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Preoperative leg length discrepancy on pelvic radiography with a distance between lesser trochanters and postoperative radiograph of the same patient.
Source publication
Background:
The complexity of femoral and acetabular anatomy and restoring anatomic center of hip rotation in Crowe type IV developmental dysplasia of the hip (DDH) complicates standard reconstruction. The aim of this study is to evaluate surgical techniques and clinical outcomes of subtrochanteric transverse shortening osteotomy with the use of c...
Context in source publication
Context 1
... length discrepancy (LLD) was calculated measuring the anterior superior iliac spine to the medial malleolus (true measurement). Preoperative LLD was also calculated with a radiographic technique based on the measurement between the lesser trochanters, while it was calculated from the acetabular teardrop to the lesser trochanter postoperatively (Fig. 1). Standard anteroposterior and lateral hip radiographs in preoperative and postoperative assessments were obtained. Thereafter, change in the vertical and lateral migration of center of the anatomical hip rotation was measured on anteroposterior radiograph by considering the vertical distance from the hip rotation center to a line drawn ...
Citations
... Femoral shortening osteotomy is vital to the surgery. The most widely used surgery is subtrochanteric osteotomy, which has some potential complications such as nonunion and instability at the osteotomy site [3]. Some clinicians have used greater trochanter osteotomy, but there are few studies and reports related to this, mainly because of the limitations of bone nonunion [4]. ...
... Harris hip scale (HHS) scores did not differ between the two groups (Table 1). Temporal trends for the 3 We enlarged the femoral bone marrow cavity to reach the maximum contact with the femoral cortex, inserted the test model, pulled the lower limb to try to restore, ensuring that there is no tension in the sciatic nerve, measured the length of the femur that needs to be shortened when it can be restored, and cut off the proximal femur according to this length. We put the femoral prosthesis in the "press-fit" mode and paid attention to ensure the correct anteversion 4 We used a 3.0 mm drill bit to drill a bone path transversely at the thickest part of the bone block, crossed the intertwined double-stranded steel wire through the bone path, crossed and bypassed the two ends of the steel wire from the inner side of the femur to the outer side of the femur respectively, and tightened the two ends of the steel wire at the outer side of the lower edge of the greater trochanter bone block and the femoral transition, in the same direction as the previous double-stranded steel wire winding, and the bone block was firmly fixed to the proximal femur. ...
... These have no significant difference in the stability of the osteotomy site [9]. Transverse STO has some potential complications, such as nonunion and instability at the osteotomy site due to the limited contact area of the osteotomy and the lack of sufficient rotational stability [3]. In addition, the diameters of the distal and proximal ends of the subtrochanteric shortening osteotomy are different, resulting in a mismatch between the prosthesis matching the distal medullary cavity and the proximal medullary cavity and the instability of the proximal end of the osteotomy. ...
Objective
The choice of osteotomy in joint replacement surgery for Crowe type IV developmental dysplasia of the hip (DDH) is a challenging and controversial procedure. In this study, we compared the clinical efficacy of a combination of greater trochanter osteotomy and tension wire fixation with that of subtrochanteric osteotomy.
Methods
We performed 15 primary total hip arthroplasty (THA) procedures between January 2016 and July 2020 on 13 patients with a combination of greater trochanter osteotomy and tension wire fixation (the GTT group) and 12 THA procedures in 11 patients using subtrochanteric osteotomy (the STO group). The mean follow-up was 2.8 years (range 2.2–4.5 years) in the GTT group and 2.6 years (range 2.5–4.3 years) in the STO group. Clinical scores and radiographic results were evaluated during the final follow-up for the 15 hips in the GTT group and 12 hips in the STO group.
Results
Postoperative Harris hip scores, implant position, and the surgery time did not differ between the treatment groups. There were no differences in preoperative leg length discrepancy LLD (P = 0.46) and postoperative LLD (P = 0.56) between the two groups. Bone union occurred within 6 months after surgery in 12 hips in the GTT group (92.3%) and in 9 hips (81.8%) in the STO group. One case in the GTT group and two cases in the STO group had nonunion, and additionally, there was one case of postoperative nerve injury in the STO group, while no symptoms of nerve damage were observed in the GTT group.
