Patients with dislocation, severe subluxation of the hip joints were treated with cementless THA combined with subtrochanteric shortening femoral osteotomy. Total hip arthroplasty (THA) requiring subtrochanteric osteot-omy has been considered to lead to several complications. The aim of this paper is to assess the clinical results and complications of this procedure. An acetabular component was placed into position at the site of the true acetabulum. After femoral corrective shortening osteotomy for dislocation or severe sub-luxation of the hip joints, an AML cementless stem was tightly inserted into the femoral canal to achieve bony union and osteointegration with the implant. Twenty-one patients (23 hips; 2 men, 19 women) treated with cementless THA combined with subtro-chanteric femoral shortening osteotomy were enrolled in this study. The mean age was 55 years and the mean follow-up period was 4.5 years. The average elongation of the limb was 48 mm after subtrochanteric shortening femoral osteotomy. Solid union of the osteotomy was obtained within an average of 5.5 months after surgery. None of these patients developed sciatic nerve palsy. There were 4 cases of non-union of the osteotomy site and 3 of aseptic loosening of the femoral component related to intraoperative femoral fracture. Upward migration of the proximal part of the femur was related to poor preoperative bone quality. In order to diminish these complications, careful patient selection, accurate femoral reaming and suitable methods of bone cutting and augmentation of the oste-otomy site are necessary

Background. Subtrochanteric femoral shortening and corrective osteotomy are considered to be an integral part of total hip arthroplasty for a completely dislocated hip or severe deformity of the proximal femur. A number of alternative femoral osteotomy techniques, transverse, oblique, step-cut, and V-shaped, have been described. Becker and Gustilo reported the “double-chevron subtrochanteric shortening derotational femoral osteotomy,” which is reasonable in that the osteotomy site is torsionally more stable and can be stabilized with a shorter stem. We have simplified this procedure, and performed it without a trochanteric osteotomy. We describe a simplified double-chevron osteotomy and provide the clinical results from a series of 22 successful procedures. Methods. In this series, we performed 22 cementless total hip arthroplasties combined with double-chevron subtrochanteric osteotomies between 1997 and 2002. There were 17 females and 2 males. Their average age at the time of the operation was 59 years old (range, 41–74 years old). Thirteen of these hips were congenitally dislocated hips (Crowe IV), and 8 hips were after proximal femoral osteotomies using a procedure described by Schanz or valgus osteotomy, and 1 hip was an ankylosed hip in malposition. Results. The mean length of the operation was 128 minutes (range, 80–215 minutes). The mean total blood loss was 1442 g (range, 809–2007 g), which included both the intraoperative blood loss and postoperative blood loss. After an average of 7.6 years of follow-up, the Japanese Orthopaedic Association Hip Score improved from 48 to 79. The mean amount of intraoperative femoral resection was 29 mm (range, 10–45 mm). The postoperative highest point of the greater trochanter was lowered by a mean of 50 mm (range, 6–74 mm) compared with its preoperative point on the radiograph. The calculated measurement (lowered greater trochanter minus intraoperative femoral resection) of leg lengthening was a mean 21 mm (range, −4–51 mm). Two acetabular component migrated, and one case required revision surgery. The other components showed no evidence of migration or loosening. There were radiolucent lines of less than 2 mm thickness in zones 1, 2, and 3 in one acetabular as previously mentioned revision case. One femoral component had subsidence 3 mm. Four femoral components had radiolucencies. One osteotomy site failed union and was varus deformity. After 6 years after the operation, the case required revision using cementless long stem. All femoral components achieved fixation with an optimal interface at the latest follow-up. Three types of complications were observed. There were no cases of neurologic abnormality, infection. There were 4 early dislocations, 3 proximal splits, and 1 nonunion at the osteotomy site. All femoral fragment fractures during the operation and all dislocations after the operation were in the Crowe IV group. Conclusions. Our study shows that double-chevron subtrochanteric osteotomy provided acceptable results for subtrochanteric femoral shortening and corrective osteotomy. The operation procedure is simple and the operation time is much shorter. However, THA combined with subtrochanteric osteotomy is a technically demanding treatment option

