Orthop Relat Res, 1979, (141): 17-27.
12. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 20-32.
13. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg (Br), 1987, 69(1): 45-55.
14. Latimer HA, Lachiewicz PF. Porous coated acetabular components with screw fixation. Five to ten-year results. J Bone Joint Surg (Am), 1996, 78(7): 975-981.
15. Dorr LD. Acetabular cup position: the imperative of getting it right. Orthopedics, 2008, 31(9): 898-899.
16. Argenson JN, Ryembault E, Flecher X, et al. Three-dimensional anatomy of the hip in osteoarthritis after developmental dysplasia. J Bone Joint Surg (Br), 2005, 87(9): 1192-1196.
17. Togrul E, Özkan C, Kalaci A, et al. A new technique of subtrochanteric shortening in total hi replacement for Crowe type 3 to 4 dysplasia of the hip. J Arthroplasty, 2010, 25(3): 465-470．.
18. Reikeraas O, Lereim P, Gabor I, et al. Femoral shortening in total arthroplasty for completely dislocated hips: 3-7 year results in 25 cases. Acta Orthop Scand, 1996, 67(1): 33-36.
19. 张洪. 髋关节发育不良诊断和治疗中的问题与对策. 中华外科杂志, 2008, 46(17): 1284-1287.
20. Unnanuntana A, Wagner D, Goodman SB. The accuracy of preoperative templating in cementless total hip arthroplasty. J Arthroplasty, 2009, 24(2): 180-186.

Chinese Journal of Reparative and Reconstructive Surgery

Becker V-SHAPED LATERAL ROTATION OSTEOTOMY IN TOTAL HIP ARTHROPLASTY FOR Crowe TYPE IV DEVELOPMENT DISLOCATION OF HIP

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