A comparative study of three different fixation methods after subtrochanteric shortening osteotomy in total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of the hip_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Yubo ^1,2,3 , MA Mingyang ^2,3,4 ^△ , YANG Minzhi ^1,2,3 , GUO Renwen ^2,3,4 ,  KONG Xiangpeng ^2,3 ,  CHAI Wei ^2,3

1. School of Medicine, Nankai University, Tianjin, 300071, P.R.China;
2. Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, 100048, P.R.China;
3. National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China;
4. Medical School of Chinese PLA, Beijing, 100853, P.R.China;

Corresponding author：

KONG Xiangpeng, Email: 18810999609@163.com; CHAI Wei, Email: chaiwei301@163.com

Keywords：

Developmental dysplasia of the hip; total hip arthroplasty; subtrochanteric shortening osteotomy; internal fixation

DOI：

10.7507/1002-1892.202107121

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Objective To compare the effectiveness of three different fixation methods after subtrochanteric shortening osteotomy (SSO) in total hip arthroplasty (THA) for Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods A clinical data of 63 patients (78 hips) with Crowe type Ⅳ DDH, who underwent THA with SSO between November 2014 and May 2019, was retrospectively analyzed. Among them, 18 patients (20 hips) obtained stability by intramedullary pressure provided by the S-ROM modular prostheses (group A); 22 patients (30 hips) underwent prophylactic binding by stainless steel wire after osteotomy and before stem implantation (group B); 23 patients (28 hips) were fixed with autogenous cortical strut grafts and stainless steel wire or cables (group C). There was no significant difference in gender, age, body mass index, affected limb side, and preoperative Harris score between groups (P>0.05). The operation time, complications, imaging results, hip functional score of the three groups were recorded and compared. Results There was no significant difference in the operation time between groups (P>0.05). All incisions healed by first intention. All patients were followed up, and the follow-up time was 2.5-4.0 years (mean, 3.1 years) in group A, 1.5-5.5 years (mean, 3.2 years) in group B, and 1.0-5.0 years (mean, 1.6 years) in group C. There was no significant difference in Harris score or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between groups at 4 and 12 months after operation (P>0.05). X-ray films showed that there was no significant difference in osteotomy healing rate at 4, 8, and 12 months after operation and the osteotomy healing time between groups (P>0.05). There was no complications such as joint dislocation, prosthesis loosening, prosthetic joint infection, or heterotopic ossification during follow-up, except for the distal femoral fracture of 1 hip during operation in group B. Conclusion In THA for patients with Crowe type Ⅳ DDH, the stainless steel wire binding alone and autogenous cortical strut grafts combined with stainless steel wire or cable binding can not significantly promote the osteotomy healing compared with femoral prosthesis intramedullary compression fixation. For patients with nonmatched medullary cavity after SSO, it is recommended to apply autogenous cortical strut grafts with wire or cables for additional fixation.

Citation： LIU Yubo, MA Mingyang, YANG Minzhi, GUO Renwen, KONG Xiangpeng, CHAI Wei. A comparative study of three different fixation methods after subtrochanteric shortening osteotomy in total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of the hip. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(12): 1519-1524. doi: 10.7507/1002-1892.202107121 Copy