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

Twenty-Six total hip arthroplasties were performed in Crowe grade 3 or 4 hip dysplasia using subtrochanteric shortening osteotomy with 2-kinds of femoral stem(Primary monoblock and modular femoral stem). The average age was 46.2 years, and the average follow-up was 4.1 years. Acetabular reconstruction with structural autograft was used in 13 hips. Radiologically, hip centers were nearly normalized by vertical height of 10.6mm elevation and horizontal lengths of 1.7mm compared with uninvolved sites. Three of four osteotomy nonunions were managed with bone graft and other one wating for surgery. One acetabular revision was performed for migration. One postoperative dislocation was managed successfully with closed reduction and abduction brace. One patient (> 7cm) showed postoperative neurologic complications was noted. Harris hip score was improved from 35.6 to 81.7. A cementless modular distal fluted femoral stem is a useful device in these patients

Aims. Complex total hip arthroplasty (THA) with subtrochanteric shortening osteotomy is necessary in conditions other than developmental dysplasia of the hip (DDH) and septic arthritis sequelae with significant proximal femur migration. Our aim was to evaluate the hip centre restoration with THAs in these hips. Methods. In all, 27 THAs in 25 patients requiring THA with femoral shortening between 2012 and 2019 were assessed. Bilateral shortening was required in two patients. Subtrochanteric shortening was required in 14 out of 27 hips (51.9%) with aetiology other than DDH or septic arthritis. Vertical centre of rotation (VCOR), horizontal centre of rotation, offset, and functional outcome was calculated. The mean followup was 24.4 months (5 to 92 months). Results. The mean VCOR was 17.43 mm (9.5 to 27 mm) and horizontal centre of rotation (HCOR) was 24.79 mm (17.2 to 37.6 mm). Dislocation at three months following acetabulum reconstruction required femoral shortening for offset correction and hip centre restoration in one hip. Mean horizontal offset was 39.72 (32.7 to 48.2 mm) compared to 42.89 (26.7 to 50.6 mm) on the normal side. Mean Harris Hip Score (HHS) of 22.64 (14 to 35) improved to 79.43 (68 to 92). Mean pre-operative shortening was 3.95 cm (2 to 8 cm). Residual limb length discrepancy was 1.5 cm (0 to 2 cm). Sciatic neuropraxia in two patients recovered by six months, and femoral neuropraxia in one hip recovered by 12 months. Mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was 13.92 (9 to 19). Mean 12-item short form survey (SF-12) physical scores of 50.6 and mental of 60.12 were obtained. Conclusion. THA with subtrochanteric shortening is valuable in complex hips with high dislocation. The restoration of the hip centre of rotation and offset is important in these hips. Level of evidence IV. Femoral shortening useful in conditions other than DDH and septic sequelae. Restoration of hip centre combined with offset to be planned and ensured

Total hip replacement for high dislocation of the hip joint remains technically difficult in terms of preparation of the true acetabulum and restoration of leg length. We describe our experience of cementless total hip replacement combined with a subtrochanteric femoral shortening osteotomy in 20 hips with Crowe grade IV dislocation with a mean follow-up of 8.1 years (4 to 11.5). There was one man and 17 women with a mean age of 55 years (44 to 69) at the time of the operation. After placment of the acetabular component at the site of the natural acetabulum, a cementless porous-coated cylindrical femoral component was implanted following a subtrochanteric femoral shortening osteotomy. The mean Japanese Orthopedic Association hip score improved from a mean of 38 (22 to 62) to a mean of 83 points (55 to 98) at the final follow-up. The mean lengthening of the leg was 14.8 mm (−9 to 34) in patients with iliofemoral osteoarthritis and 35.3 mm (15 to 51) in patients with no arthritic changes. No nerve palsy was observed. Total hip replacement combined with subtrochanteric shortening femoral osteotomy in this situation is beneficial in avoiding nerve injury and still permits valuable improvement in inequality of leg length

