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Bone & Joint Open
Vol. 1, Issue 5 | Pages 152 - 159
22 May 2020
Oommen AT Chandy VJ Jeyaraj C Kandagaddala M Hariharan TD Arun Shankar A Poonnoose PM Korula RJ

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


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 9 | Pages 1189 - 1193
1 Sep 2011
Zhao X Zhu Z Xie Y Yu B Yu D

When performing total hip replacement (THR) in high dislocated hips, the presence of soft-tissue contractures means that most surgeons prefer to use a femoral shortening osteotomy in order to avoid the risk of neurovascular damage. However, this technique will sacrifice femoral length and reduce the extent of any leg-length equalisation. We report our experience of 74 THRs performed between 2000 and 2008 in 65 patients with a high dislocated hip without a femoral shortening osteotomy. The mean age of the patients was 55 years (46 to 72) and the mean follow-up was 42 months (12 to 78). All implants were cementless except for one resurfacing hip implant. We attempted to place the acetabular component in the anatomical position in each hip. The mean Harris hip score improved from 53 points (34 to 74) pre-operatively to 86 points (78 to 95) at final follow-up. The mean radiologically determined leg lengthening was 42 mm (30 to 66), and the mean leg-length discrepancy decreased from 36 mm (5 to 56) pre-operatively to 8.5 mm (0 to 18) postoperatively. Although there were four (5%) post-operative femoral nerve palsies, three had fully resolved by six months after the operation. No loosening of the implant was observed, and no dislocations or infections were encountered. Total hip replacement without a femoral shortening osteotomy proved to be a safe and effective surgical treatment for high dislocated hips


The Journal of Bone & Joint Surgery British Volume
Vol. 83-B, Issue 4 | Pages 572 - 578
1 May 2001
Olsson O Ceder L Hauggaard A

We compared 54 patients treated by a Medoff sliding plate (MSP) with 60 stabilised by a compression hip screw (CHS) in a prospective, randomised study of the management of intertrochanteric femoral fractures. Four months after the operation femoral shortening was determined from radiographs of both femora. In unstable fractures the mean femoral shortening was 15 mm with the MSP and 11 mm with the CHS (p = 0.03). A subgroup in which shortening was classified as large, comprising one-third of the patients in each group, had a similar extent of shortening, but more medialisation of the femoral shaft occurred in the CHS (26%) than in the MSP (12%) group (p = 0.03). Five postoperative failures of fixation occurred with the CHS and none with the MSP (p = 0.03). The marginally greater femoral shortening seen with the MSP compared with the CHS appeared to be justified by the improved control of impaction of the fracture. Biaxial dynamisation in unstable intertrochanteric fractures is a safe principle of treatment, which minimises the rate of postoperative failure of fixation


The Journal of Bone & Joint Surgery British Volume
Vol. 91-B, Issue 9 | Pages 1142 - 1147
1 Sep 2009
Nagoya S Kaya M Sasaki M Tateda K Kosukegawa I Yamashita T

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


The Journal of Bone & Joint Surgery British Volume
Vol. 86-B, Issue 8 | Pages 1182 - 1186
1 Nov 2004
Barker KL Simpson AHRW

This prospective, longitudinal study documents the muscle strength and baseline function of 18 patients undergoing closed femoral shortening for discrepancy in limb length. Patients were studied for two years following surgery. Function was measured by a self-reported questionnaire, timed tests of performance and measurements of muscle strength and power. After two years, the self-reported function and ability to complete timed functional tests had returned to or improved on the pre-operative values. Muscle strength remained slightly below the pre-operative value and was more marked in the quadriceps than the hamstrings. This study suggests that small decreases in muscle strength and power following closed femoral shortening do not adversely affect the patients’ ability to perform everyday activities


The Journal of Bone & Joint Surgery British Volume
Vol. 74-B, Issue 3 | Pages 406 - 408
1 May 1992
Nordsletten L Holm I Steen H Folleras G Bjerkreim I

