APPROACH VIA TRIPLE FEMORAL OSTEOTOMY FOR IMPLANTATION OF HIP PROSTHESES FOR HIGH UNSTABLE HIP DISLOCATION

Abstract

Purpose of the study: Generally, hip prosthesis implantation for congenital hip dysplasia is a routine procedure.

Material and methods: We compared preliminary results between two surgical techniques. On one hand, hip prostheses were implanted via trochanterotomy with femoral shortening osteotomy for cemented insertion and trochanteroplasty. On the other, access was achieved via a triple infratrochanteric osteotomy for shortening, correction of valgum and derotation followed by implantation of a press-fit prosthesis without osteosynthesis.

Results:

1. Between 1993 and 2001, 61 patients underwent surgery for Crowe III or Eftekhar grade C hips (n=45) and Crowe IV or Eftekhar grade D hips (n=16). Mean patient age was 42 years. Prostheses inserted via the trans-trochanteric approach with femoral shortening osteotomy and cementing developed complications related to the trochanteroplasty: nonunion of the greater trochanter (n=6), functional impairment (n=2), infection after bursitis on suture and secondary necrosis (n=1). Because of these complications we adopted the triple femoral osteotomy technique for shortening, derotation and press-fit femoral implants.

2. Between 2001 and 2005, eight Eftekhar D hips were treated with this technique. Locked non-cemented femoral prostheses were inserted. Pre- and postoperative clinical assessment was based on the Postel-Merle-d’Aubigné score. For the cup, the technique remained unchanged, with cemented implants. The lengthening obtaine varied from 3.5 to 5.5 cm with no cases of sciatic palsy. There has been no case of prosthesis dislocation.

Conclusion: These preliminary results concern non-cemented femoral prosthesis with insufficient follow-up. We nevertheless have found this an attractive technique free of femoral complications.