Aims. Total hip arthroplasty (THA) in patients with post-polio residual paralysis (PPRP) is challenging. Despite relief in pain after THA, pre-existing muscle imbalance and altered gait may cause persistence of difficulty in walking. The associated soft tissue contractures not only imbalances the pelvis, but also poses the risk of dislocation, accelerated polyethylene liner wear, and early loosening. Methods. In all, ten hips in ten patients with PPRP with fixed pelvic obliquity who underwent THA as per an algorithmic approach in two centres from January 2014 to March 2018 were followed-up for a minimum of two years (2 to 6). All patients required one or more additional soft tissue procedures in a pre-determined sequence to correct the pelvic obliquity. All were invited for the latest clinical and radiological assessment. Results. The mean Harris Hip Score at the latest follow-up was 79.2 (68 to 90). There was significant improvement in the coronal pelvic obliquity from 16.6. o. (SD 7.9. o. ) to 1.8. o. (SD 2.4. o. ; p < 0.001). Radiographs of all ten hips showed stable prostheses with no signs of loosening or migration, regardless of whether paralytic or non-paralytic hip was replaced. No complications, including dislocation or infection related to the surgery, were observed in any patient. The subtrochanteric shortening osteotomy done in two patients had united by nine months. Conclusion. Simultaneous correction of soft tissue contractures is necessary for obtaining a stable hip with balanced pelvis while treating hip arthritis by THA in patients with PPRP and fixed pelvic obliquity. Cite this article: Bone Jt Open 2021;2(9):696–704

Total hip arthroplasty in adult patients with congenital high dislocation of the hip (DDH, Crowe type IV) presents many challenges. Various reconstruction methods including iliofemoral distraction lenghtening and custom made prosthesis have been reported but the standard technique for dealing with this problem is femoral shortening with a subtrochanteric osteotomy. There are many reports of different subtrochanteric osteotomy techniques with satisfactory results.

Since 1999, we have been using the same anatomic reconstruction principles with a proximally hydroxyapatite coated cementless stem. Surgical technique on the femoral side comprises a short oblique subtrochanteric osteotomy and excision of a segment as indicated for a safe reduction. This usually requires extensive soft tissue releases of the pelvifemoral muscles. Gluteus maximus, tensor fascia latae and adductors are routinely released. However, we don’t want to do any more release until it is absolutely necessary. Preserving the attachment of the abductors and iliopsoas are important for eventual functional outcome. They help stabilizing the joint, avoid limping and promote hip flexion during the initial swing phase of the gait and stair climbing. We never resect neither osteotomize the trochanters and, if a release is unavoidable, it is performed proximally. Thus, it is possible to preserve a complete segment of the proximal femur with a soft tissue envelope. This segment allows for better bone stock, prompt healing, reliable proximal fixation through the intact medial calcar and, avoids the complications of trochanteric osteotomy. With this technique we have not observed a femoral revision for any reason in 101 high dislocated hips (in 84 patents), since 1999. Compared with other techniques for arthroplasty in patients with developmental hip dysplasia, this surgical technique has a better functional outcome and a low prevalence of revision.

To evaluate the effect of this reconstruction on gait parameters we analyzed the gait cycle in 17 hips in 10 patients before and after the the total hip arthroplasty and compared it with the patients with hip arthroplasty due to primary osteoarthritis. Our aim is to determine the restoration of normal anatomy in DDH patients compared to the patients with total hip arthroplasty but a normal hip anatomy. As a result we have demon-strated that our technique restores normal gait parameters by improving walking speed, lengthening step-stride length, correcting hip and knee flexion and ankle equinus, improving hip and knee stiffness during gait and helps to restore normal gait parameters

