ObjectiveTo assess the effectiveness of two osteotomy methods in total hip arthroplasty (THA) for treating Crowe type ⅠV adult developmental dysplasia of the hip (DDH), trochanteric osteotomy and subtrochanteric osteotomy. MethodsA retrospective analysis was made on the clinical data of 36 patients (43 hips) with Crowe type ⅠV DDH undergoing THA between June 2007 and December 2013. In THA, 19 patients (23 hips) underwent trochanteric osteotomy (group A) and 17 patients (20 hips) underwent subtrochanteric osteotomy (group B). There was no significant difference in age, gender, body mass index, side, preoperative Harris score, and limb length difference between 2 groups (P>0.05). The operation duration, bleeding volume, hospitalization duration, intraoperative and postoperative complications were compared between 2 groups. ResultsThere was no significant difference in operation duration, bleeding volume, and hospitalization days between 2 groups (P>0.05). The rate of intraoperative complication was 21.7% (5/23) in group A and 5.0% (1/20) in group B, showing no significant difference between 2 groups (P>0.05). The rate of postoperative complications was 10.5% (2/19) in group A and 22.2% (4/18) in group B, showing no significant difference between 2 groups (P>0.05). Thirty-one patients (37 hips) were followed up 1-7 years (mean, 3 years), including 16 cases (19 hips) in group A and 15 cases (18 hips) in group B. X-ray films showed good position of the prostheses. The Harris score at last follow-up was significantly increased when compared with preoperative score in 2 groups (P<0.05), but there was no significant difference between 2 groups (P>0.05). The postoperative discrepancy of bilateral lower limbs had no significant difference (t=-1.343, P=0.188). ConclusionTHA with trochanteric osteotomy or subtrochanteric osteotomy both can effectively treat Crowe type ⅠV DDH. THA with subtrochanteric osteotomy has an advantage in correcting lower limb discrepancy.
ObjectiveTo evaluate the effectiveness of reduction osteotomy for correction of varus knee during total knee arthroplasty. MethodsA retrospective analysis was made on the clinical data of 16 patients (24 knees) who received reduction osteotomy for correcting varus knee during total knee arthroplasty between May 2010 and July 2012. There were 2 males (3 knees) and 14 females (21 knees), with an average age of 67 years (range, 57-79 years). The disease duration ranged from 3 to 15 years (mean, 9.1 years). The Knee Society Score (KSS) was 38.71±10.04 for clinical score and 50.31±14.31 for functional score. The range of motion (ROM) of the knee was (91.88±13.01)°. The tibiofemoral angle was (9.04±4.53)° of varus deformity. Reduction osteotomy was applied to correct varus knee. ResultsThe operation time was 85-245 minutes (mean, 165.5 minutes); the obvious blood loss was 10-800 mL (mean, 183.1 mL); the hospitalization time was 8-22 days (mean, 13.6 days). All incisions healed by first intention. No neurovascular injury or patellar fracture occurred. The follow-up duration ranged from 37 to 62 months (mean, 48 months). The tibiofemoral angle was corrected to (3.92±1.89)° of valgus at 48 hours after operation. The lower limb alignment recovered to normal. The X-ray films showed no evidence of obvious radiolucent line, osteolysis, or prosthesis subsidence. The results of KSS were significantly improved to 84.21±6.49 for clinical score and 85.31±6.95 for functional score (t=20.665, P=0.000; t=9.585, P=0.000); and ROM of the knee was significantly increased to (105.83±11.29)° (t=8.333, P=0.000) at last follow-up. ConclusionThe effectiveness of reduction osteotomy for varus knee deformity during total knee arthroplasty is satisfactory. Proper alignment, ROM, and function of knee can be achieved.