CLINGING LESSER TROCHANTER OSTEOTOMY WITH WAGNER CONE IN TREATMENT OF CROWE TYPE IV DEVELOPMENTAL DYSPLASIA OF THE HIP IN ADULT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUOJiang , ZHANGZhongjie , XIABo , ZHANGCaidong , LILun , LUXiaobo , YANGHongbin ,  TANMeiyun

Department of Bone and Joint Surgery, the Affiliated Hospital of Luzhou Medical College, Luzhou Sichuan, 646000, P. R. China;

Corresponding author：

TANMeiyun, Email: drtmy@126.com

Keywords：

Developmental dysplastia of the hip; Lesser trochanter osteotomy; Wagner cone femoral prosthesis; Total hip arthroplasty; Adult

DOI：

10.7507/1002-1892.20150094

Video：

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Objective To investigate the effectivness of the clinging lesser trochanter osteotomy with the Wagner cone in total hip arthroplasty (THA) for Crowe type ⅠV developmental dysplasia of the hip (DDH) in adult. Methods Between November 2009 and September 2012, 7 female patients (9 hips) with Crowe type ⅠV DDH were treated by THA procedures of clinging lesser trochanter osteotomy with Wagner cone, aged 24-62 years (mean, 42 years). All patients experienced severe pain and claudication. The left hip was involved in 2 cases, the right hip in 3 cases, and bilateral hips in 2 cases. The Harris score of involved hip was 50.00±7.04. The both limps were discrepancy with an average length difference of 3.4 cm (range, 3-4 cm). The results of Trendelenburg sign were positive. X-ray films showed high complete dislocation of the involved hips. Results The incisions healed by first intention. There was no complication such as infection, dislocation, prosthesis loosening, neurovascular injury. The average follow-up was 36.4 months (range, 25-48 months). Pain and claudication were improved and all patients could restore to work. The Harris score was improved to 83.42±6.47, showing significant difference when compared with preoperative score (t=8.90, P=0.00). The results of Trendelenburg sign were negative. X-ray films showed that all patients got a bony union at osteotomy site of greater trochanter at 3-6 months after operation. And the interface between prosthesis and bone was stable. There was no prosthesis loosening or sinking during the follow-up. Conclusion Clinging lesser trochanter osteotomy with Wagner cone could be an option to shorten the femur in THA for patients with Crowe type ⅠV DDH. It is effective in decreasing the risk of neurovascular injury.

Citation： GUOJiang, ZHANGZhongjie, XIABo, ZHANGCaidong, LILun, LUXiaobo, YANGHongbin, TANMeiyun. CLINGING LESSER TROCHANTER OSTEOTOMY WITH WAGNER CONE IN TREATMENT OF CROWE TYPE IV DEVELOPMENTAL DYSPLASIA OF THE HIP IN ADULT. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(4): 435-438. doi: 10.7507/1002-1892.20150094 Copy

