title: Cementless Total Hip Arthroplasty Involving Trochanteric Osteotomy without Subtrochanteric Shortening for High Hip Dislocation.
abstract: BACKGROUND
  Total hip arthroplasty with subtrochanteric shortening osteotomy is widely performed for high hip dislocation. However, suboptimal leg length discrepancy correction and nonunion of the osteotomy site remain concerns. Although total hip arthroplasty using trochanteric osteotomy without subtrochanteric osteotomy was introduced, cemented implants have been more commonly used than contemporary cementless implants in this procedure. We evaluated the long-term results of cementless total hip arthroplasty with trochanteric osteotomy without subtrochanteric osteotomy for high hip dislocation.
  
  
  METHODS
  From 1990 to 2002, 27 cementless total hip arthroplasties using trochanteric osteotomy without subtrochanteric osteotomy were performed in 26 patients with Crowe III or IV high hip dislocation and a mean age of 36.4 ± 12.9 years. Seven ceramic-on-ceramic, 8 ceramic-on-polyethylene, 10 metal-on-polyethylene, and 2 metal-on-metal bearings were inserted. Mean follow-up was 15.1 ± 3.7 years. We retrospectively reviewed medical records and radiographic data and evaluated the clinical and radiological results including the Harris hip score, implant survival, correction of leg length discrepancy, and occurrence of complications.
  
  
  RESULTS
  The mean Harris hip score and leg length discrepancy improved significantly from 73.3 to 94.9 points and from 4.3 cm to 1.0 cm, respectively. With revision for loosening set as the end point, implant survival rates at 10 and 15 years postoperatively were 96.0% and 90.9% for stems and 74.1% and 52.3% for cups. In 8 of 10 hips with the metal-on-polyethylene bearing and 4 of 8 hips with the ceramic-on-polyethylene bearing, revision surgery was performed for aseptic loosening. However, no revision was performed in hips with the ceramic-on-ceramic bearing or the metal-on-metal bearing. Implant survival was significantly different by the type of bearing surface. Two permanent neurologic complications occurred in patients with a limb lengthening over 3.5 cm.
  
  
  CONCLUSIONS
  With proper selection of the bearing surface coupled with adjustment of lengthening, cementless total hip arthroplasty using trochanteric osteotomy without subtrochanteric osteotomy might be a favorable treatment option for high hip dislocation.
authors.affiliation: Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Soong Joon
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jeong Joon
authors.initials: JJ
authors.lastname: Yoo
authors.affiliation: Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hee Joong
authors.initials: HJ
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation / Q000379:methods*; D002516:Ceramics; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000000981:diagnostic imaging / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D007870:Leg Length Inequality / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D061825:Metal-on-Metal Joint Prostheses; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D020959:Polyethylene; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D015996:Survival Rate; D055815:Young Adult
chemical_list: D020959:Polyethylene
keywords: Congenital hip dislocation; Dislocations; Hip replacement; Leg length inequality; Osteotomy