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Kanda A, Obayashi O, Mogami A, Morohashi I, Ishijima M. Total hip arthroplasty with subtrochanteric femoral shortening osteotomy using a monoblock cylindrical cementless stem for severe developmental hip dysplasia (Crowe type III, IV). SICOT J 2024; 10:34. [PMID: 39240143 PMCID: PMC11378714 DOI: 10.1051/sicotj/2024032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/02/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Treatment of patients with Crowe type III and IV dislocated hips is challenging because of the hip deformity in these patients. In addition to the usual total hip replacement, shortening and reduction of the femur are often required. We herein report on our surgical technique using a monoblock cylindrical cementless stem and a direct lateral approach. METHODS This study included patients with a diagnosis of severe developmental dysplasia of the hip (Crowe types III and IV) who underwent primary total hip arthroplasty at our hospital from August 2019 to January 2022. Eleven hips of seven patients were treated. All patients underwent horizontal osteotomy using a monoblock cylindrical cementless stem and a direct lateral approach. Complications such as dislocation, infection, and implant dropout were evaluated. In addition, the clinical assessment included the hip range of motion at the last observation and hip function based on the Japanese Orthopaedic Association (JOA) hip score and the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). RESULTS The average operation time was 224 min (range, 194-296 min), and the average bleeding amount was 396.1 g (range, 20-1010 g). The main complications were acetabular implant dislocation, postoperative dislocation, intraoperative arterial injury, intraoperative proximal femoral fracture, subsidence of femoral implant. and postoperative pulmonary infarction, which occurred in one patient each. CONCLUSION Total hip arthroplasty for Crowe type III and IV hips is associated with various surgical technical difficulties because of its anatomical characteristics. While patients with severe osteoporosis are contraindicated, the use of a cylindrical monoblock cementless stem and the direct lateral approach makes it possible to simplify the procedure for shortening the femur and increase the indications for surgery. LEVEL OF EVIDENCE Therapeutic Level Ⅳ.
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Affiliation(s)
- Akio Kanda
- Department of Orthopaedic Surgery, Juntendo Shizuoka Hospital, Nagaoka 1129, Izunokuni-country, 410-2295 Shizuoka, Japan
| | - Osamu Obayashi
- Department of Orthopaedic Surgery, Juntendo Shizuoka Hospital, Nagaoka 1129, Izunokuni-country, 410-2295 Shizuoka, Japan
| | - Atsuhiko Mogami
- Department of Orthopaedic Surgery, Juntendo Shizuoka Hospital, Nagaoka 1129, Izunokuni-country, 410-2295 Shizuoka, Japan
| | - Itaru Morohashi
- Department of Orthopaedic Surgery, Juntendo Shizuoka Hospital, Nagaoka 1129, Izunokuni-country, 410-2295 Shizuoka, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University, Hongou 3-1-3, Bunkyou ward, 113-8431 Tokyo, Japan
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Fan S, Yin M, Xu Y, Ren C, Ma T, Lu Y, Li M, Li Z, Zhang K. Locking compression plate fixation of femoral intertrochanteric fractures in patients with preexisting proximal femoral deformity: a retrospective study. J Orthop Surg Res 2021; 16:285. [PMID: 33926490 PMCID: PMC8082780 DOI: 10.1186/s13018-021-02430-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background To investigate the clinical efficacy of locking compression plate fixation for the treatment of femoral intertrochanteric fractures in patients with preexisting proximal femoral deformity. Methods A retrospective analysis was conducted on 37 patients with femoral intertrochanteric fractures combined with preexisting proximal femoral deformity between January 2013 and July 2019. The patients included 24 males and 13 females aged from 23 to 69 years old, with an average age of 47.5 years. The preexisting proximal femoral deformities resulted from poliomyelitis sequela, proximal femoral fibrous dysplasia, malunion and implant failure combined with coxa vara after intramedullary nailing fixation. There were 6 cases of 31-A2.1, 6 cases of 31-A2.2, 20 cases of 31-A3.1, and 5 cases of 31-A3.2, determined based on the AO classification of intertrochanteric fractures. All fractures were managed through open reduction and locking plate fixation. The hip disability and osteoarthritis outcome score (HOOS) was used to assess hip function before injury and at the last postoperative follow-up. The short form 36 (SF-36) Health Survey Questionnaire was used to assess quality of life. Results Thirty-seven patients were followed up for 12 to 27 months (average, 20.7 months). All patients achieved bone healing within 5.1 months on average (range, 3 to 6 months). Postoperative complications included deep vein thrombosis in three patients, bedsores in one and delayed union in one patient. No other complications, such as surgical site infection, fat embolism, nonunion and re-fracture, were presented. There was no significant difference in the HOOS scores and the SF-36 Health Questionnaire outcomes at pre-injury and at the last postoperative follow-up (p > 0.05). Conclusions It is difficult to perform intramedullary fixation of femoral intertrochanteric fractures in patients with preexisting proximal femoral deformity, while locking compression plate fixation is a simple and effective method of treatment.