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


The Journal of Bone & Joint Surgery British Volume
Vol. 75-B, Issue 4 | Pages 566 - 571
1 Jul 1993
Murray D Kambouroglou G Kenwright J

One-stage femoral lengthening is thought to have an unacceptably high complication rate and is not widely practised. We reviewed 17 patients after one-stage lengthening for femoral shortening with associated angular or rotational deformities. Minimal dissection of the bone ends was undertaken. The mean length gain was 4 cm (2 to 7), and the average time to union was 6 months (3 to 10). There were no neurovascular complications. Four patients had delayed or nonunion, but union was achieved after bone grafting. We conclude that with minimal dissection, and with iliac crest cancellous bone grafting, one-stage leg lengthening for correction of deformity and leg-length inequality of up to 7 cm, in selected patients, can be effected safely with a relatively short rehabilitation


The Journal of Bone & Joint Surgery British Volume
Vol. 76-B, Issue 1 | Pages 143 - 146
1 Jan 1994
Holm I Nordsletten L Steen H Folleras G Bjerkreim I

We performed isokinetic knee testing to assess thigh muscle function in ten patients (12 legs) before and after mid-shaft femoral shortening averaging 46 mm (27 to 70). Tests were at angular velocities of 60 degrees/sec and 180 degrees/sec, and were performed preoperatively and after 3, 6, 12 and 24 months. Isokinetic tests at two years showed a significant reduction in muscle function in both quadriceps and hamstrings, but recovery of function was significantly better for the hamstrings. There was a linear relationship with correlation of r2 = 0.31 to 0.86 between loss of muscle force at two years and the magnitude of shortening. Long-term loss of muscle force should be expected after a mid-shaft shortening of the femur of more than 10%


The Journal of Bone & Joint Surgery British Volume
Vol. 61-B, Issue 1 | Pages 7 - 12
1 Feb 1979
Browne R

Thirty hips affected by congenital dislocation or subluxation underwent surgical treatment between the ages of five and fifteen years, and the results are presented. Reduction was aided by concurrent femoral shortening in seventeen. An aggressive approach in older children not only relieves the presenting symptoms in most, but also, by improving the anatomical relationships, increases the prospect of success should total replacement become indicated in the future


The Journal of Bone & Joint Surgery British Volume
Vol. 88-B, Issue 8 | Pages 1076 - 1081
1 Aug 2006
Vallamshetla VRP Mughal E O’Hara JN

Difficulties posed in managing developmental dysplasia of the hip diagnosed late include a high-placed femoral head, contracted soft tissues and a dysplastic acetabulum. A combination of open reduction with femoral shortening of untreated congenital dislocations is a well-established practice. Femoral shortening prevents excessive pressure on the located femoral head which can cause avascular necrosis. Instability due to a coexisting dysplastic shallow acetabulum is common, and so a pelvic osteotomy is performed to achieve a stable and concentric hip reduction. We retrospectively reviewed 15 patients (18 hips) presenting with developmental dysplasia of the hip aged four years and above who were treated by a one-stage combined procedure performed by the senior author. The mean age at operation was five years and nine months (4 years to 11 years). The mean follow-up was six years ten months (2 years and 8 months to 8 years and 8 months). All patients were followed up clinically and radiologically in accordance with McKay’s criteria and the modified Severin classification. According to the McKay criteria, 12 hips were rated excellent and six were good. All but one had a full range of movement. Eight had a limb-length discrepancy of about 1 cm. All were Trendelenburg negative. The modified Severin classification demonstrated four hips of grade IA, six of grade IB, and eight of grade II. One patient had avascular necrosis and one an early subluxation requiring revision. One-stage correction of congenital dislocation of the hip in an older child is a safe and effective treatment with good results in the short to medium term


The Journal of Bone & Joint Surgery British Volume
Vol. 78-B, Issue 5 | Pages 718 - 721
1 Sep 1996
Hung S Kurokawa T Nakamura K Matsushita T Shiro R Okazaki H

