title: Subtrochanteric shortening osteotomy combined with cemented total hip arthroplasty for Crowe group IV hips.
abstract: BACKGROUND
  Total hip arthroplasty (THA) is a challenging surgical procedure that can be used to treat severely dislocated hips. There are few reports regarding cemented THAs involving subtrochanteric shortening osteotomy (SSO), even though cemented THAs provide great advantages because the femur is generally hypoplastic with a narrow, deformed canal.
  
  
  OBJECTIVE
  We evaluated the utility of cemented THA with SSO for Crowe group IV hips, and assessed the relationship between leg lengthening and nerve injury. Our goal was to describe surgical techniques for optimizing surgical outcomes while minimizing the risk of nerve injury.
  
  
  METHODS
  We retrospectively reviewed 34 cases of cemented THAs with transverse SSO for Crowe group IV. Prior to surgery, mean hip flexion was 93.1° (40°-130°). The mean follow-up period was 5.2 years (3-10 years).
  
  
  RESULTS
  Bone union took an average of 7.7 months (3-24 months). Mean leg lengthening was 40.5 mm (15-70 mm) and was greater in patients without hip flexion contracture. None of the patients experienced any nerve injuries associated with leg lengthening, and radiographic evidence of loosening was not observed at the final follow-up.
  
  
  CONCLUSIONS
  SSO combined with cemented THA is an effective treatment for severely dislocated hips. Leg lengthening is not necessarily associated with nerve injuries, and the likelihood of this surgical complication may be related to the presence of hip flexion contracture.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Oe
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Iida
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Nakamura
authors.forename: Naofumi
authors.initials: N
authors.lastname: Okamoto
authors.forename: Takahiko
authors.initials: T
authors.lastname: Wada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D001852:Bone Lengthening / Q000379:methods; D002484:Cementation; D005260:Female; D005269:Femur / Q000002:abnormalities / Q000601:surgery*; D006618:Hip Dislocation, Congenital / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D007870:Leg Length Inequality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D012189:Retrospective Studies