Cementless Total Hip Arthroplasty with Subtrochanteric Transverse Shortening Osteotomy for Severely Dysplastic or Dislocated Hips

Abstract

Total hip arthroplasty in dislocated developmental hip dysplasia is a complex, technically demanding procedure with high complication rates. Anatomic abnormalities and the young age of the patients influence the results. Restoration of the anatomic hip center often requires shortening of the femur in order to avoid over-stretching of neurovascular structures. We performed cementless total hip arthroplasty with subtrochanteric transverse osteotomy on 44 hips in 31 patients. There were 29 female and 2 male patients. The average age at the time of the operation was 43.2 (range, 22–63 years) and the mean follow up period was 62 months (range, 24–96 months). Harris hip scores improved from 36.2 to 81.2 with good and excellent results in 79.5% of the patients. We stabilized the osteotomy line with low contact plates and screws primarily on 10 hips when rotational stability was in doubt. In the other hips, good initial rotational stability was obtained by the femoral component. However, we observed 5 nonunions in patients whose osteotomies were not stabilized with plates. These patients were later treated succesfully with internal fixation and autogenous bone grafting. The osteotomies healed at a mean time of 4 months (range, 2.5–14 months). Postoperatively two dislocations, one acetabular component displacement under the structural bone autograft and two superficial infections were seen. There were no cases of symptomatic loosening, deep infection, or neurovascular injury. Subtrochanteric transverse osteotomy is a versatile, relatively easy and reliable method for shortening the femur when performing cementless total hip arthroplasty in hip dysplasia cases. This technique makes it possible to implant standard sized cementless femoral stems. When necessary, tortional stability may further be augmented with a plate and screws.