title: Comparison of transverse and modified subtrochanteric femoral shortening osteotomy in total hip arthroplasty for developmental dysplasia of hip: a meta-analysis.
abstract: BACKGROUND
  Subtrochanteric femoral shortening osteotomy is a crucial procedure to prevent nerve injury in total hip arthroplasty for severe developmental dysplasia of the hip. Transverse osteotomy was first applied, and other modified methods have also been reported. Each has its own advantages and limitations, but no definitive conclusions regarding differences in outcomes have been reached to date.
  
  
  METHODS
  We therefore performed a comprehensive meta-analysis to compare the outcomes of different approaches. 37 studies (795 hips) were included in the final analysis. Meta-analysis, subgroup analysis and meta-regression were performed.
  
  
  RESULTS
  Meta-analysis and subgroup analysis showed no significant difference between transverse and modified method. This is further confirmed by meta-regression. Method of osteotomy was found to be not associated with nonunion rate (P = 0.472), as well as other post-operative outcomes including nerve palsy (P = 0.240), dislocation (P = 0.735), revision (P = 0.653) and Harris hip score improvement (P = 0.562). In addition, western countries (P = 0.010) and duration of follow-up more than 5 years (P = 0.014) were associated with higher revision rate.
  
  
  CONCLUSIONS
  Transverse osteotomy and modified osteotomy appear to be equivalent in terms of nonunion, safety and efficacy. Transverse osteotomy may be recommended, due to its simplicity and convenience in adjusting the anteversion angle. Well-designed and large-sample-size randomized controlled trials are expected to confirm and update the findings of this analysis.
authors.forename: Changchuan
authors.initials: C
authors.lastname: Li
authors.forename: Chi
authors.initials: C
authors.lastname: Zhang
authors.forename: Maolin
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, No,107 on Yanjiangxi Road, Yuexiu District, 510120 Guangzhou, Guangdong, China. profdingyue@163.com.
authors.forename: Yue
authors.initials: Y
authors.lastname: Ding
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation / Q000379:methods*; D002986:Clinical Trials as Topic / Q000379:methods; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D010027:Osteotomy / Q000379:methods*