1.	Çatma MF, Ünlü S, Öztürk A, et al. Femoral shortening osteotomy in total hip arthroplasty for severe dysplasia: a comparison of two fixation techniques. Int Orthop, 2016, 40(11): 2271-2276.
2.	Kong X, Chai W, Chen J, et al. Intraoperative monitoring of the femoral and sciatic nerves in total hip arthroplasty with high-riding developmental dysplasia. Bone Joint J, 2019, 101-B(11): 1438-1446.
3.	Sun J, Guo L, Ni M, et al. Changes in distribution of lower limb alignment after total hip arthroplasty for Crowe Ⅳ developmental dysplasia of the hip. Ther Clin Risk Manag, 2021, 17: 389-396.
4.	Wang S, Zhou Y, Ma H, et al. Mid-term results of total hip replacement with subtrochanteric osteotomy, modular stem, and ceramic surface in Crowe Ⅳ hip dysplasia. Arthroplast Today, 2017, 4(3): 363-369.
5.	Yoder SA, Brand RA, Pedersen DR, et al. Total hip acetabular component position affects component loosening rates. Clin Orthop Relat Res, 1988, (228): 79-87.
6.	Rogers BA, Garbedian S, Kuchinad RA, et al. Total hip arthroplasty for adult hip dysplasia. J Bone Joint Surg (Am), 2012, 94(19): 1809-1821.
7.	Shi XT, Li CF, Han Y, et al. Total Hip arthroplasty for Crowe type Ⅳ hip dysplasia: surgical techniques and postoperative complications. Orthop Surg, 2019, 11(6): 966-973.
8.	Becker DA, Gustilo RB. Double-chevron subtrochanteric shortening derotational femoral osteotomy combined with total hip arthroplasty for the treatment of complete congenital dislocation of the hip in the adult. Preliminary report and description of a new surgical technique. J Arthroplasty, 1995, 10(3): 313-318.
9.	Huo MH, Zatorski LE, Keggi KJ. Oblique femoral osteotomy in cementless total hip arthroplasty. Prospective consecutive series with a 3-year minimum follow-up period. J Arthroplasty, 1995, 10(3): 319-327.
10.	Sponseller PD, McBeath AA. Subtrochanteric osteotomy with intramedullary fixation for arthroplasty of the dysplastic hip. A case report. J Arthroplasty, 1988, 3(4): 351-354.
11.	Muratli KS, Karatosun V, Uzun B, et al. Subtrochanteric shortening in total hip arthroplasty: biomechanical comparison of four techniques. J Arthroplasty, 2014, 29(4): 836-842.
12.	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.
13.	Çağlar Ö, Özdemir E, Tokgözoğlu AM, et al. Use of proximal humerus plates for the fixation of the subtrochanteric femoral shortening osteotomy during total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of the hip patients. Jt Dis Relat Surg, 2020, 31(2): 306-311.
14.	Togrul E, Ozkan C, Kalaci A, et al. A new technique of subtrochanteric shortening in total hip replacement for Crowe type 3 to 4 dysplasia of the hip. J Arthroplasty, 2010, 25(3): 465-470.
15.	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.
16.	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.
17.	Sutherland CJ, Wilde AH, Borden LS, et al. A ten-year follow-up of one hundred consecutive Müller curved-stem total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1982, 64(7): 970-982.
18.	Brooker AF, Bowerman JW, Robinson RA, et al. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg (Am), 1973, 55(8): 1629-1632.
19.	Wang D, Li LL, Wang HY, et al. Long-term results of cementless total hip arthroplasty with subtrochanteric shortening osteotomy in Crowe type Ⅳ developmental dysplasia. J Arthroplasty, 2017, 32(4): 1211-1219.
20.	Ma HY, Lu Q, Sun JY, et al. One-stage total hip arthroplasty with modular S-ROM stem for patients with bilateral Crowe type Ⅳ developmental dysplasia. Orthop Surg, 2020, 12(6): 1913-1922.
21.	Gong S, Xu W, Wang R, et al. The causes and management of nonunion of femoral subtrochanteric shortening osteotomy in a THA patient: a case report. BMC Musculoskelet Disord, 2019, 20(1): 203. doi: 10.1186/s12891-019-2612-2.
22.	Wang D, Li DH, Li Q, et al. Subtrochanteric shortening osteotomy during cementless total hip arthroplasty in young patients with severe developmental dysplasia of the hip. BMC Musculoskelet Disord, 2017, 18(1): 491. doi: 10.1186/s12891-017-1857-x.
23.	Onodera S, Majima T, Ito H, et al. Cementless total hip arthroplasty using the modular S-ROM prosthesis combined with corrective proximal femoral osteotomy. J Arthroplasty, 2006, 21(5): 664-669.
24.	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.
25.	刘宇博, 孔祥朋, 柴伟. Crowe Ⅳ型髋关节发育不良的全髋关节置换术: 术中股骨短缩截骨的文献回顾. 骨科, 2021, 12(4): 383-388.
26.	Krych AJ, Howard JL, Trousdale RT, et al. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-Ⅳ developmental dysplasia: surgical technique. J Bone Joint Surg (Am), 2010, 92(Suppl 1 Pt 2): 176-187.
27.	Berton C, Puskas GJ, Christofilopoulos P, et al. Comparison of the outcome following the fixation of osteotomies or fractures associated with total hip replacement using cables or wires: the results at five years. J Bone Joint Surg (Br), 2021, 94(11): 1475-1481.
28.	Daou S, El Chemaly A, Christofilopoulos P, et al. The potential role of cobalt ions released from metal prosthesis on the inhibition of Hv1 proton channels and the decrease in Staphyloccocus epidermidis killing by human neutrophils. J Biomaterials, 2011, 32(7): 1769-1777.
29.	Rae T. The action of cobalt, nickel and chromium on phagocytosis and bacterial killing by human polymorphonuclear leucocytes; its relevance to infection after total joint arthroplasty. J Biomaterials, 1983, 4(3): 175-180.
30.	Kawai T, Goto K, Kuroda Y, et al. Total hip arthroplasty combined with subtrochanteric transverse shortening osteotomy: factors associated with delayed union at the osteotomy site. J Am Acad Orthop Surg Glob Res Rev, 2020, 4(8): e20.00056. doi: 10.5435/JAAOSGlobal-D-20-00056.
31.	Dorr LD, Faugere MC, Mackel AM, et al. Structural and cellular assessment of bone quality of proximal femur. Bone, 1993, 14(3): 231-242.