Background. Total hip arthroplasty for Crowe type IV developmental dysplasia of the hip is a technically demanding procedure. Restoration of the anatomical hip center frequently requires limb lengthening in excess of 4 cm and increases the risk of neurologic traction injury. However, it can be difficult to predict potential leg length change, especially in total hip arthroplasty for Crowe type IV developmental hip dysplasia. The purpose of the present study was to better define features that might aid in the preoperative prediction of leg length change in THAs with subtrochanteric femoral shortening osteotomy for Crowe type IV developmental dysplasia of the hip. Patients and Methods. Primary total hip arthroplasties with subtrochanteric femoral shortening osteotomy were performed in 70 hips for the treatment of Crowe type IV developmental hip dysplasia. The patients were subdivided into two groups with or without iliofemoral osteoarthritis. Leg length change after surgery was measured radiographically by subtracting the amount of resection of the femur from the amount of distraction of the greater trochanter. Preoperative passive hip motion was retrospectively reviewed from medical records and defined as either higher or lower motion groups. Results. The preoperative flexion of patients without iliofemoral osteoarthritis was significantly higher than for patients with iliofemoral osteoarthritis. All hips without iliofemoral OA had higher motion. The preoperative flexion in the higher motion group both with and without iliofemoral OA was significantly greater than in the lower group with iliofemoral OA (Figure 1). Leg length change in patients without iliofemoral osteoarthritis was significantly greater than with iliofemoral osteoarthritis (Figure 2), and the higher hip motion group had greater leg length change in THA than the lower motion group. No clinical evidence of postoperative neurologic injury was observed in patients with iliofemoral OA. Postoperative transient calf numbness in the distribution of the sciatic nerve was observed in 2 of 25 hips without iliofemoral OA (8.0%), however, no sensory and motor nerve deficit was observed. Discussion. The authors hypothesized that preoperative hip motion could affect soft tissue contractures, and our findings suggest that the soft tissues surrounding the hip joint with iliofemoral OA should be more contracted than the hip without OA. We also found leg length change in the higher motion group was greater than in the lower motion group. Previous studies reported limb lengthening in excess of 4 cm could increase the risk of nerve palsy. Transient calf numbness in the distribution of the sciatic nerve was observed in 2 hips without iliofemoral OA and their leg length change was not greater than 4 cm. Our findings suggest that hips without iliofemoral OA should be paid attention to protect the nerves from excessive elongation. The current study identifies several features that might help predict leg length change during the preoperative planning of total hip arthroplasty for Crowe type IV developmental hip dysplasia

Restoration of an anatomical hip centre frequently requires limb lengthening, which increases the risk of nerve injury in the treatment of Crowe 4 DDH. The objective was to perform a prospective evaluation of SDTSO with Cemented Exeter Femoral Component.

15 female patients (18 hips – 3 bilateral) with a mean age at time of operation of 51 years were followed-up for a mean of 77 months (11 to 133). 16 cemented and 2 uncemented acetabular components were implanted. Exeter cemented DDH stems were used in all cases. No patient was lost to follow-up.

Charnley-d'Aubigné-Postel scores for pain, function and range of movement were improved from a mean of 2, 2, 3 to 5, 4, 5 respectively. One osteotomy failed to unite at 14 months and was revised successfully. Clinical healing was achieved at a mean of 6 months and radiological at a mean of 9 months. The mean length of the excised segment was 3cm and the mean true limb lengthening was 2cm. A 3.5mm DCP plate with unicortical screws was used to reduce the osteotomy, and intramedullary autografting was performed in all cases. Mean subsidence was 1mm and no stem was found loose at the latest follow-up. No sciatic nerve palsy was observed and no dislocation.

Cemented Exeter femoral components perform well in the treatment of Crowe IV DDH with SDTSO. Transverse osteotomy is necessary to achieve derotation and reduction can be maintained with a DCP plate. Intramedullary autografting prevents cement interposition at the osteotomy site.

Introduction: Restoration of an anatomical hip centre frequently requires limb lengthening, which increases the risk of nerve injury in the treatment of Crowe 4 DDH.

Objective: Prospective evaluation of SDTSO with Cemented Exeter Femoral Component.

