title: Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-IV developmental dysplasia: surgical technique.
abstract: BACKGROUND
  When surgeons perform total hip arthroplasty for hips with a high dislocation related to developmental dysplasia of the hip, obtaining long-term stable implant fixation and optimizing patient function remain challenges. The purpose of this paper was to evaluate the results of cementless arthroplasty with a simultaneous subtrochanteric shortening osteotomy in a group of patients with Crowe type-IV developmental dysplasia of the hip.
  
  
  METHODS
  In a retrospective study, we evaluated the results and complications of twenty-eight consecutive primary cementless total hip arthroplasties in twenty-four patients (twenty women and four men), all of whom had Crowe type-IV developmental dysplasia of the hip. The arthroplasty was performed in combination with a subtrochanteric shortening osteotomy and with placement of the acetabular component at the level of the anatomic hip center. The patients were evaluated at a mean of 4.8 years postoperatively.
  
  
  RESULTS
  The mean Harris hip score increased from 43 points preoperatively to 89 points at the time of final follow-up (p < 0.01). Twelve (43%) of the twenty-eight hips had an early or late complication or a reoperation. Two (7%) of the twenty-eight subtrochanteric osteotomies were followed by nonunion. There was one instance of isolated loosening of the femoral stem. One acetabular component loosened, and one acetabular liner disengaged. Four hips dislocated postoperatively. All remaining components were well-fixed at the time of the last radiographic follow-up. No sciatic neurapraxic injuries were identified.
  
  
  CONCLUSIONS
  Cementless total hip arthroplasty combined with a subtrochanteric femoral shortening osteotomy in patients with a high hip dislocation secondary to developmental dysplasia was associated with high rates of successful fixation of the implants and healing of the osteotomy site and a mean postoperative Harris hip score of 89 points. The complication rate, however, was substantially higher than that associated with primary total hip arthroplasty in patients with degenerative arthritis.
authors.affiliation: Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Krych
authors.forename: James L
authors.initials: JL
authors.lastname: Howard
authors.forename: Robert T
authors.initials: RT
authors.lastname: Trousdale
authors.forename: Miguel E
authors.initials: ME
authors.lastname: Cabanela
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Berry
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005269:Femur / Q000601:surgery; D005272:Femur Neck / Q000601:surgery*; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D011183:Postoperative Complications / Q000503:physiopathology; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome