Total hip arthroplasty with subtrochanteric femoral shortening osteotomy using a monoblock cylindrical cementless stem for severe developmental hip dysplasia (Crowe type III, IV).

IF 1.8 Q2 ORTHOPEDICS SICOT-J Pub Date : 2024-01-01 Epub Date: 2024-09-06 DOI:10.1051/sicotj/2024032
Akio Kanda, Osamu Obayashi, Atsuhiko Mogami, Itaru Morohashi, Muneaki Ishijima
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Abstract

Background: Treatment of patients with Crowe type III and IV dislocated hips is challenging because of the hip deformity in these patients. In addition to the usual total hip replacement, shortening and reduction of the femur are often required. We herein report on our surgical technique using a monoblock cylindrical cementless stem and a direct lateral approach.

Methods: This study included patients with a diagnosis of severe developmental dysplasia of the hip (Crowe types III and IV) who underwent primary total hip arthroplasty at our hospital from August 2019 to January 2022. Eleven hips of seven patients were treated. All patients underwent horizontal osteotomy using a monoblock cylindrical cementless stem and a direct lateral approach. Complications such as dislocation, infection, and implant dropout were evaluated. In addition, the clinical assessment included the hip range of motion at the last observation and hip function based on the Japanese Orthopaedic Association (JOA) hip score and the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ).

Results: The average operation time was 224 min (range, 194-296 min), and the average bleeding amount was 396.1 g (range, 20-1010 g). The main complications were acetabular implant dislocation, postoperative dislocation, intraoperative arterial injury, intraoperative proximal femoral fracture, subsidence of femoral implant. and postoperative pulmonary infarction, which occurred in one patient each.

Conclusion: Total hip arthroplasty for Crowe type III and IV hips is associated with various surgical technical difficulties because of its anatomical characteristics. While patients with severe osteoporosis are contraindicated, the use of a cylindrical monoblock cementless stem and the direct lateral approach makes it possible to simplify the procedure for shortening the femur and increase the indications for surgery.

Level of evidence: Therapeutic Level Ⅳ.

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使用单体圆柱形无骨水泥柄进行股骨转子下缩短截骨的全髋关节置换术,治疗严重发育性髋关节发育不良(克罗III型、IV型)。
背景:由于克劳III型和IV型髋关节脱位患者的髋关节畸形,对这些患者的治疗极具挑战性。除了常规的全髋关节置换术外,通常还需要缩短和缩小股骨。我们在此报告使用单体圆柱形无骨水泥柄和直接侧方入路的手术技术:本研究纳入了2019年8月至2022年1月期间在我院接受初次全髋关节置换术的被诊断为严重髋关节发育不良(克罗III型和IV型)的患者。7名患者的11个髋关节接受了治疗。所有患者均接受了水平截骨术,使用单块圆柱形无骨水泥柄和直接外侧入路。对脱位、感染和植入物脱落等并发症进行了评估。此外,临床评估还包括最后一次观察时的髋关节活动范围以及基于日本骨科协会(JOA)髋关节评分和日本骨科协会髋关节疾病评估问卷(JHEQ)的髋关节功能:平均手术时间为 224 分钟(范围为 194-296 分钟),平均出血量为 396.1 克(范围为 20-1010 克)。主要并发症为髋臼假体脱位、术后脱位、术中动脉损伤、术中股骨近端骨折、股骨假体下沉和术后肺梗死,各发生 1 例:结论:Crowe III 型和 IV 型髋关节的全髋关节置换术因其解剖特点而存在各种手术技术难度。虽然严重骨质疏松症患者是禁忌症,但使用圆柱形整体式无骨水泥柄和直接侧方入路可简化股骨缩短手术,增加手术适应症:治疗水平Ⅳ。
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来源期刊
SICOT-J
SICOT-J ORTHOPEDICS-
CiteScore
3.20
自引率
12.50%
发文量
44
审稿时长
14 weeks
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