Femoral lengthening has been associated with narrowing of the joint space at the hip. We have studied the joint space before lengthening in 20 patients with a short femur due to a femoral-shaft fracture (15) or distal femoral epiphyseal injury (5). Their mean age at injury was 16 years (3 to 27) and the mean shortening was 5.4 cm (1.1 to 14). We found that the hip joint space of the shortened femur was significantly narrower (p < 0.001) than that on the normal side, with a mean narrowing ratio of 15.5% (−5 to +43). The narrowing ratio was directly related to the period spent non-weight-bearing (p < 0.001), but not to the amount of femoral shortening. We have shown that the joint space of the hip in patients with post-traumatic femoral shortening was narrowed even before femoral lengthening had been started


The Bone & Joint Journal
Vol. 105-B, Issue 12 | Pages 1327 - 1332
1 Dec 2023
Morris WZ Kak A Mayfield LM Kang MS Jo C Kim HKW

Aims

Abduction bracing is commonly used to treat developmental dysplasia of the hip (DDH) following closed reduction and spica casting, with little evidence to support or refute this practice. The purpose of this study was to determine the efficacy of abduction bracing after closed reduction in improving acetabular index (AI) and reducing secondary surgery for residual hip dysplasia.

Methods

We performed a retrospective review of patients treated with closed reduction for DDH at a single tertiary referral centre. Demographic data were obtained including severity of dislocation based on the International Hip Dysplasia Institute (IHDI) classification, age at reduction, and casting duration. Patients were prescribed no abduction bracing, part-time, or full-time wear post-reduction and casting. AI measurements were obtained immediately upon cast removal and from two- and four-year follow-up radiographs.


Bone & Joint 360
Vol. 13, Issue 4 | Pages 37 - 40
2 Aug 2024

The August 2024 Children’s orthopaedics Roundup360 looks at: Antibiotic prophylaxis and infection rates in paediatric supracondylar humerus fractures; Clinical consensus recommendations for the non-surgical treatment of children with Perthes’ disease in the UK; Health-related quality of life in idiopathic toe walkers: a multicentre prospective cross-sectional study; Children with spinal dysraphism: a systematic review of reported outcomes; No delay in age of crawling, standing, or walking with Pavlik harness treatment: a prospective cohort study; No value found with routine early postoperative radiographs after implant removal in paediatric patients; What do we know about the natural history of spastic hip dysplasia and pain in total-involvement cerebral palsy?; Evaluating the efficacy and safety of preoperative gallows traction for hip open reduction in infants


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 1 | Pages 34 - 38
1 Jan 2011
Charity JAF Tsiridis E Sheeraz A Howell JR Hubble MJW Timperley AJ Gie GA

We evaluated all cases involving the combined use of a subtrochanteric derotational femoral shortening osteotomy with a cemented Exeter stem performed at our institution. With severe developmental dysplasia of the hip an osteotomy is often necessary to achieve shortening and derotation of the proximal femur. Reduction can be maintained with a 3.5 mm compression plate while the implant is cemented into place. Such a plate was used to stabilise the osteotomy in all cases. Intramedullary autograft helps to prevent cement interposition at the osteotomy site and promotes healing. There were 15 female patients (18 hips) with a mean age of 51 years (33 to 75) who had a Crowe IV dysplasia of the hip and were followed up for a mean of 114 months (52 to 168). None was lost to follow-up. All clinical scores were collected prospectively. The Charnley modification of the Merle D’Aubigné-Postel scores for pain, function and range of movement showed a statistically significant improvement from a mean of 2.4 (1 to 4), 2.3 (1 to 4), 3.4 (1 to 6) to 5.2 (3 to 6), 4.4 (3 to 6), 5.2 (4 to 6), respectively. Three acetabular revisions were required for aseptic loosening; one required femoral revision for access. One osteotomy failed to unite at 14 months and was revised successfully. No other case required a femoral revision. No postoperative sciatic nerve palsy was observed. Cemented Exeter femoral components perform well in the treatment of Crowe IV dysplasia with this procedure