1. Çatma MF, Ünlü S, Öztürk A, et al. Femoral shortening osteotomy in total hip arthroplasty for severe dysplasia: a comparison of two fixation techniques. Int Orthop, 2016, 40(11): 2271-2276.
2. Kong X, Chai W, Chen J, et al. Intraoperative monitoring of the femoral and sciatic nerves in total hip arthroplasty with high-riding developmental dysplasia. Bone Joint J, 2019, 101-B(11): 1438-1446.
3. Sun J, Guo L, Ni M, et al. Changes in distribution of lower limb alignment after total hip arthroplasty for Crowe Ⅳ developmental dysplasia of the hip. Ther Clin Risk Manag, 2021, 17: 389-396.
4. Wang S, Zhou Y, Ma H, et al. Mid-term results of total hip replacement with subtrochanteric osteotomy, modular stem, and ceramic surface in Crowe Ⅳ hip dysplasia. Arthroplast Today, 2017, 4(3): 363-369.
5. Yoder SA, Brand RA, Pedersen DR, et al. Total hip acetabular component position affects component loosening rates. Clin Orthop Relat Res, 1988, (228): 79-87.
6. Rogers BA, Garbedian S, Kuchinad RA, et al. Total hip arthroplasty for adult hip dysplasia. J Bone Joint Surg (Am), 2012, 94(19): 1809-1821.
7. Shi XT, Li CF, Han Y, et al. Total Hip arthroplasty for Crowe type Ⅳ hip dysplasia: surgical techniques and postoperative complications. Orthop Surg, 2019, 11(6): 966-973.
8. Becker DA, Gustilo RB. Double-chevron subtrochanteric shortening derotational femoral osteotomy combined with total hip arthroplasty for the treatment of complete congenital dislocation of the hip in the adult. Preliminary report and description of a new surgical technique. J Arthroplasty, 1995, 10(3): 313-318.
9. Huo MH, Zatorski LE, Keggi KJ. Oblique femoral osteotomy in cementless total hip arthroplasty. Prospective consecutive series with a 3-year minimum follow-up period. J Arthroplasty, 1995, 10(3): 319-327.
10. Sponseller PD, McBeath AA. Subtrochanteric osteotomy with intramedullary fixation for arthroplasty of the dysplastic hip. A case report. J Arthroplasty, 1988, 3(4): 351-354.
11. Muratli KS, Karatosun V, Uzun B, et al. Subtrochanteric shortening in total hip arthroplasty: biomechanical comparison of four techniques. J Arthroplasty, 2014, 29(4): 836-842.
12. 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.
13. Çağlar Ö, Özdemir E, Tokgözoğlu AM, et al. Use of proximal humerus plates for the fixation of the subtrochanteric femoral shortening osteotomy during total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of the hip patients. Jt Dis Relat Surg, 2020, 31(2): 306-311.
14. Togrul E, Ozkan C, Kalaci A, et al. A new technique of subtrochanteric shortening in total hip replacement for Crowe type 3 to 4 dysplasia of the hip. J Arthroplasty, 2010, 25(3): 465-470.
15. 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.
16. 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.
17. Sutherland CJ, Wilde AH, Borden LS, et al. A ten-year follow-up of one hundred consecutive Müller curved-stem total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1982, 64(7): 970-982.
