Total hip arthroplasty with subtrochanteric osteotomy in neglected dysplastic hip.

PURPOSE: Total hip arthroplasty (THA) in the presence of developmental dysplasia of the hip (DDH) presents many challenges to the reconstructive surgeon. The complexity of femoral and acetabular anatomy in these cases makes standard reconstruction technically challenging. Restoring the anatomic centre of hip rotation may require femoral osteotomy. The aim of this study was to determine the rate of union, complications and functional results in a series of patients with Crowe IV dysplastic hips who underwent cementless THA and simultaneous subtrochanteric oblique osteotomy.

METHODS: A retrospective study was designed in a series of 13 patients (14 hips) with Crowe IV DDH who underwent cementless THA and simultaneous subtrochanteric oblique osteotomy at a mean age of 37 years. Patients were reviewed clinically and radiographically with a minimum follow-up of two years. Complications were noted. Harris Hip Score (HHS) was recorded pre-operatively and at six and 12 months postoperatively.

RESULTS: Union occurred in 14 of 14 femora (100%). The overall revision rate was 14% (7% femoral, 7% acetabular). No dislocations necessitated further surgery. No patient had intraoperative femoral fracture, sciatic nerve injury, infection or deep venous thrombosis. Mean HHS improved from 42 preoperatively to 79 at 6 months and 86 at 12 months.

CONCLUSION: Combined subtrochanteric femoral osteotomy and cementless THA is technically demanding and proved to be safe and effective in femoral shortening for treatment of Crowe IV DDH.