title: Total hip arthroplasty combined with double-chevron subtrochanteric osteotomy.
abstract: BACKGROUND
  Subtrochanteric femoral shortening and corrective osteotomy are regarded as an integral part of total hip arthroplasty for a completely dislocated hip or severe deformity of the proximal femur. Alternative femoral osteotomy techniques-transverse, oblique, step-cut, and V-shaped, have been described.
  
  
  METHODS
  In this series, we performed 22 cementless total hip arthroplasties combined with double-chevron subtrochanteric osteotomies between 1997 and 2002. There were 17 females and 2 males. Their average age at the time of the operation was 59 years (range 41-74 years). Thirteen hips were completely dislocated, 8 hips needed treatment after a proximal femoral osteotomy, and there was 1 case of hip ankylosis.
  
  
  RESULTS
  The mean length of the operation was 128 min (range 80-215 min). Mean total blood loss was 1442 g (range 809-2007 g), which included both the intraoperative blood loss and postoperative blood loss. After an average of 7.6 years of follow-up, the Japanese Orthopaedic Association Hip Score improved from 48 to 79. Three types of complication were observed. There were 4 early dislocations, 3 proximal splits, and 1 nonunion at the osteotomy site.
  
  
  CONCLUSIONS
  Our study shows that acceptable results are obtained from double-chevron subtrochanteric osteotomy for subtrochanteric femoral shortening and corrective osteotomy. However, total hip arthroplasty combined with subtrochanteric osteotomy is a technically demanding treatment option.
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan. sonohata@cc.saga-u.ac.jp
authors.forename: Motoki
authors.initials: M
authors.lastname: Sonohata
authors.forename: Tomonori
authors.initials: T
authors.lastname: Tajima
authors.forename: Masaru
authors.initials: M
authors.lastname: Kitajima
authors.forename: Kenji
authors.initials: K
authors.lastname: Ogawa
authors.forename: Syunsuke
authors.initials: S
authors.lastname: Kawano
authors.forename: Masaaki
authors.initials: M
authors.lastname: Mawatari
authors.forename: Takao
authors.initials: T
authors.lastname: Hotokebuchi
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D004185:Disability Evaluation; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010027:Osteotomy / Q000379:methods*; D011183:Postoperative Complications; D011859:Radiography; D020127:Recovery of Function; D018570:Risk Assessment; D016896:Treatment Outcome