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General Orthopaedics

SIMULTANEOUS SUBTROCHANTERIC FEMORAL OSTEOTOMY AND CEMENTED TOTAL HIP REPLACEMENT FOR DEVELOPMENTAL HIP DYSPLASIA

12th Combined Meeting of the Orthopaedic Associations (AAOS, AOA, AOA, BOA, COA, NZOA, SAOA)



Abstract

Hypothesis

Successful total hip arthroplasty (THA) in the presence of developmental dysplasia of the hip (DDH) depends on restoration of the anatomic centre of hip rotation and may require simultaneous femoral osteotomy. Techniques using uncemented components are widely reported. In osteopenic bone an all-cemented technique may be more appropriate; however, the outcome following this procedure is not known. We present the results of a series of thirty-five cemented THA with simultaneous subtrochanteric osteotomy.

Methods and analysis

28 patients with DDH (35 hips) who underwent this procedure at a mean age of 47.3 years were retrospectively reviewed. Two patients (two hips) died within 12 months of surgery. The clinical notes and radiographs of the remaining patients were reviewed with a minimum follow-up of 2 years (mean, 5.6 years; range, 2-14 years). Complications were noted. SF-12 and Oxford hip scores (OHS) were recorded for 18 patients pre-operatively and after 6 and 12 months.

Results

Union occurred in 32 of 33 femora (97%); one patient had an infected nonunion. The overall revision rate was 19% at 5.6 years (8% femoral revision rate). There were three dislocations, two of which required further surgery. Two patients had a transient neuropraxia. The mean SF-12 physical component score increased from 32 to 52 and mean SF-12 mental component score increased from 48 to 51. The mean OHS decreased from 40 to 27.

Conclusion

Combined subtrochanteric osteotomy and cemented THA is technically demanding with a higher complication rate than routine THA. The rate of union, complications, implant survivorship, and early OHS were comparable to those for similar techniques using cementless components.


Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK