CEMENTLESS TOTAL HIP ARTHROPLASTY WITH TRANSVERSE SUBTROCHANTERIC SHORTENING OSTEOTOMY IN DEVELOPMENTAL HIGH DISLOCATED HIPS AND MINIMUM 4 YEARS FOLLOW UP.

Abstract

Background: the purpose of this paper is to evaluate the functional and clinical results of the developmental high dislocated hips after subtrochanteric transverse shortening osteotomy fixed axially and rotationally by cementless femoral stem and the asetabular component placed into the anatomical place.

Methods: in a retrospective study, we evaluated the results and complications of twenty-four consecutive primary cementless total hip arthroplasty in eighteen patients (sixteen female and two male) all of whom had Crowe IV (Hartofilakidis type III) high dislocations. The arthroplasty was performed in combination with a subtrochanteric transverse shortening osteotomy and Zweymüller femoral stem(SL plus) without any fixation instruments for the osteotomy site and with placement of the acetabular component at the level of anatomic hip center. All of the patients were evaluated at a mean of 4 years postoperatively.

Results: the mean Harris Hip score increased from 17.25 points preoperatively to 84.87 points at the time of final follow up (p< 0.01). Seven of the twenty four hips had an early or late complications and/or reoperations. None of the subtrochanteric osteotomies were followed by non-union and no other complications concerning the femoral site is seen. There was one instance of isolated loosening of asetabuler component. Two hips dislocated postoperatively which were treated by closed reduction and bracing for 12 weeks. One siatic neurapraxic injury was identified which resolved within 6 months’ time. Intraoperative femoral cracks were seen in three hips. One of them on the proximal part (trochanteric site) and the other two on the distal femur. All were fixed by cerclage and cables without any further pain and complications.

Conclusions: subtrochanteric shortening osteotomy and cementless total hip arthoplasty for the treatment of developmental dysplasia and dislocations of the hip were associated with high rates of successful fixation of the femoral component and the asetabulum. The osteotomy site has a healing potential within the eight weeks’ time without any complications. The mean Harris hip score was 84.87 points. The complication rate is higher than that associated with primary total hip arthroplasty for the degenerative arthritis.