1.	沈彬, 裴福兴, 杨静, 等. 全髋关节置换术治疗成人先天性髋关节脱位. 中华骨科杂志, 2002, 22(4):212-215.
2.	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.
3.	Rosenstein AD, Diaz RJ. Challenges and solutions for total hip arthroplasty in treatment of patients with symptomatic sequelae of developmental dysplasia of the hip. Am J Orthop (Belle Mead NJ), 2011, 40(2):87-91.
4.	Rogers BA, Garbedian S, Kuchinad RA, et al. Total hip arthroplasty for adult hip dysplasia. J Bone Joint Surg, 2012, 94(19):1809-1821.
5.	Takao M, Ohzono K, Nishii T, et al. Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia. J Bone Joint Surg, 2011, 93(6):548-555.
6.	Antoniades J, Pellegrini VD Jr. Cross-sectional anatomy of the illum:implications for acetabular compoment placement in total hip arthroplasty. Clin Orthop Relat Res, 2012, 470(12):3537-3541.
7.	Moskal JK, Capps SG, Scanelli JA. Improving the accuracy of acctabular component orientation:avoiding malpositioning. J Bone Joint Surg (Am), 2013, 95(11):e76.
8.	沈彬, 裴福兴, 杨静. 髋关节发育不良的髋臼重建. 中华外科杂志, 2004, 42(16):1001-1005.
9.	彭阳, 杨柳, 陈光兴, 等. CroweⅢ及Ⅳ型髋关节发育不良全髋关节置换术中髋臼骨缺损的重建. 中华外科杂志, 2014, 52(1):25-29.
10.	潘浩, 胡庆丰, 朱杭, 等. 非股骨短缩截骨全髋关节置换术治疗Crowe Ⅳ型髋关节发育不良.中医正骨, 2014, 26(10):778-780.
11.	史振才, 李子荣, 孙伟. 髋关节发育不良患者全髋关节置换术的髋臼中心化.中华外科杂志, 2004, 42(23):1412-1415.
12.	Linde F, Jensen J. Socket loosening in arthroplasty for congenital dislocation of the hip. Acta Orthop Scand, 1988, 59(3):254-257.
13.	Garvin KL, Bowen MK, Salvati EA, et al. long-term results of total hip arthroplasty in congenitial dislocation and dysplasia of the hip. A follow-up note. J Bone Joint Surg (Am), 1991, 73(9):1348-1354.
14.	Kiliçoğlu OI, Türker M, Akgul 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.
15.	Sanchez-Sotelo J, Berry DJ, Trousdale RT, et al. Surgical treatment of developmental dysplasia of the hip in adults:Ⅱ. Arthroplasty options. J Am Acad Orthop Surg, 2002, 10(5):334-344.
16.	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.
17.	Li C, Zhang C, Zhang M, et al. Comparison of transverse and modified subtrochanteric femoral shortening osteotomy in total hip arthroplasty for developmental dysplasia of hip:a meta-analysis. BMC Musculoskelet Disord, 2014, 15:331.
18.	Akiyama H, Kawanabe K, Yamamoto K, et al. Cemented total hip arthroplasty with subtrochanteric femoral shortening transverse osteotomy for severely dislocated hips:outcome with a 3- to 10-year follow-up period. J Orthop Sci, 2011, 16(3):270-277.
19.	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.
20.	杨述华, 许伟华, 叶树楠, 等. 髋臼重建及股骨转子下短缩截骨全髋关节置换治疗CroweⅣ型髋关节发育不良. 中华骨科杂志, 2013, 33(9):888-894.
21.	Sanchez-Sotelo J, Berry DJ, TrousdaIe RT, et al. SurgicaI treatment of deveIopmental dyspIasia of the hip in aduIts:Ⅱ. ArthropIasty options. J Am Acad Orthop Surg, 2002, 10(5):334-344.
22.	朱振安, 戴尅戎, 王友, 等. 全髋关节置换术治疗成人Crowe Ⅳ型先天性髋关节脱位的临床研究. 中外外科杂志, 2006, 44(20):1403-1406.
23.	史占军, 金大地, 景宗森, 等. 股骨距切除替代转子下截骨在成人髋关节发育不良全髋关节置换术中的应用. 中华关节外科杂志(电子版), 2007, 1(2):76-81.
24.	Claramunt RT1, 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.
25.	Schuh A, Schraml A, Hohenberger G. Long-term results of the Wagner cone prosthesis. Int Orthop, 2009, 33(1):53-58.