The Journal of Bone & Joint Surgery British Volume
Vol. 73-B, Issue 4 | Pages 671 - 675
1 Jul 1991
Kenwright J Albinana J

We reviewed 46 leg-shortening operations (37 femoral and nine tibial), performed by different methods, to assess the incidence of complications and permanent disability. Shortening of as much as 7.5 cm in the femur and 5 cm in the tibia was achieved in men of normal height without any loss of function. Complications were seen with all surgical techniques despite the use of modern implants. Most problems arose from inadequate stabilisation of the osteotomy. The most reliable method of femoral shortening was open subtrochanteric osteotomy with preservation of the isthmus, and fixation with an intramedullary nail locked at its proximal end. In tibial shortening, bone excision should be at the level of the flare in the lower diaphysis in order to achieve reliable bone healing. Simple intramedullary nail fixation should be supplemented with a long-leg cast for six weeks or the nail should be locked at both ends to prevent postoperative distraction or rotation


The Bone & Joint Journal
Vol. 103-B, Issue 11 | Pages 1736 - 1741
1 Nov 2021
Tolk JJ Eastwood DM Hashemi-Nejad A

Aims

Perthes’ disease (PD) often results in femoral head deformity and leg length discrepancy (LLD). Our objective was to analyze femoral morphology in PD patients at skeletal maturity to assess where the LLD originates, and evaluate the effect of contralateral epiphysiodesis for length equalization on proximal and subtrochanteric femoral lengths.

Methods

All patients treated for PD in our institution between January 2013 and June 2020 were reviewed retrospectively. Patients with unilateral PD, LLD of ≥ 5 mm, and long-leg standing radiographs at skeletal maturity were included. Total leg length, femoral and tibial length, articulotrochanteric distance (ATD), and subtrochanteric femoral length were compared between PD side and the unaffected side. Furthermore, we compared leg length measurements between patients who did and who did not have a contralateral epiphysiodesis.


The Bone & Joint Journal
Vol. 101-B, Issue 9 | Pages 1168 - 1176
1 Sep 2019
Calder PR McKay JE Timms AJ Roskrow T Fugazzotto S Edel P Goodier WD

Aims

The Precice intramedullary limb-lengthening system has demonstrated significant benefits over external fixation lengthening methods, leading to a paradigm shift in limb lengthening. This study compares outcomes following antegrade and retrograde femoral lengthening in both adolescent and adult patients.

Patients and Methods

A retrospective review of prospectively collected data was undertaken of a consecutive series of 107 femoral lengthening operations in 92 patients. In total, 73 antegrade nails and 34 retrograde nails were inserted. Outcome was assessed by the regenerate healing index (HI), hip and knee range of movement (ROM), and the presence of any complications.


The Bone & Joint Journal
Vol. 99-B, Issue 7 | Pages 872 - 879
1 Jul 2017
Li Y Zhang X Wang Q Peng X Wang Q Jiang Y Chen Y

Aims

There is no consensus about the best method of achieving equal leg lengths at total hip arthroplasty (THA) in patients with Crowe type-IV developmental dysplasia of the hip (DDH). We reviewed our experience of a consecutive series of patients who underwent THA for this indication.

Patients and Methods

We retrospectively reviewed 78 patients (86 THAs) with Crowe type-IV DDH, including 64 women and 14 men, with a minimum follow-up of two years. The mean age at the time of surgery was 52.2 years (34 to 82). We subdivided Crowe type-IV DDH into two major types according to the number of dislocated hips, and further categorised them into three groups according to the occurrence of pelvic obliquity or spinal curvature. Leg length discrepancy (LLD) and functional scores were analysed.


Bone & Joint 360
Vol. 7, Issue 6 | Pages 31 - 33
1 Dec 2018


Bone & Joint 360
Vol. 6, Issue 4 | Pages 25 - 29
1 Aug 2017