title: Total hip replacement in congenital high hip dislocation following iliofemoral monotube distraction.
abstract: The aim of this study was to prospectively evaluate our single-centre one- and five-year results of anatomically correct cementless total hip arthroplasty in unilateral and bilateral Crowe type IV high hip dislocations in ten hips following iliofemoral monotube soft tissue distraction. Six consecutive patients (five females and one male) with unilateral and two female patients with bilateral high hip dislocation with an average age of 46 years and height of dislocation up to 110 mm were treated in our institution. Limb lengthening was achieved up to 100 mm. The mean leg-length-discrepancy was -4 mm postoperatively. Harris hip score increased significantly at one year (p < 0.001) and significantly further (p < 0.05) at five years postoperative. WOMAC, VAS pain scale as well as gait and pain-free walking distance also improved significantly at follow-up. Two pin infections and one temporary peroneal nerve palsy occurred during monotube extension. Three cup protrusions that required revision surgery were observed in two patients. This study shows that iliofemoral distraction prior to total hip replacement achieves leg length equality and improved gluteal function and therefore gait in patients with Crowe type IV hip dislocation.
authors.affiliation: Department of Orthopaedic Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. johannes.holinka@meduniwien.ac.at
authors.forename: Johannes
authors.initials: J
authors.lastname: Holinka
authors.forename: Martin
authors.initials: M
authors.lastname: Pfeiffer
authors.forename: Jochen G
authors.initials: JG
authors.lastname: Hofstaetter
authors.forename: Richard
authors.initials: R
authors.lastname: Lass
authors.forename: Rainer I
authors.initials: RI
authors.lastname: Kotz
authors.forename: Alexander
authors.initials: A
authors.lastname: Giurea
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D004185:Disability Evaluation; D016267:External Fixators; D005260:Female; D005269:Femur / Q000601:surgery*; D020233:Gait Disorders, Neurologic / Q000503:physiopathology / Q000601:surgery; D006618:Hip Dislocation, Congenital / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D007085:Ilium / Q000601:surgery*; D007870:Leg Length Inequality / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019857:Osteogenesis, Distraction / Q000379:methods*; D010147:Pain Measurement; D011183:Postoperative Complications; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome