Application of sliding trochanteric osteotomy in total hip arthroplasty for Crowe type <b>Ⅳ</b> developmental dysplasia of the hip_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PAN Yuqi ¹ , LI Yamin ¹ , ZHANG Xianlong ¹ , WANG Qi ¹ ,  CHEN Yunsu ¹ , JIANG Chang ²

1. Department of Joint Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233, P.R.China;
2. Department of Joint Surgery, the First People’s Hospital of Wenling, Wenling Zhejiang, 317500, P.R.China;

Corresponding author：

CHEN Yunsu, Email: yschenb@163.com

Keywords：

Developmental dysplasia of the hip; Crowe type Ⅳ; total hip arthroplasty; sliding trochanteric osteotomy; Wagner-cone stem

DOI：

10.7507/1002-1892.202108125

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Objective To investigate the effectiveness of sliding trochanteric osteotomy (STO) in total hip arthroplasty (THA) for Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods Between July 2016 and April 2021, 52 patients (57 hips) with Crowe type Ⅳ DDH who underwent primary THA were enrolled according to inclusion criteria. There were 5 males and 47 females with a median age of 51 years (range, 18-76 years). There were 47 cases of single hip and 5 cases of bilateral hips. The leg length discrepancy (LLD) was 50.50 (44.00, 55.00) mm, visual analogue scale (VAS) score was 8.0 (6.0, 9.0), and Harris score was 58.0±5.0 before operation. Trendelenburg sign was positive in 46 patients (46 hips). All patients underwent STO and THA using Wagner-cone stem. The operation time, intraoperative blood loss, blood transfusion volume, Trendelenburg sign, and related complications were observed. During follow-up, VAS and Harris scores were recorded to evaluate the hip pain and function. X-ray film was used to measure the LLD and observe the bone union situations. Results The operation time was 90-125 minutes (mean, 105 minutes). Introperative blood loss was 420-800 mL (mean, 640 mL). Ten patients underwent blood transfusion and the amount of allogeneic blood transfusion was 2-4 U (mean, 3 U). All incisions healed by first intention after operation. All patients were followed up 4-60 months (median, 24 months). At last follow-up, LLD was 6.00 (4.00, 7.75) mm, showing significant difference when compared with that before operation (Z=−6.278, P=0.000). After operation, 51 hips (89.5%) achieved bone union at the osteotomy site, 4 hips (7.0%) had fibrous union, and 2 hips (3.5%) had nonunion. The healing time of osteotomy was 3-12 months, with an average of 6 months. At last follow-up, the VAS score was 3.0 (2.0, 5.0) and the Harris score was 85.0±6.0. The differences between pre- and post-operation were significant (Z=−6.176, P=0.000; t=−25.285, P=0.000). Trendelenburg sign remained positive in 4 patients (4 hips) at last follow-up and the difference was significant when compared with preoperative (χ²=67.947, P=0.000). One patient had a medial femoral cortical fracture when Wagner-cone stem was implanted during operation, and 2 patients had early symptoms of sciatic nerve palsy after operation, and no other related complications occurred. Conclusion For Crowe type Ⅳ DDH patients, STO applied in THA can reduce the resected bone mass, provide better exposure of hip as well as improve function of hip abductor muscle. Wagner-cone stem is recommended.

Citation： PAN Yuqi, LI Yamin, ZHANG Xianlong, WANG Qi, CHEN Yunsu, JIANG Chang. Application of sliding trochanteric osteotomy in total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of the hip. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(12): 1525-1530. doi: 10.7507/1002-1892.202108125 Copy