Conclusion
The GTT method demonstrated many advantages and reliable clinical results for Crowe type IV DDH patients undergoing THA. This is a surgical method that warrants further development and promotion clinically.
... of femoral anteversion, they are relatively easier techniques, and have similar complication rates. [6,7] Although neurovascular problems can be avoided by performing a femoral shortening osteotomy, ensuring adequate union after osteotomy has remained a problem. Fixation methods such as plate, cable, and strut graft are used for fixation in femoral shortening osteotomy. ...
... Studies reporting lower rates of union in the literature have shown that non-unions are mostly due to rotational instability. Erdem et al. [7] also reported in their study that the rectangular femoral stem provided sufficient stability of the osteotomy and that they achieved complete union in all patients. We believe that the reason for the higher union rates compared to our study is the autograft and cable fixation applied to the osteotomy line. ...
Objectives
This study aims to analyze the clinical, functional, and radiographic results of patients with Crowe type IV developmental dysplasia of the hip (DDH) sequelae undergoing cementless total hip arthroplasty (THA) with transverse subtrochanteric shortening osteotomy without fixation at the osteotomy site.
Patients and methods
Between March 2013 and February 2020, a total of 42 hips of 34 patients (8 males, 26 females; mean age: 50.7±11.7 years; range, 27 to 76 years) with Crowe type IV DDH treated with subtrochanteric shortening osteotomy combined with primary cementless THA were retrospectively analyzed. Each case was evaluated to the Harris Hip Score (HHS). Crowe classification, location of the rotation center of hip, loosening of the implants, and union at the osteotomy line were evaluated radiologically.
Results
The mean follow-up was 57.9±31.5 (range, 24 to 192) months. The mean interval to complete bone union in 40 hips (95%) after surgery was 3.5±0.9 (range, 2 to 6) months. The mean preoperative HHS scores of the patients was 35.6±6.86, while the scores increased to 91.53±5.41 at the final follow-up (p<0.001).
Conclusion
Our study results suggest that excellent clinical and radiological results can be obtained in Crowe type IV dysplastic hips in patients undergoing THA with the rectangular femoral component and transverse shortening osteotomy technique, without fixation at the osteotomy site.
... We were unable to retrieve radiographs for 1 patient due to institutional record purge. All femoral osteotomies healed with a mean time to union of 6.5 ± 3 months (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. This was measured by radiographic union of the osteotomy. ...
... The purpose of this study was to evaluate the long-term results of DDH patients that underwent THA with the femoral [3]. Another study of 56 SDO-THA cases reported HHS of 87 at 10 years [12]. ...
... We observed no hip-related nerve palsies, which is consistent with similar studies [3,4,8,15,28]. However, Eskelinen et al. reported 5 nerve palsies in a cohort of 68 THA-DDH cases [14]. ...
Background
Total hip arthroplasty (THA) for developmental hip dysplasia (DDH) often requires a subtrochanteric shortening derotational osteotomy (SDO) to limit leg lengthening, mitigate risk of peripheral nerve palsy, and reduce excessive femoral anteversion. Few studies exist detailing long-term clinical outcomes and survivorship. The aim of this study is to analyze the long-term outcomes and survivorship of an SDO-THA cohort.
Methods
We retrospectively reviewed all patients who underwent cementless THA with femoral osteotomy due to Crowe I-IV DDH between 1991 and 2001. Primary outcome measures included revision surgery for any reason and functional outcome measures using modified Harris Hip scores. Secondary outcome measures included mode of implant failure and radiographic assessment for osteotomy union, polyethylene wear, osteolysis, and implant loosening.
Results
Our review resulted in 24 SDO-THA cases in 20 patients with a mean follow-up of 19 years (range, 8-27 years). Overall survivorship was 67%. All 8 failures were treated with acetabular revision at a mean time to revision of 11 years (range, 1-25 years). Of the failures, there were 5 cases due to polyethylene wear (62.5%), 2 cases due to acetabular loosening (25%), and 1 case due to recurrent instability (12.5%). The mean postoperative modified Harris Hip score was 76 (range, 52-91) with long-term improvement of 43 points maintained (P < .001).