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Affiliation(s)
- Shan Fan
- Department of Surgery and Anesthesiology II, Xi'an Honghui Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, 710054, P. R. China
| | - Mingming Yin
- Department of Burn and Microsurgery, The People's Hospital of Ankang, Ankang, Shaanxi Province, 725000, P.R. China
| | - Yibo Xu
- Department of Orthopedics Trauma, Xi'an Honghui Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, 710054, P.R. China.
| | - Cheng Ren
- Department of Orthopedics Trauma, Xi'an Honghui Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, 710054, P.R. China
| | - Teng Ma
- Department of Orthopedics Trauma, Xi'an Honghui Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, 710054, P.R. China
| | - Yao Lu
- Department of Orthopedics Trauma, Xi'an Honghui Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, 710054, P.R. China
| | - Ming Li
- Department of Orthopedics Trauma, Xi'an Honghui Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, 710054, P.R. China
| | - Zhong Li
- Department of Orthopedics Trauma, Xi'an Honghui Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, 710054, P.R. China
| | - Kun Zhang
- Department of Orthopedics Trauma, Xi'an Honghui Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, 710054, P.R. China
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Kim JT, Kim HS, Lee YK, Ha YC, Koo KH. Total Hip Arthroplasty With Trochanteric Ostectomy for Patients With Angular Deformity of the Proximal Femur. J Arthroplasty 2020; 35:2911-2918. [PMID: 32473769 DOI: 10.1016/j.arth.2020.04.099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) of patients with a proximal femoral deformity is technically demanding. This deformity poses the risk of femoral fracture or perforation; stem malposition; and failed stem fixation. To insert a femoral stem in neutral position with a good fit, we removed the greater trochanter in case of a varus deformity, and the lesser trochanter in case of valgus deformity, while performing THA. We aimed to evaluate stem position, implant stability, clinical results, and radiological changes after THAs using this technique. METHODS Fifteen patients (17 hips; 11 varus hips and 6 valgus hips) underwent cementless THA using the trochanteric osteotomy technique in one institution. We evaluated procedure-specific complications: intraoperative femoral fracture, stem malposition, weakness of the abductor power and limp. Modified Harris Hip Score, radiological changes, and the stability of stems were assessed at a mean of 7.1 years of follow-up (range 2.0-15.5). RESULTS Femoral fracture occurred during the insertion of the stem in 4 hips. All stems were aligned in neutral position. At the latest follow-up, the mean power of the abductor was 4.3 (range 3-5). Eleven patients had slight limp and 4 patients had moderate limp. All stems had bone-ingrown stability and no stem was revised. The mean modified Harris Hip Score improved from 50 points at the preoperative evaluation to 81 points at the final follow-up. CONCLUSION The trochanteric excision enabled neutral insertion of cementless stem in patients with varus/valgus deformity of the proximal femur, and THA using this technique rendered favorable results.