1.	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: 10.2106/JBJS.H.01024.
2.	Charnley J, Ferrera A. Transplantation of the greater trochanter in arthroplasty of the hip. J Bone Joint Surg (Br), 1964, 46: 191-197.
3.	Glassman AH, Engh CA, Bobyn JD. A technique of extensile exposure for total hip arthroplasty. J Arthroplasty, 1987, 2(1): 11-21.
4.	Thakur NA, Crisco JJ, Moore DC, et al. An improved method for cable grip fixation of the greater trochanter after trochanteric slide osteotomy. J Arthroplasty, 2010, 25(2): 319-324.
5.	Luo Z, Chen M, Hu F, et al. Cementless total hip arthroplasty with extended sliding trochanteric osteotomy for high congenital hip dislocation: A retrospective study. Medicine (Baltimore), 2017, 96(14): e6581. doi: 10.1097/MD.0000000000006581.
6.	Sundaram K, Siddiqi A, Kamath AF, et al. Trochanteric osteotomy in revision total hip arthroplasty. EFORT Open Rev, 2020, 5(8): 477-485.
7.	Browne AO, Sheehan JM. Trochanteric osteotomy in Charnley low-friction arthroplasty of the hip. Clin Orthop Relat Res, 1986, (211): 128-133.
8.	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.
9.	Zagra L, Bianchi L, Mondini A, et al. Oblique femoral shortening osteotomy in total hip arthroplasty for high dislocation in patients with hip dysplasia. Int Orthop, 2015, 39(9): 1797-1802.
10.	Chen G, Nie Y, Xie J, et al. Gait analysis of leg length discrepancy-differentiated hip replacement patients with developmental dysplasia: a midterm follow-up. J Arthroplasty, 2018, 33(5): 1437-1441.
11.	Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res, 1987, (218): 136-141.
12.	Li Y, Zhang X, Wang Q, et al. Equalisation of leg lengths in total hip arthroplasty for patients with Crowe type-Ⅳ developmental dysplasia of the hip: classification and management. Bone Joint J, 2017, 99-B(7): 872-879.
13.	Karaismailoglu B, Karaismailoglu TN. Comparison of trochanteric slide and subtrochanteric shortening osteotomy in the treatment of severe hip dysplasia: mid-term clinical outcomes of cementless total hip arthroplasty. J Arthroplasty, 2020, 35(9): 2529-2536.
14.	Lakstein D, Backstein DJ, Safir O, et al. Modified trochanteric slide for complex hip arthroplasty: clinical outcomes and complication rates. J Arthroplasty, 2010, 25(3): 363-368.
15.	Altay M, Demirkale İ, Çatma MF, et al. Results of Crowe type Ⅳ developmental dysplasia of hip treated by subtrochantric osteotomy and total hip arthroplasty. Indian J Orthop, 2018, 52(4): 374-379.
16.	Lee SJ, Yoo JJ, Kim HJ. Cementless total hip arthroplasty involving trochanteric osteotomy without subtrochanteric shortening for high hip dislocation. Clin Orthop Surg, 2017, 9(1): 19-28.
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. doi: 10.1186/1471-2474-15-331.
18.	Gholson JJ, Wallace SS, Akram F, et al. Wagner cone midterm survivorship and outcomes. J Arthroplasty, 2020, 35(8): 2155-2160.

1. 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: 10.2106/JBJS.H.01024.
2. Charnley J, Ferrera A. Transplantation of the greater trochanter in arthroplasty of the hip. J Bone Joint Surg (Br), 1964, 46: 191-197.
3. Glassman AH, Engh CA, Bobyn JD. A technique of extensile exposure for total hip arthroplasty. J Arthroplasty, 1987, 2(1): 11-21.
4. Thakur NA, Crisco JJ, Moore DC, et al. An improved method for cable grip fixation of the greater trochanter after trochanteric slide osteotomy. J Arthroplasty, 2010, 25(2): 319-324.
5. Luo Z, Chen M, Hu F, et al. Cementless total hip arthroplasty with extended sliding trochanteric osteotomy for high congenital hip dislocation: A retrospective study. Medicine (Baltimore), 2017, 96(14): e6581. doi: 10.1097/MD.0000000000006581.
6. Sundaram K, Siddiqi A, Kamath AF, et al. Trochanteric osteotomy in revision total hip arthroplasty. EFORT Open Rev, 2020, 5(8): 477-485.
7. Browne AO, Sheehan JM. Trochanteric osteotomy in Charnley low-friction arthroplasty of the hip. Clin Orthop Relat Res, 1986, (211): 128-133.
8. 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.
9. Zagra L, Bianchi L, Mondini A, et al. Oblique femoral shortening osteotomy in total hip arthroplasty for high dislocation in patients with hip dysplasia. Int Orthop, 2015, 39(9): 1797-1802.
10. Chen G, Nie Y, Xie J, et al. Gait analysis of leg length discrepancy-differentiated hip replacement patients with developmental dysplasia: a midterm follow-up. J Arthroplasty, 2018, 33(5): 1437-1441.
11. Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res, 1987, (218): 136-141.
12. Li Y, Zhang X, Wang Q, et al. Equalisation of leg lengths in total hip arthroplasty for patients with Crowe type-Ⅳ developmental dysplasia of the hip: classification and management. Bone Joint J, 2017, 99-B(7): 872-879.
13. Karaismailoglu B, Karaismailoglu TN. Comparison of trochanteric slide and subtrochanteric shortening osteotomy in the treatment of severe hip dysplasia: mid-term clinical outcomes of cementless total hip arthroplasty. J Arthroplasty, 2020, 35(9): 2529-2536.
14. Lakstein D, Backstein DJ, Safir O, et al. Modified trochanteric slide for complex hip arthroplasty: clinical outcomes and complication rates. J Arthroplasty, 2010, 25(3): 363-368.
15. Altay M, Demirkale İ, Çatma MF, et al. Results of Crowe type Ⅳ developmental dysplasia of hip treated by subtrochantric osteotomy and total hip arthroplasty. Indian J Orthop, 2018, 52(4): 374-379.
16. Lee SJ, Yoo JJ, Kim HJ. Cementless total hip arthroplasty involving trochanteric osteotomy without subtrochanteric shortening for high hip dislocation. Clin Orthop Surg, 2017, 9(1): 19-28.
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. doi: 10.1186/1471-2474-15-331.
18. Gholson JJ, Wallace SS, Akram F, et al. Wagner cone midterm survivorship and outcomes. J Arthroplasty, 2020, 35(8): 2155-2160.

Chinese Journal of Reparative and Reconstructive Surgery

Application of sliding trochanteric osteotomy in total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of the hip

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