Original Article
Distal Femoral Shortening in Total Hip Arthroplasty for Complex Primary Hip Reconstruction. A New Surgical Technique

https://doi.org/10.1016/j.arth.2007.09.013Get rights and content

Abstract

Successful total hip arthroplasty (THA) in congenital dislocated hips demands anatomical reduction in the normal center of rotation without overstretching the sciatic nerve and without excessive compression or abnormal forces across the joint. Proximal femoral and subtrochanteric shortening osteotomy has been described for THA for the treatment of dislocated hips. However, these osteotomies are demanding, associated with deformation of femoral canal and nonunion, and may increase the femoral stem stress. This study reports excellent results in 24 patients with a new surgical technique that combines THA with a distal femoral shortening in severely deformed hips using customized components.

Section snippets

Materials and Methods

Fifty-two consecutive patients—67 hips—with congenital hip dysplasia were recruited at the outpatient clinic of a university tertiary care center and underwent total hip arthroplasty (THA) with customized femoral implants. In 24 patients, a distal femoral shortening osteotomy was necessary. The most common reason was congenital hip dislocation. According to the classification by Hartofilakidis et al [14], there were 18 high dislocations (Crowe et al [3] type IV), 5 low dislocations (Crowe et al

Results

This was a prospective nonrandomized study. The mean follow-up was 55.7 months (range, 28-72 months; SD, 11.54 months). The mean weight was 72 kg (range, 60-80 kg; SD, 4.91 kg), and the mean height was 1.62 cm (range, 1.55-1.74 cm; SD, 0.047 cm). There were 22 women and 2 men. The mean age was 45.75 years (range, 22-69 years; SD, 10.43 years). At follow-up, pain, hip mobility, and walking ability were rated on a numerical scale, according to the method of D'Aubigne and Postel [30]. The mean

Discussion

We report our results with use of distal femoral shortening in 24 patients with congenital dislocated hips. Our subjects were carefully evaluated preoperatively and observed prospectively every 2, 4, and 6 months, and then annually with clinical assessment radiographic studies and standardized clinical outcome scales. We had excellent results regarding both intraoperative and immediate postoperative complications. Clinical outcomes (pain, mobility, and walking) were also excellent.

The

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    No benefits or funds were received in support of the study.

    Investigation performed at the Orthopaedic Department of the University Hospital of Ioannina, Greece.

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