Total Hip Arthroplasty for High Hip Dislocation

Abstract

Introduction Total hip arthroplasty in patients with high hip dislocation is a surgically demanding procedure. This is due to the congenital disorder of hip maturation and the resulting anatomical features. The aim of the arthroplasty is implantation of the cup prosthesis in the original centre of rotation, at the same time correcting femoral deformities and reducing the hip joint.

Indications The indications include advanced osteoarthritis in the secondary acetabulum, existing instability, severe contractures and secondary changes in adjacent joints.

Contraindications The contraindications include cerebrospinal dysfunction with impaired coordination, muscular dystrophies, overt metabolic bone disorders and complete or nearly complete absence of muscles that stabilise the hip/hip-stabilising musculature.

Operation Technique The operation is preferably performed through an anterolateral approach with the patient supine or through a posterolateral approach with the patient on his side. Sparing the pelvitrochanteric muscles is crucial for the functional outcome. Exposure of the original acetabulum is essential for correct and secure placement of the cup component. We perform planned shortening femoral osteotomy above an increase in length of more than 3.0 cm in patients without previous surgery and depending on the operative findings in previously operated patients. As a rule of thumb, the bone fragment to be removed should be approximately 60% of the distance between the planned and the preoperative position of the trochanter tip. Additional fixation is necessary only in the absence of primary stability between the parts of the femur divided by the osteotomy.

Postoperative Management In these patients, the postoperative management is determined individually depending on the stability of the prosthetic cup fixation, bone quality, rotational stability of the stem in both segments of the femur after the osteotomy, existing soft tissue contractures and the resulting postoperative leg length difference.

Complications The most frequent complications are nerve injuries, femoral fractures, malpositioning of the components, absence of integration of the components (usually due to inadequate primary stability), joint instability due to damage to the pelvitrochanteric muscles and therefore an increased risk of dislocation, pseudarthrosis of the femoral osteotomy and increased perioperative blood loss due to the prolonged operation time.

Results The currently published results show that subtrochanteric shortening osteotomy in patients with high hip dislocation with anatomic reconstruction of the original centre of rotation delivers good functional results with insignificantly increased 10-year loosening rates compared with standard management of primary hip osteoarthritis.

Key words

total hip arthroplasty - high hip dislocation - developmental dysplasia of the hip - shortening subtrochanteric osteotomy - Crowe IV

