Objective: Subtrochanteric shortening osteotomy (SSO) with autogenous cortical plate grafting is a critical but technically demanding procedure in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip. Conventional instruments often result in inaccurate osteotomies and unstable graft fixation. This study aimed to evaluate a novel surgical instrumentation system designed to address these challenges.
Methods: A retrospective cohort study was conducted on 49 patients (60 hips) with Crowe type IV DDH who underwent primary THA with SSO. The control group included 25 patients (30 hips) treated with conventional instruments. The novel instrumentation group included 24 patients (30 hips) treated with the newly developed system. All surgeries were performed by a single senior surgeon. Demographic and clinical data were analyzed, and all patients completed the 24-month postoperative follow-up. Statistical analysis was performed using t-tests and chi-squared tests as appropriate.
Results: The mean operative time was significantly shorter in the novel instrumentation group than in the control group (t = 2.123, p = 0.040). The novel instrumentation system was estimated to reduce the time required for the autogenous cortical plate technique by 43%. Patients in the novel instrumentation group also reported significantly less intraoperative blood loss (t = 3.078, p = 0.003). The satisfaction rate regarding autogenous graft and wire positions was significantly higher in the novel instrumentation group (χ2 = 5.455, p = 0.020). No significant differences were observed in clinical scores between the two groups during the 24-month follow-up. No severe perioperative or postoperative complications occurred in either group.
Conclusion: The novel surgical instrumentation system demonstrated advantages over conventional devices in terms of operating time, blood loss, and satisfaction with autogenous graft and wire positioning. It represents an ideal set of surgical tools for Crowe type IV DDH patients undergoing THA with SSO.
Level of Evidence: Level III, retrospective study.
| [1] |
J. F. Crowe, V. J. Mani, and C. S. Ranawat, “Total Hip Replacement in Congenital Dislocation and Dysplasia of the Hip,” Journal of Bone and Joint Surgery. American Volume 61, no. 1 (1979): 15–23.
|
| [2] |
C. Sun, Y. Zhang, L. T. Li, H. Ding, T. Guo, and J. N. Zhao, “Long-Term Outcomes of Total Hip Arthroplasty With Transverse Subtrochanteric Shortening Osteotomy and Modular Stem in Crowe IV Developmental Dysplasia,” Journal of Arthroplasty 36, no. 2 (2021): 630–635.
|
| [3] |
Y. Q. Du, J. Y. Sun, H. Y. Ma, S. Wang, M. Ni, and Y. G. Zhou, “Leg Length Balance in Total Hip Arthroplasty for Patients With Unilateral Crowe Type IV Developmental Dysplasia of the Hip,” Orthopaedic Surgery 12, no. 3 (2020): 749–755.
|
| [4] |
H. Y. Ma, J. Y. Sun, Y. Q. Du, et al., “Model to Predict Need for Subtrochanteric Shortening Osteotomy During Total Hip Arthroplasty for Crowe Type IV Developmental Dysplasia,” Medical Science Monitor: International Medical Journal of Experimental and Clinical Research 26 (2020): e926239.
|
| [5] |
J. B. Masson, C. Foissey, A. Bertani, V. Pibarot, and F. Rongieras, “Transverse Subtrochanteric Shortening Osteotomy With Double Tension-Band Fixation During THA for Crowe III-IV Developmental Dysplasia: 12-Year Outcomes,” Orthopaedics & Traumatology, Surgery & Research 109, no. 7 (2023): 103684.
|
| [6] |
O. Akıncı and A. Turgut, “Long-Term Results of Total Hip Arthroplasty With Step-Cut Osteotomy in Crowe Type IV Dysplastic Hips,” Indian Journal of Orthopaedics 56, no. 4 (2022): 672–679.
|
| [7] |
Y. Liu, S. Zhang, C. Li, et al., “Fixation by Autogenous Cortical Plate Technique on Sites of Subtrochanteric Shortening Osteotomy Contributes to Early Bone Union in Total Hip Arthroplasty for Crowe Type IV Developmental Dysplasia of the Hip,” Therapeutics and Clinical Risk Management 18 (2022): 1059–1067.
|
| [8] |
C. Casciaro, C. Rampulla, S. Bargeri, S. Guida, and L. Zagra, “What Is the Femoral Shortening Osteotomy in THA for Congenital High Hip Dislocation With the Lowest Complication Rate? A Systematic Review,” EFORT Open Rev 11, no. 2 (2026): 107–118.