Material and Methods: 15 female patients (18 hips – 3 bilateral) with a mean age at time of operation of 51 years followed-up for a mean of 77 months (11 to 133). 16 cemented and 2 uncemented acetabular components were implanted. Exeter cemented DDH stems were used in all cases. No patient lost to follow up.

Results: 18 Crowe IV hips. Charnley-D’Aubigne-Postel score for pain, function and range of movement were improved from a mean of 2, 2,3 to 5,4,5 respectively. One osteotomy failed to unite at 14 months and revised successfully. Clinical healing was achieved at a mean of 6 month while radiological at a mean of 9 months. The mean length of the excised segment was 3cm and the mean true limb lengthening was 2cm. 3.5mm DCP plate with unicortical screws was used to reduce the osteotomy, and intramedullary autografting performed in all cases. Mean subsidence was 1mm and no stem was found loose at the latest follow up. No sciatic nerve palsy observed and no dislocation.

Conclusion: Cemented Exeter femoral components perform well in the treatment of Crowe IV DDH with SDTSO. Transverse osteotomy is necessary to achieve derotation and reduction can be maintained with a DCP plate. Intramedulary autografting prevents cement interposition at the osteotomy site.

Aim. To assess the survivorship of a tapered fluted Titanium monoblock stem in conjunction with subtrochanteric shortening for patients with High Dislocation performed at 2 centres. Methods. This was a retrospective study of 84 hips in 52 patients between two centres. All patients had a high dislocation. Thirty five patients had bilateral dysplasia. All patients had total hip arthroplasty with a subtrochanteric shortening osteotomy. The acetabular component was placed at the level of the anatomic hip centre. The femoral component was the “Wagner Cone prosthesis” which is a monoblock Titnium Alloy stem, tapered and fluted. The acetabular component varied. All patients had a follow up examination with a Harris Hip Score and a plain radiograph. The radiographs were assessed for osteotomy complications, change in stem position, evidence of loosening, heterotopic ossification & stress shielding if any. Notes were reviewed for complications. Results. The mean age at operation was 55 yrs (range 20–83). The mean follow up was 9 years (range3–20). Eight patients were lost to follow up (16%). All the rest of the femoral components survived that were available for follow up −84% (worst case scenario). Six patients (7.8%) had an early complication that needed a reoperation. The Mean Harris Hip Score (HHS) improved from 42 points to 88 points. Conclusion. The success rate of patients undergoing Cementless Arthroplasty using the Wagner cone stem in conjunction with a subtrochanteric shortening osteotomy is very high. The complication rate is however larger than in the normal population

We performed bilateral femoral shortening operations on 15 skeletally mature patients (11 women and four men). Their mean height pre-operatively was 193.5 cm and they were shortened by 5 to 9 cm. We used a subtrochanteric Z-osteotomy with an AO condylar plate in 11 patients, and mid-diaphyseal osteotomy with an intramedullary locking nail in four. After an average follow-up of 8.1 years, isokinetic muscle testing showed that muscle strength was reduced bilaterally in five patients. The strength ratio between hamstrings and quadriceps muscles was normal in all those treated by subtrochanteric shortening; in those shortened at the mid-shaft the quadriceps was relatively weaker. The result was rated as excellent by 11 patients, very good by three, and good by one

Objectives: We evaluated the results of a femoral shortening z-osteotomy in patients who underwent THA due to high dislocation of the hip. Methods: From 8/1997 until 11/2003 we performed THA in combination with a z-shaped subtrochanteric shortening osteotomy in 6 patients (4 females, 2 males) with high dislocation of the hip. In all cases for the reconstruction of the acetabulum a cementless press fit component was implanted, in 5 cases in combination with an acetabular roof reconstruction by autograft. For the femoral component we used standard titanium cementless stems in 5 cases, in one case a revision model. The z-shaped shortening osteotomy was fixed by titanium cerclages in all cases. Results: Postoperative complications (nerve lesions, THA dislocations, non union) could not be observed in the clinical and radiological follow up examinations 6 to 72 months postoperatively. In all cases femoral union at the area of the shortening osteotomy could be observed 3 months postoperatively. Conclusion: Femoral shortening z-osteotomy in THR is a safe technique in patients with high total dislocation of the hip, leading to satisfactory postoperative results

