Original ArticleDistal Femoral Shortening in Total Hip Arthroplasty for Complex Primary Hip Reconstruction. A New Surgical Technique
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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Cited by (42)
Finite Element Analysis of Optimal Positioning of Femoral Osteotomy in Total Hip Arthroplasty With Subtrochanteric Shortening
2022, Arthroplasty TodayCitation Excerpt :Therefore, THA with femoral shortening is the most recommended surgical approach to reduce the risk of nerve palsy in patients with high hip dislocation due to DDH [2,3]. Previous reports have demonstrated various subtrochanteric osteotomy techniques with many cutting shapes, including transverse, oblique, Z-shaped, and double-chevron [4-10]. Transverse osteotomy may be recommended because of the minimal invasion of the periosteum at the osteotomy site and the relative technical ease of cutting and adjusting the anteversion angle [11].
Total hip arthroplasty in the developmental dysplasia of the hip using transverse subtrochanteric osteotomy
2016, Journal of OrthopaedicsCitation Excerpt :Percutaneous adductor tenotomy was applied when hip abduction limitation was determined. Femoral shortening can be achieved through proximal, subtrochanteric or distal osteotomies.4,6,7,25,9,28,29 Most authors in the literature discuss the superiority and advantages of their own osteotomy techniques.
Biomechanical Comparison of 2 Different Femoral Stems in the Shortening Osteotomy of the High-Riding Hip
2016, Journal of ArthroplastyTotal hip arthroplasty with a non-modular conical stem and transverse subtrochanteric osteotomy in treatment of high dislocated hips
2015, Journal of ArthroplastyCitation Excerpt :After the anatomic placement of acetabular components, femoral shortening osteotomy was needed to overcome the excessive stretching of the sciatic nerve. Different techniques of femoral shortening including proximal, diaphyseal and distal osteotomies have been described [23–25]. These techniques were difficult to be compared because of the differences in the types of hips, ages of patients and follow-up periods under investigation [26].
Subtrochanteric shortening and uncemented arthroplasty in hips with high dislocation - a cohort study with 13–30 years follow-up
2019, Journal of OrthopaedicsCitation Excerpt :When performing a shortening osteotomy, preservation of the anatomy of the trochanteric region and thereby avoiding problems with soft tissue reattachment is a priority. Several techniques have been described, including subtrochanteric,5–7 diaphyseal,8 and distal shortening osteotomies.9 There are some disadvantages to the osteotomy, including the risk of fracture or non-union.
No benefits or funds were received in support of the study.
Investigation performed at the Orthopaedic Department of the University Hospital of Ioannina, Greece.