Total hip arthroplasty with a monoblock conical stem and subtrochanteric transverse shortening osteotomy in Crowe type IV dysplastic hips

Guido Grappiolo¹ & Francesco La Camera¹ & Antonello Della Rocca¹ & Giuseppe Mazziotta¹ & Giuseppe Santoro¹ & Mattia Loppini^1,2

1. Hip Diseases and Joint Replacement Surgery Unit, Humanitas clinical and Research Center, Via AlessandroManzoni 56, Rozzano,20089 Milan, Italy
2. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy

Abstract

Purpose This series assessed the clinical and radiographic outcomes of total hip arthroplasty (THA) with femoral shortening osteotomy for the management of patients with Crowe type IV hip dysplasia.

Methods Only patients with Crowe type IV hip dysplasia who underwent primary THA combined with a subtrochanteric transverse osteotomy with an uncemented monoblock conical stem were included. The clinical and radiographic evaluations were performed before and immediately after surgery, and at last follow-up. The hip function was assessed with the Harris Hip Score (HHS).

Results Seventy-four patients (102 hips) with a mean age of 53.9 (range, 20–83) were evaluated at an average follow-up of 11.3 years (range, 5–25). Stem revision occurred in two (1.9%) cases, with a survivorship of 95.9% (95%IC, 91.9–99.9%) at ten years. The average HHS increased from 44 (range, 15–78) pre-operatively to 90.3 (range, 62–100) at last follow-up (p < 0.001). Osteotomy site non-union and early dislocation were observed in 3.9 and 3.8%, respectively. No cases of nerve palsy were reported.

Conclusions THAwith a monoblock conical stem associated with subtrochanteric transverse osteotomy provides good long-term survival, clinical and radiographic results. It may be considered an effective management of patientswith Crowe IV hip dysplasia.

Keywords Crowe type IV dislocation . Total hip arthroplasty . Monoblock conical stem . Transverse femoral shortening

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