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Affiliation(s)
- Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Hong Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Tang L, Chen M, Li G, Luo Z, Ji X, Zhang X, Wu K, Zhu C, Shang X. [Effectiveness of proximal femur reconstruction combined with total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of hip]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:683-688. [PMID: 32538556 DOI: 10.7507/1002-1892.201911073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the early effectiveness of proximal femur reconstruction combined with total hip arthroplasty (THA) in the treatment of adult Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods Between May 2015 and March 2018, 29 cases (33 hips) suffering from Crowe type Ⅳ DDH were treated with proximal femur reconstruction combined with THA. Of the 29 cases, there were 6 males (7 hips) and 23 females (26 hips), aged from 24 to 74 years with an average age of 44.9 years. The preoperative Harris hip score was 44.0±12.0. Gait abnormalities were found in all of the 33 hips with positive Trendelenburg sign, and the lower limb discrepancy was (3.8±1.6) cm. Preoperative X-ray films and CT both indicated serious anatomical abnormalities, including complete dislocation of the affected hip with significant move-up of the greater trochanter, abnormal development of the femoral neck, abnormal anterversion angle and neck-shaft angle, dysplasia of proximal femur and dysplasia of medullary cavity. The operation time, intraoperative blood loss, transfusion rate, and complications were recorded. The Gruen and DeLee-Charnley zoning methods were used to evaluate the aseptic loosening of the prosthesis on X-ray films. The Harris score was used to evaluate hip function. The lower limb discrepancy was calculated and compared with the preoperative value. Results The operation time ranged from 80 to 240 minutes, with an average of 124.8 minutes. The intraoperative blood loss ranged from 165 to 1 300 mL, with an average of 568.4 mL. Seventeen patients (51.5%) received blood transfusion treatment. All the incisions healed by first intention without infection or deep vein thrombosis. All patients were followed up 19-53 months, with an average of 33 months. One patient had posterior hip dislocation because of falling from the bed at 4 weeks after operation, and was treated with manual reduction and fixation with abduction brace for 4 weeks, and no dislocation occurred during next 12-month follow-up. Two patients developed sciatic nerve palsy of the affected limbs after operation and were treated with mecobalamin, and recovered completely at 12 weeks later. Trendelenburg sign was positive in 3 patients and mild claudication occurred in 4 patients after operation. X-ray films showed that all the osteotomy sites healed at 3-6 months after operation, and no wire fracture was observed during the follow-up. The Harris score was 89.8±2.8 and lower limb discrepancy was (0.6±0.4) cm at last follow-up, both improved significantly ( t=-22.917, P=0.000; t=11.958, P=0.000). The prosthesis of femur and acetabulum showed no obvious loosening and displacement, and achieved good bone ingrowth except 2 patients who had local osteolysis in the area of Gruen 1 and 7 around the femoral prosthesis, but no sign of loosening and sinking was observed. Conclusion The treatment of Crowe Ⅳ DDH with proximal femur reconstruction and THA was satisfactory in the early postoperative period. The reconstruction technique of proximal femur can effectively restore the anatomical structure of proximal femur, which is one of the effective methods to deal with the deformity of proximal femur.
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Affiliation(s)
- Lei Tang
- Department of Orthopaedics, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei Anhui, 230000, P.R.China
| | - Min Chen
- Department of Orthopaedics, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei Anhui, 230000, P.R.China
| | - Guoyuan Li
- Department of Orthopaedics, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei Anhui, 230000, P.R.China
| | - Zhengliang Luo
- Department of Orthopaedics, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei Anhui, 230000, P.R.China
| | - Xiaofeng Ji
- Department of Orthopaedics, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei Anhui, 230000, P.R.China
| | - Xiaoqi Zhang
- Department of Orthopaedics, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei Anhui, 230000, P.R.China
| | - Kerong Wu
- Department of Orthopaedics, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei Anhui, 230000, P.R.China
| | - Chen Zhu
- Department of Orthopaedics, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei Anhui, 230000, P.R.China
| | - Xifu Shang
- Department of Orthopaedics, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei Anhui, 230000, P.R.China
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Yang M, Chen JY, Kong X, Chai W. Nonsurgical Management of Distal Femur Stem Cortical Perforation. Arthroplast Today 2020; 6:153-157. [PMID: 32368603 PMCID: PMC7184104 DOI: 10.1016/j.artd.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/01/2020] [Accepted: 03/05/2020] [Indexed: 11/08/2022] Open
Abstract
Distal femur stem cortical perforation is a rare but potentially catastrophic complication during total hip arthroplasty. If unrecognized, it can lead to transverse fracture of the femur while the patient is ambulating. If an uncemented femur stem was used, previous literature unanimously agrees that revision surgery should be performed. We report a case of uncemented distal femur stem cortical perforation that was treated nonsurgically successfully with protected weight-bearing for 6 weeks. Our patient had previous osteotomy surgeries of the proximal femur with a residual deformity which increased her risk for distal femur stem cortical perforation. At 40-month follow-up, she was asymptomatic, ambulated with normal gait, and was able to perform deep squats. The discussion involves avoiding, recognizing, and managing distal femur stem cortical perforation.
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Affiliation(s)
- Minzhi Yang
- Department of Joint Surgery, Chinese PLA General Hospital, Haidian, Beijing, China.,Medical School, Nankai University, Nankai, Tianjin, China
| | | | - Xiangpeng Kong
- Department of Joint Surgery, Chinese PLA General Hospital, Haidian, Beijing, China
| | - Wei Chai
- Department of Joint Surgery, Chinese PLA General Hospital, Haidian, Beijing, China
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