Introduction: Angular and torsional deviations of femur are usually combined with Congenital Dislocation of the Hip (CDH) and increase the complications of hip arthroplasty. The aim of this study is to evaluate surgical and reconstructive options for the treatment of CDH. Material and Methods: In this retrospective study, we evaluated the results and complications of 55 primary cementless total hip arthroplasties, all of whom had Crowe type-IV developmental dysplasia of the hip. The arthroplasty was performed in combination with a subtrochanteric shortening osteotomy and with placement of the acetabular component at the level of the anatomic hip center. The patients were evaluated at a mean of 8,1 years postoperatively. Results: From 1984, more than 2000 cases of arthroplasty have been performed in dysplastic hip, 565 cases had a previous femoral osteotomy; 128 cases needed correction of femoral side deformity; 64 had a greater trochanteric osteotomy. In 9 cases rotational abnormality and shortening were controlled with plate and distal femur osteotomy. 55 cases were treated by a shortening subtrochanteric osteotomy. Only non-cemented stems were used. 4 failures occurred for the incorrect fixation of the metaphysis. The fixation can be obtained only by prosthetic press-fit, but it is preferable to use metal wires. There was no sciatic injury; indeed shortening osteotomy provides an easy control of deformity and lengthening, with a maximum of 4 cm. One case was reviewed for heterotopic calcification (grade 4). One infection of the soft tissue was medically cured. There were two revisions for polyethylene failure at 8 and 12 years postoperative. Discussion: The anatomic abnormalities associated with CDH and previous femoral osteotomy increase the complexity of hip arthroplasty. We had best results with the femoral shortening subtrochanteric osteotomy where a rapid consolidation was obtained. Moreover, the functional result was better for the management of the insertion of the muscle tendons in particular the mediogluteus and also for the relatively correct positioning in favour of the reciprocal relationship of the pelvic-trochanter. The detachment of the greater trochanter associated with a metaphyseal proximal shortening, remains an effective technique for the treatment of malformations that are difficult to treat, but there is a high risk of pseudarthrosis of greater trochanter. Conclusion: Femoral shortening subtrochanteric osteotomy preserves the proximal femoral anatomy, avoids the problems associated with reattachment of the greater trochanter, and facilitating a cementless femoral reconstruction in relatively young patients

The longevity of the fixation of implants in a formerly dysplastic hip is compromised by several risk factors:. Young age. Severity of the dislocation. Previous surgery. Hip arthroplasty after a previous intertrochanteric osteotomy is technically more demanding but not necessarily associated with a higher rate of complications. Distortion of the acetabulum. Fixation of the socket in a dysplastic hip joint acetabulum (one of the main aims of a THR) is compromised both by using a small implant and an insufficient containment of the socket in the bony acetabulum. Small cups (small implant/bone contact area, thin polyethylene wall). Small cups are especially used in cases where the implant must be positioned higher up in the iliac bone. High hip center and lateral placement of the cup. A high hip center is not to be considered as a risk factor as long as there is no simultaneous lateralisation of the cup. Upward displacement of the center of rotation must be compensated for by changing muscle length and the arms of the abductors with a longer neck in order to preserve muscle power. The acetabular component, i.e., the center of rotation of the hip articulation should be positioned as medially as possible. Insufficient containment of the acetabular socket. As a rule, the positioning of the socket into the original acetabulum creates normal mechanics of the hip and provides the best bone stock for fixation of the cup, especially in complete dislocations. However, placement of the cup into the original acetabulum of a subluxated femoral head in an angle that is not too vertical leaves a supero-lateral void. Enlargement, i.e., reinforcement of the roof of the acetabulum with screws and bone cement has not proven to be adequate. Acetabuloplasty, i.e., grafting with an autologous cortico-cancellous graft taken from the resected femoral head or using an acetabular reinforcement ring (ARR) is indicated if 20 and more degrees of the weight-bearing surface of the cup would otherwise remain uncovered. Massive cortico-cancellous bone grafts. The use of bulky autologous or homologous cortico-cancellous grafts which would be loaded over 50% or more of the weight-bearing surface of the cup is not recommended. Excessive anteversion, narrow medullary cavity, and capsular contractures on the femoral side. The most typical deformity of the proximal end of the femur in hip dysplasia is an excessive anteversion angle of the neck of the femur. Anteversion angles of 45 degrees and more are corrected by a derotational osteotomy of the femur. To avoid overlength of the leg by positioning the cup into the original acetabulum, a subtrochanteric shortening osteotomy may be indicated. Preoperative planning is mandatory. Procedure, choice of method, and availability of appropriate equipment and endoprosthetic implants must be ensured. Computerised tomography with 3-D reconstruction is recommended for more complex anatomical situations