Conclusions
THA with SDO can produce durable long-term outcomes for the patient with DDH. It is important to consider some common reasons for revision, namely polyethylene wear and osteolysis, acetabular loosening, and recurrent acetabular dislocations.
... Therefore, THA for Crowe Type IV DDH often requires femoral shortening osteotomy to prevent nerve palsy due to leg extension. There have been several reports of THA with femoral shortening osteotomy using cementless stems with good clinical outcomes [9,15]. ...
Introduction
There is still little information regarding the advantages of a using a polished tapered stem for Crowe Type IV developmental dysplasia of the hip (DDH). This study aimed to investigate the mid-term clinical and radiological outcomes of primary total hip arthroplasty (THA) with femoral shortening osteotomy using modular and polished tapered stems and to compare the results between the modular and polished tapered stems.
Materials and methods
This retrospective review included 32 patients (37 hips) with Crowe type IV DDH who underwent primary THA with femoral shortening osteotomy using a modular stem (cementless group, 14 hips) or a polished tapered stem (cement group, 23 hips) between 1996 and 2018. Clinical data and radiographic assessments were reviewed to analyze the differences between the two groups.
Results
The mean duration of patient follow-up of the cementless group (134.4 months) was longer than that of the cement group (75.5 months). There were no differences in clinical results, time of bone union, and survival rate between the two groups. However, the cementless group exhibited a higher ratio of intraoperative fracture and thinning of cortical bone including stress shielding, medullary changes, stem alignment changes, and osteolysis, compared to the cement group.
Conclusions
The findings of this study suggest that THA with femoral shortening osteotomy using both cemented and modular stems can provide satisfactory results. However, considering the occurrence of intraoperative fracture and radiographic analysis in the current study, the cement stem may have an advantage for patients with bone fragility and deterioration in bone quality.
... However, it was shown that measurements involving proximal femur could only have up to a 2.4 mm of measurement error on x-rays [26]. Similar studies also used X-ray images for analysis [4,27,28]; wherefore, data from this study can also be accepted valid for comparison. Lastly, a longer follow-up time might reveal more comprehensive insight into the radiological and clinical findings described in this study. ...
Introduction and objective
Total hip arthroplasty with rectangular femoral component and transverse osteotomy for patients with Crowe type 3 or 4 dysplasia yields successful results with varying radiological findings. This study aims to investigate the surgery and patient related factors associated with successful clinical and radiological results.
Patients and methods
Fifty hips of 41 patients were retrospectively examined. Length and percentage of the stem passing the osteotomy level and canal fill ratio were measured. Radiological findings such as radiolucent lines (RL) around the stem, hypertrophic callus or an identifiable osteotomy line on X-ray images were assessed. All clinical and radiological results were analyzed for any significant association.
Results
Mean stem length and percentage passing the osteotomy level were 6.4 cm (± 0.7) and 51% (± 6). Presence of an identifiable osteotomy line was positively associated with the increasing length of the stem passing the osteotomy level and with a lower HHS (p < 0.05). RL around the stem were associated with a lesser reduction in VAS score (p < 0.05).
Conclusion
Rectangular femoral stem conveniently accommodate the proximal femur in severely dysplastic hips. An upper limit for the femoral stem exists to obtain better bony union and higher HHS. RL around the stem are clinically relevant and is associated with a worse VAS score at the latest follow-up.
... Few studies have reported the functional outcomes as well as morbidity and mortality rates in Crowe type IV patients managed with onestage THA. Recent studies describing the results of THA for Crowe type IV DDH patients are summarized in Table 3 15,[22][23][24][25][26][27] . The results are favorable, but these studies examined small numbers of cases and few bilateral cases were included. ...
Objective
The aim of the present paper was to evaluate the results of one‐stage total hip arthroplasty (THA) for patients with bilateral Crowe type IV developmental dysplasia of the hip (DDH).
