The results of monoblock stem with step-cut femoral shortening osteotomy for developmentally dislocated hips.
BACKGROUND
The main objective of this study was to evaluate the midterm results of cementless THA with the use of monoblock stems combined with step-cut femoral shortening derotational osteotomy for DDH.


METHODS
A total of 66 hips of 49 patients with Crowe type IV developmental hip dislocation, with a mean follow-up of 90 (range 26-207) months, were reviewed retrospectively. Subtrochanteric step-cut shortening osteotomy and monoblock femoral stems were used. The cup was placed in the true acetabulum in all cases. 21 hips had previous femoral valgisation osteotomies. Anteroposterior and lateral radiographs of both hips were obtained preoperatively and at the last follow-up examination. The Harris Hip Score (HHS) was used for pre- and postoperative clinical evaluation.


RESULTS
The mean HHS increased from 49 to 86 points. A total of 13 hips of 10 patients (the isolated acetabular component in 7 hips of 6 patients, the femoral component in 3 hips of 3 patients, and both components in 2 patients) were revised during the follow-up period. Dislocation occurred in 3 hips, deep periprosthetic infection in 2, superficial wound infection in 2, and femoral vein injury and sciatic nerve palsy in 1. Nonunion was observed in 3 osteotomy sites. 10-year survival probabilities of 91% for femoral components for all cases and 78% for acetabular components were found.


CONCLUSIONS
THA with subtrochanteric femoral shortening osteotomy was proven to be an effective technique for avoiding neurological complications for Crowe IV DDH. Cementless THA with the use of monoblock stems showed overall survival rates of 95% at 5 years and 85% at 10 years.
Department of Orthopaedics and Traumatology, Acıbadem Maslak Hospital, Istanbul - Turkey.
İsmail Remzi
İR
Tözün
Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul - Turkey.
Turgut
T
Akgül
Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul - Turkey.
Volkan
V
Şensoy
Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul - Turkey.
Önder İsmet
Öİ
Kılıçoğlu
D000293:Adolescent; D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D001843:Bone Cements; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D011474:Prosthesis Design; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D001843:Bone Cements