Aims

The aim of this study was to evaluate the suitability of the tapered cone stem in total hip arthroplasty (THA) in patients with excessive femoral anteversion and after femoral osteotomy.

Aims

The main aims were to identify risk factors predictive of a radiolucent line (RLL) around the acetabular component with an interface bioactive bone cement (IBBC) technique in the first year after THA, and evaluate whether these risk factors influence the development of RLLs at five and ten years after THA.

Introduction. Total hip arthroplasty (THA) for a highly dislocated hip can be problematic and technically challenging. Our previous study on cemented THA with subtrochanteric femoral shortening osteotomy revealed a high incidence (20%) of non-union. Therefore, in 2008, we introduced reverse hybrid THA using S-ROM stem for the treatment of a highly dislocated hip. The purpose of this study was to assess the short-term clinical outcomes of this new method. Patients and methods. Between 2008 and 2014, 13 consecutive reverse hybrid THAs were performed on nine female patients with highly dislocated hips. The average age at the time of operation was 66 years (range, 55–85 years). The acetabular component was fixed in the true acetabulum with bone cement. Transverse osteotomy was performed below the lesser trochanter to shorten the femur and to prevent over-lengthening. The proximal sleeve of the S-ROM stem was then fixed within the proximal fragment, and the distal fin provided rotational stability of the distal fragment. Thus, the two fragments were fixed to each other with the S-ROM stem, and the resected segment was longitudinally cut for grafting at the junction. The postoperative follow-up period was an average of 4 years (range, 1–7 years), and no patients were lost. Preoperative and final Japanese Orthopaedic Association (JOA) hip score, operation time, bleeding amount, intraoperative and postoperative complications, bone healing at the osteotomy site, implant loosening, and revision surgery were retrospectively investigated. Results. The mean JOA hip score improved from 56 points preoperatively to 82 points postoperatively. The operation time and amount of bleeding were an average of 208 min and 643 g, respectively. The mean length of femoral resection was 4 cm (range, 2–6 cm), and the tip of the greater trochanter migrated an average distance of 7 cm (range, 5–9 cm) distally. The calculated limb lengthening was an average of 3 cm (range, 2–4 cm). Intraoperative fracture was seen in two patients, but no repeat operation was required. Two patients experienced postoperative dislocation in their hips, but additional surgery was not necessary. Postoperative nerve palsy did not occur in any patient, and all the osteotomy sites showed complete bone union. There was no implant loosening seen in any patient, and there was also no need for revision surgery. Discussion and conclusions. To achieve satisfactory outcomes with this method, resection of necessary and sufficient length of femur and accomplishment of adequate fixation between the proximal and distal fragments are necessary. In this study, dislocation occurred in two patients, and no nerve palsy was seen. Larger femoral heads may be recommended to eradicate dislocations. In cases where metaphysis of the femur is hypoplastic or the medullary canal is wide, reaming and stem insertion should be carefully performed. In this series, no additional surgery was required for the intra- and post-operative complications, and the osteotomy sites achieved bone union in all patients. Therefore, we recommend the use of this method, although longer follow-up periods are necessary