Methods
Data for 58 patients (116 hips) with bilateral Crowe type IV DDH who had one‐stage THA performed by the same surgeon during the period of April 2008 to February 2019 were retrospectively reviewed. The mean age of the patients was 37.3 years; 5 were men and 53 were women. All patients underwent THA through the posterolateral approach using the Pinnacle acetabular cup, a ceramic‐on‐ceramic bearing, and the modular S‐ROM stem. Subtrochanteric shortening osteotomy was performed on 86/116 hips. Intraoperative conditions were recorded. Radiographic and functional outcomes were evaluated, and complications were recorded.
Results
All patients were followed up for an average of 71.3 ± 37.6 months (range, 12–140). The mean operative time was 276.5 ± 57.9 min (range, 175–540). The mean intraoperative blood loss was 933.6 ± 400.8 mL (range, 300–2000). The mean transfusion requirement was 1778 ± 798.0 mL (range, 575–4550). The mean length of hospital stay was 8.6 ± 3.7 days (range, 5–22). At the final follow‐up, no loosening of acetabular and femoral components was observed. No osteolysis and heterotopic ossification occurred. The mean Harris hip scores were improved from 55.4 ± 14.3 preoperatively to 91.3 ± 4.2 postoperatively (P < 0.001) In terms of complications, no perioperative deaths were recorded. Deep vein thrombosis occurred in 1 hip, with no pulmonary embolism. Intraoperative femur fracture occurred in 3 hips, nerve injury in 1 hip, and leg length discrepancy in 1 patient. Postoperative dislocation occurred in 5 hips and nonunion in 1 hip.
Conclusion
Our data demonstrated that one‐stage bilateral THA for bilateral Crowe type IV DDH is feasible and can effectively restore hip function.
... Leg length discrepancy (LLD) is a frequent and serious postoperative complication after total hip arthroplasty (THA) in patients with Crowe type IV developmental dysplasia of the hip (DDH) [1][2][3] and its clinical importance is due to its associated with increased incidence of gait disorders, chronic back pain, neurological sequelae and general postoperative dissatisfaction [4]. In Crowe type IV DDH patients, it is difficult to correct LLD during THA due to the preoperative high hip dislocation [5,6]. ...
Background: The study assessed the correlation among the patients’ perception on leg length discrepancy (LLD) after total hip arthroplasty (THA) in patients with unilateral Crowe type IV developmental dysplasia of the hip (DDH) and the four methods of measuring the leg length in the full-length standing anteroposterior radiographs.
Methods: 60 patients with unilateral Crowe type IV DDH were recruited in this retrospective study between January 2012 and January 2019. Four methods of measurement were used: (1) TD-TP: distance between the inferior aspect of teardrop and the midpoint of tibial plafond (TP). (2) CH-TP: distance between the center of femoral head or acetabular cup and the TP. (3) GT-TP: distance between the apex of greater trochanter and the TP. (4) FL + TL: the sum of femoral length and tibial length.
Results: Association was found among the patients’ perception on LLD with difference in TD-TP (OR, 1.157), and the difference in FL + TL (OR, 1.166). The area under the curve of the difference in FL + TL and the difference TD-TP (0.704 and 0.679) was significantly higher than those of the difference in CH-TP and the difference in GT-TP (0.564 and 0.483). With the calculated threshold of LLD set at 9.0 mm, the sensitivity and specificity of the difference in TD-TP and the difference in FL + TL were 57.7%, 79.4% and 61.5%, 79.4%, respectively.
Conclusion: Patients’ perception on LLD had good correlation and reliability on the difference of FL + TL and the difference of TD-TP.
... All cups were stable at a mean duration of 3.7 years follow-up. Erdem et al. 23 , in a study of 26 hips with Crowe type IV DDH that were reconstructed in the true acetabulum (the height of COR of hip: 15 mm), found that all the cups were stable at a mean follow up of 7.1 years. In our study, the procedure of reconstructing the acetabular cup followed the methods of Zhou et al 10 . ...
Objective
To explore the leg length balance in total hip arthroplasty (THA) with shortening subtrochanteric osteotomy (SSTO) or not for unilateral Crowe type IV developmental dysplasia of the hip (DDH) through the evaluation of postoperative full‐length anteroposterior radiographs.