18. Brooker AF, Bowerman JW, Robinson RA, et al. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg (Am), 1973, 55(8): 1629-1632.
19. Wang D, Li LL, Wang HY, et al. Long-term results of cementless total hip arthroplasty with subtrochanteric shortening osteotomy in Crowe type Ⅳ developmental dysplasia. J Arthroplasty, 2017, 32(4): 1211-1219.
20. Ma HY, Lu Q, Sun JY, et al. One-stage total hip arthroplasty with modular S-ROM stem for patients with bilateral Crowe type Ⅳ developmental dysplasia. Orthop Surg, 2020, 12(6): 1913-1922.
21. Gong S, Xu W, Wang R, et al. The causes and management of nonunion of femoral subtrochanteric shortening osteotomy in a THA patient: a case report. BMC Musculoskelet Disord, 2019, 20(1): 203. doi: 10.1186/s12891-019-2612-2.
22. Wang D, Li DH, Li Q, et al. Subtrochanteric shortening osteotomy during cementless total hip arthroplasty in young patients with severe developmental dysplasia of the hip. BMC Musculoskelet Disord, 2017, 18(1): 491. doi: 10.1186/s12891-017-1857-x.
23. Onodera S, Majima T, Ito H, et al. Cementless total hip arthroplasty using the modular S-ROM prosthesis combined with corrective proximal femoral osteotomy. J Arthroplasty, 2006, 21(5): 664-669.
24. 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.
25. 刘宇博, 孔祥朋, 柴伟. Crowe Ⅳ型髋关节发育不良的全髋关节置换术: 术中股骨短缩截骨的文献回顾. 骨科, 2021, 12(4): 383-388.
26. Krych AJ, Howard JL, Trousdale RT, et al. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-Ⅳ developmental dysplasia: surgical technique. J Bone Joint Surg (Am), 2010, 92(Suppl 1 Pt 2): 176-187.
27. Berton C, Puskas GJ, Christofilopoulos P, et al. Comparison of the outcome following the fixation of osteotomies or fractures associated with total hip replacement using cables or wires: the results at five years. J Bone Joint Surg (Br), 2021, 94(11): 1475-1481.
28. Daou S, El Chemaly A, Christofilopoulos P, et al. The potential role of cobalt ions released from metal prosthesis on the inhibition of Hv1 proton channels and the decrease in Staphyloccocus epidermidis killing by human neutrophils. J Biomaterials, 2011, 32(7): 1769-1777.
29. Rae T. The action of cobalt, nickel and chromium on phagocytosis and bacterial killing by human polymorphonuclear leucocytes; its relevance to infection after total joint arthroplasty. J Biomaterials, 1983, 4(3): 175-180.
30. Kawai T, Goto K, Kuroda Y, et al. Total hip arthroplasty combined with subtrochanteric transverse shortening osteotomy: factors associated with delayed union at the osteotomy site. J Am Acad Orthop Surg Glob Res Rev, 2020, 4(8): e20.00056. doi: 10.5435/JAAOSGlobal-D-20-00056.
31. Dorr LD, Faugere MC, Mackel AM, et al. Structural and cellular assessment of bone quality of proximal femur. Bone, 1993, 14(3): 231-242.

Chinese Journal of Reparative and Reconstructive Surgery

A comparative study of three different fixation methods after subtrochanteric shortening osteotomy in total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of the hip

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