• References/Literatur

• 1 Rosenstein AD, Diaz RJ. Challenges and solutions for total hip arthroplasty in treatment of patients with symptomatic sequelae of developmental dysplasia of the hip. Am J Orthop 2011; 40: 87-91
• 2 Tschauner C, Hoffmann S. Residuelle Hüftdysplasie. In: Tschauner C. Hrsg. Orthopädie und Orthopädische Chirurgie. Bd. Becken, Hüfte. Stuttgart: Thieme; 2004: 156-169
• 3 Pauwels F. Gesammelte Abhandlungen zur funktionellen Anatomie des Bewegungsapparates. Berlin: Springer; 1965
• 4 Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am 1979; 61: 15-23
• 5 Hartofilakidis G, Stamos K, Karachalios T. et al. Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg Am 1996; 78: 683-692
• 6 Stans AA, Pagnano MW, Shaughnessy WJ. et al. Results of total hip arthroplasty for Crowe type III developmental hip dysplasia. Clin Orthop Relat Res 1998; (348) 149-157
• 7 Pagnano W, Hanssen AD, Lewallen DG. et al. The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty. J Bone Joint Surg Am 1996; 78: 1004-1014
• 8 Yoder SA, Brand RA, Pedersen DR. et al. Total hip acetabular component position affects component loosening rates. Clin Orthop Relat Res 1988; (228) 79-87
• 9 Biant LC, Bruce WJ, Assini JB. et al. Primary total hip arthroplasty in severe developmental dysplasia of the hip. Ten-year results using a cementless modular stem. J Arthroplasty 2009; 24: 27-32
• 10 Faldini C, Nanni M, Leonetti D. et al. Total hip arthroplasty in developmental hip dysplasia using cementless tapered stem. Results after a minimum 10-year follow-up. Hip Int 2011; 21: 415-420
• 11 Mu W, Yang D, Xu B. et al. Midterm outcome of cementless total hip arthroplasty in Crowe IV-Hartofilakidis type III developmental dysplasia of the hip. J Arthroplasty 2016; 31: 668-675
• 12 Sugano N, Noble PC, Kamaric E. et al. The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg Br 1998; 80: 711-719
• 13 Ito H, Tanino H, Yamanaka Y. et al. Hybrid total hip arthroplasty using specifically-designed stems for patients with developmental dysplasia of the hip. A minimum five-year follow-up study. Int Orthop 2011; 35: 1289-1294
• 14 Bao N, Meng J, Zhou L. et al. Lesser trochanteric osteotomy in total hip arthroplasty for treating CROWE type IV developmental dysplasia of hip. Int Orthop 2013; 37: 385-390
• 15 Makita H, Inaba Y, Hirakawa K. et al. Results on total hip arthroplasties with femoral shortening for Croweʼs group IV dislocated hips. J Arthroplasty 2007; 22: 32-38
• 16 Bernasek TL, Haidukewych GJ, Gustke KA. et al. Total hip arthroplasty requiring subtrochanteric osteotomy for developmental hip dysplasia: 5- to 14-year results. J Arthroplasty 2007; 22: 145-150
• 17 Anwar MM, Sugano N, Masuhara K. et al. Total hip arthroplasty in the neglected congenital dislocation of the hip. A five- to 14-year follow-up study. Clin Orthop Relat Res 1993; (295) 127-134
• 18 Watts CD, Abdel MP, Hanssen AD. et al. Anatomic hip center decreases aseptic loosening rates after total hip arthroplasty with cement in patients with Crowe type-II dysplasia: a concise follow-up report at a mean of thirty-six years. J Bone Joint Surg Am 2016; 98: 910-915
• 19 Takao M, Ohzono K, Nishii T. et al. Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia. J Bone Joint Surg Am 2011; 93: 548-555
• 20 Kawai T, Tanaka C, Ikenaga M. et al. Cemented total hip arthroplasty with transverse subtrochanteric shortening osteotomy for Crowe group IV dislocated hip. J Arthroplasty 2011; 26: 229-235
• 21 Charity JA, Tsiridis E, Sheeraz A. et al. Treatment of Crowe IV high hip dysplasia with total hip replacement using the Exeter stem and shortening derotational subtrochanteric osteotomy. J Bone Joint Surg Br 2011; 93: 34-38
• 22 Oinuma K, Tamaki T, Miura Y. et al. Total hip arthroplasty with subtrochanteric shortening osteotomy for Crowe grade 4 dysplasia using the direct anterior approach. J Arthroplasty 2014; 29: 626-629
• 23 Krych AJ, Howard JL, Trousdale RT. et al. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-IV developmental dysplasia. J Bone Joint Surg Am 2009; 91: 2213-2221
• 24 Perka C, Fischer U, Taylor WR. et al. Developmental hip dysplasia treated with total hip arthroplasty with a straight stem and a threaded cup. J Bone Joint Surg Am 2004; 86-A: 312-319
• 25 Baz AB, Senol V, Akalin S. et al. Treatment of high hip dislocation with a cementless stem combined with a shortening osteotomy. Arch Orthop Trauma Surg 2012; 132: 1481-1486
• 26 Hu J, Shen C, Chen X. et al. Total hip arthroplasty with a non-modular conical stem and transverse subtrochanteric osteotomy in treatment of high dislocated hips. J Arthroplasty 2015; 30: 611-614
• 27 Akiyama H, Kawanabe K, Yamamoto K. et al. Cemented total hip arthroplasty with subtrochanteric femoral shortening transverse osteotomy for severely dislocated hips: outcome with a 3- to 10-year follow-up period. J Orthop Sci 2011; 16: 270-277
• 28 Hua WB, Yang SH, Xu WH. et al. Total hip arthroplasty with subtrochanteric femoral shortening osteotomy for high hip dislocation. Orthop Surg 2015; 7: 112-118
• 29 Imam MA, Fathalla I, Holton J. et al. Cementless total hip replacement for the management of severe developmental dysplasia of the hip in the Middle Eastern population: a prospective analysis. Front Surg 2016; 3: 31
• 30 Li W, Zhang W, Bai G. et al. [Total hip arthroplasty for treatment of Crowe type IV congenital dysplasia of hip with dislocation in adults]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2013; 27: 1153-1156
• 31 Oe K, Lida H, Nakamura T. et al. Subtrochanteric shortening osteotomy combined with cemented total hip arthroplasty for Crowe group IV hips. Arch Orthop Trauma Surg 2013; 133: 1763-1770
• 32 Ollivier M, Abdel MP, Krych AJ. et al. Long-term results of total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe IV developmental dysplasia. J Arthroplasty 2016; 31: 1756-1760
• 33 Wang D, Li LL, Wang HY, Pei FX. et al. Long-term results of cementless total hip arthroplasty with subtrochanteric shortening osteotomy in Crowe type IV developmental dysplasia. J Arthroplasty 2017; 32: 1211-1219
• 34 Rollo G, Solarino G, Vicenti G. et al. Subtrochanteric femoral shortening osteotomy combined with cementless total hip replacement for Crowe type IV developmental dysplasia: a retrospective study. J Orthop Traumatol 2017; 18: 407-413
• 35 Sofu H, Şahin V, Gürsu S. et al. Cementless total hip arthroplasty in patients with Crowe type-4 developmental dysplasia. Hip Int 2013; 23: 472-477
• 36 Yalcin N, Kilicarslan K, Karatas F. et al. Cementless total hip arthroplasty with subtrochanteric transverse shortening osteotomy for severely dysplastic or dislocated hips. Hip Int 2010; 20: 87-93
• 37 Hartofilakidis G, Babis GC, Lampropoulou-Adamidou K. et al. Results of total hip arthroplasty differ in subtypes of high dislocation. Clin Orthop Relat Res 2013; 471: 2972-2979
• 38 Nagoya S, Kaya M, Sasaki M. et al. Cementless total hip replacement with subtrochanteric femoral shortening for severe developmental dysplasia of the hip. J Bone Joint Surg Br 2009; 91: 1142-1147