Methods
The postoperative radiographs of 60 patients with unilateral Crowe type IV DDH from July 2012 to May 2019 were retrospectively reviewed. All patients underwent THA using the Pinnacle Acetabular Cup system, a ceramic liner and femoral head, and the S‐ROM stem with a proximal sleeve or cone. Patients with leg length discrepancy (LLD) < 10 mm were defined as the non‐LLD group. To identify differences associated with SSTO, the group was further divided into two groups based on whether the patient underwent SSTO. A total of 48 patients (26 for SSTO and 22 for non‐SSTO) were in the non‐LLD group. There were 3 male and 45 female patients. The mean age of the patients in the non‐LLD group was 39 years. These data, including leg length, femoral length, the height of center of rotation (COR) of the hip, the depth of the sleeve or cone in the femoral medullary canal and the height of the greater trochanter, were measured.
Results
In the non‐LLD group, the femoral lengths in both SSTO and non‐SSTO groups were significantly shorter on the operated side compared with the contralateral side, and the mean discrepancy in the SSTO group was approximately equal to the mean length of the SSTO. The mean height of the COR of the hip on the operated sides in both SSTO and non‐SSTO groups was 13.2 mm, and the contralateral sides were 15.2 and 15.5 mm, respectively. The depth of the sleeve or cone in the femoral medullary canal between SSTO and non‐SSTO groups was 21.7 and 30.6 mm, respectively. The depth of the sleeve or cone in the SSTO group was negatively correlated with the length of SSTO. The heights of the greater trochanter in the operated and contralateral sides were 5.3 and 16.6 mm in the SSTO group, and 13.2 and 17.2 mm in the non‐SSTO group, respectively.
Conclusions
Shortening subtrochanteric osteotomy led to femoral shortening on the operated side for patients with unilateral Crowe type IV DDH. The position of the sleeve or cone should be close to the apex of the greater trochanter to compensate the length of the SSTO. The position of the sleeve or cone without SSTO should be adjusted to make sure that the height of the greater trochanter on the operated side is close to that on the contralateral side.
... All cups were stable at a mean duration of 3.7 years follow-up. Erdem et al. [19] in a study of 26 hips with Crowe type IV DDH, which were reconstructed in the true acetabulum (the height of COR of hip: 15 mm), found all the cups were stable at a mean follow-up of 7.1 years. In our study, the procedure of reconstructing the acetabular cup was followed the methods of Zhou et al. [2]. ...
Background: The purpose of this study was to explore that how to equalize the leg length in total hip arthroplasty (THA) with shortening subtrochanteric osteotomy (SSTO) or not for unilateral Crowe type IV developmental dysplasia of the hip (DDH) through the evaluation of the postoperative full-length anteroposterior radiographs.
Methods: The postoperative radiographs of 60 patients with unilateral Crowe type IV DDH from July 2012 to May 2019 were retrospectively reviewed. These data included leg length, femoral length, height of center of rotation (COR) of hip, height of greater trochanter, and depth of the sleeve or cone. Patients with leg length discrepancy (LLD) < 10 mm were defined as the non-LLD group.
Results: In the non LLD group (26 patients of SSTO and 22 of non-SSTO), the femoral length both SSTO and non-SSTO groups were significantly shorter on operated side, compared with the contralateral side, and the mean discrepancy in SSTO group was approximately equal to the mean length of SSTO. The mean height of COR of hip on operated sides both SSTO and non-SSTO groups were 13.2 mm, and the contralateral sides were 15.2 mm and 15.5 mm, respectively. The depth of the sleeve or cone between SSTO and non-SSTO groups were 21.7 mm and 30.6 mm, respectively. The depth of the sleeve or cone in SSTO group was negatively correlated with the length of SSTO. The height of the greater trochanter of the operated and contralateral sides were 5.3 mm and 16.6 mm in SSTO group, and those in the non-SSTO group were 13.2 mm and 17.2 mm.
Conclusions: SSTO leaded to femoral shortening on the operated side for patients with unilateral Crowe type IV DDH. The position of sleeve or cone should be close to the apex of greater trochanter to compensate the lengh of SSTO.