1. 沈彬, 裴福兴, 杨静, 等. 全髋关节置换术治疗成人先天性髋关节脱位. 中华骨科杂志, 2002, 22(4):212-215.
2. 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.
3. Rosenstein AD, Diaz RJ. Challenges and solutions for total hip arthroplasty in treatment of patients with symptomatic sequelae of developmental dysplasia of the hip. Am J Orthop (Belle Mead NJ), 2011, 40(2):87-91.
4. Rogers BA, Garbedian S, Kuchinad RA, et al. Total hip arthroplasty for adult hip dysplasia. J Bone Joint Surg, 2012, 94(19):1809-1821.
5. Takao M, Ohzono K, Nishii T, et al. Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia. J Bone Joint Surg, 2011, 93(6):548-555.
6. Antoniades J, Pellegrini VD Jr. Cross-sectional anatomy of the illum:implications for acetabular compoment placement in total hip arthroplasty. Clin Orthop Relat Res, 2012, 470(12):3537-3541.
7. Moskal JK, Capps SG, Scanelli JA. Improving the accuracy of acctabular component orientation:avoiding malpositioning. J Bone Joint Surg (Am), 2013, 95(11):e76.
8. 沈彬, 裴福兴, 杨静. 髋关节发育不良的髋臼重建. 中华外科杂志, 2004, 42(16):1001-1005.
9. 彭阳, 杨柳, 陈光兴, 等. CroweⅢ及Ⅳ型髋关节发育不良全髋关节置换术中髋臼骨缺损的重建. 中华外科杂志, 2014, 52(1):25-29.
10. 潘浩, 胡庆丰, 朱杭, 等. 非股骨短缩截骨全髋关节置换术治疗Crowe Ⅳ型髋关节发育不良.中医正骨, 2014, 26(10):778-780.
11. 史振才, 李子荣, 孙伟. 髋关节发育不良患者全髋关节置换术的髋臼中心化.中华外科杂志, 2004, 42(23):1412-1415.
12. Linde F, Jensen J. Socket loosening in arthroplasty for congenital dislocation of the hip. Acta Orthop Scand, 1988, 59(3):254-257.
13. Garvin KL, Bowen MK, Salvati EA, et al. long-term results of total hip arthroplasty in congenitial dislocation and dysplasia of the hip. A follow-up note. J Bone Joint Surg (Am), 1991, 73(9):1348-1354.
14. Kiliçoğlu OI, Türker M, Akgul 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.
15. Sanchez-Sotelo J, Berry DJ, Trousdale RT, et al. Surgical treatment of developmental dysplasia of the hip in adults:Ⅱ. Arthroplasty options. J Am Acad Orthop Surg, 2002, 10(5):334-344.
16. 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.
17. Li C, Zhang C, Zhang M, et al. Comparison of transverse and modified subtrochanteric femoral shortening osteotomy in total hip arthroplasty for developmental dysplasia of hip:a meta-analysis. BMC Musculoskelet Disord, 2014, 15:331.
18. Akiyama H, Kawanabe K, Yamamoto K, et al. Cemented total hip arthroplasty with subtrochanteric femoral shortening transverse osteotomy for severely dislocated hips:outcome with a 3- to 10-year follow-up period. J Orthop Sci, 2011, 16(3):270-277.
19. 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.
20. 杨述华, 许伟华, 叶树楠, 等. 髋臼重建及股骨转子下短缩截骨全髋关节置换治疗CroweⅣ型髋关节发育不良. 中华骨科杂志, 2013, 33(9):888-894.
21. Sanchez-Sotelo J, Berry DJ, TrousdaIe RT, et al. SurgicaI treatment of deveIopmental dyspIasia of the hip in aduIts:Ⅱ. ArthropIasty options. J Am Acad Orthop Surg, 2002, 10(5):334-344.
22. 朱振安, 戴尅戎, 王友, 等. 全髋关节置换术治疗成人Crowe Ⅳ型先天性髋关节脱位的临床研究. 中外外科杂志, 2006, 44(20):1403-1406.
23. 史占军, 金大地, 景宗森, 等. 股骨距切除替代转子下截骨在成人髋关节发育不良全髋关节置换术中的应用. 中华关节外科杂志(电子版), 2007, 1(2):76-81.
24. Claramunt RT1, 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.
25. Schuh A, Schraml A, Hohenberger G. Long-term results of the Wagner cone prosthesis. Int Orthop, 2009, 33(1):53-58.

Chinese Journal of Reparative and Reconstructive Surgery

CLINGING LESSER TROCHANTER OSTEOTOMY WITH WAGNER CONE IN TREATMENT OF CROWE TYPE IV DEVELOPMENTAL DYSPLASIA OF THE HIP IN ADULT

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