|
| [9] |
J. B. Gross, “Estimating Allowable Blood Loss: Corrected for Dilution,” Anesthesiology 58, no. 3 (1983): 277–280.
|
| [10] |
D. J. Yasgur, S. A. Stuchin, E. M. Adler, and P. E. DiCesare, “Subtrochanteric Femoral Shortening Osteotomy in Total Hip Arthroplasty for High-Riding Developmental Dislocation of the Hip,” Journal of Arthroplasty 12, no. 8 (1997): 880.
|
| [11] |
A. J. Krych, J. L. Howard, R. T. Trousdale, M. E. Cabanela, and D. J. Berry, “Total Hip Arthroplasty With Shortening Subtrochanteric Osteotomy in Crowe Type-IV Developmental Dysplasia: Surgical Technique,” Journal of Bone and Joint Surgery. American Volume 92, no. Suppl 1 Pt 2 (2010): 176–187.
|
| [12] |
A. C. DeNovio, N. A. Bedard, R. T. Trousdale, M. P. Abdel, C. P. Hannon, and D. J. Berry, “Long-Term Outcomes of Total Hip Arthroplasty With Subtrochanteric Osteotomy for Crowe IV Dysplasia,” Journal of Arthroplasty 40, no. 10 (2025): 2679–2684.
|
| [13] |
J. Meng, B. Hu, S. Yan, A. Liu, and H. Wu, “Comparison of Cementless Total Hip Arthroplasty With or Without Subtrochanteric Shortening Osteotomy in Crowe Type IV Developmental Dysplasia of the Hip,” Journal of Arthroplasty 40 (2025): S61–S67.
|
| [14] |
T. Hayama, M. Takahashi, T. Otani, et al., “Total Hip Arthroplasty for Crowe III/IV Hip Dysplasia With Oblique Subtrochanteric Shortening Osteotomy and S-ROM-A Modular Stem: 10-Year Outcomes,” Orthopaedic Surgery 17, no. 10 (2025): 2895–2902.
|
| [15] |
Y. Hu, J. Zhang, Z. Sun, et al., “Application of a Novel Osteotomy Instrumentation as a Substitute Tool in Total Hip Arthroplasty,” BMC Musculoskeletal Disorders 23, no. 1 (2022): 437.
|
| [16] |
S. Gong, W. Xu, R. Wang, et al., “The Causes and Management of Nonunion of Femoral Subtrochanteric Shortening Osteotomy in a THA Patient: A Case Report,” BMC Musculoskeletal Disorders 20, no. 1 (2019): 203.
|
| [17] |
H. Ravanbod, K. Gharanizadeh, P. Mirghaderi, A. Hassan, and M. Abolghasemian, “Subtrochanteric Shortening Osteotomy Provides Superior Function to Trochanter Slide Osteotomy in THA for Patients With Unilateral Crowe Type IV Dysplasia at a Minimum of 3 Years,” Clinical Orthopaedics and Related Research 482, no. 6 (2024): 1038–1047.
|
| [18] |
E. Fahri, E. Uluyardimci, M. Tahta, A. A. Karaaslan, and Ç. Işik, “Cementless THA With Femoral Shortening Osteotomy Provides Excellent Results for Patients With Crowe Type IV Hip Dysplasia,” Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca 92, no. 3 (2025): 153–159.
|
| [19] |
X. Kong, W. Chai, J. Chen, C. Yan, L. Shi, and Y. Wang, “Intraoperative Monitoring of the Femoral and Sciatic Nerves in Total Hip Arthroplasty With High-Riding Developmental Dysplasia,” Bone & Joint Journal 11 (2019): 1438–1446.
|
| [20] |
D. Wang, D. H. Li, Q. Li, et al., “Subtrochanteric Shortening Osteotomy During Cementless Total Hip Arthroplasty in Young Patients With Severe Developmental Dysplasia of the Hip,” BMC Musculoskeletal Disorders 18, no. 1 (2017): 491.
|
| [21] |
Y. Zhou, H. Shao, Y. Huang, W. Deng, D. Yang, and T. Bian, “Does Robotic Assisted Technology Improve the Accuracy of Acetabular Component Positioning in Patients With DDH?,” Journal of Orthopaedic Surgery (Hong Kong) 29, no. 2 (2021): 23094990211025325.
|
| [22] |
W. Ando, M. Takao, H. Hamada, K. Uemura, and N. Sugano, “Comparison of the Accuracy of the Cup Position and Orientation in Total Hip Arthroplasty for Osteoarthritis Secondary to Developmental Dysplasia of the Hip Between the Mako Robotic Arm-Assisted System and Computed Tomography-Based Navigation,” International Orthopaedics 45, no. 7 (2021): 1719–1725.
|
| [23] |
S. Hayashi, S. Hashimoto, Y. Kuroda, et al., “Robotic-Arm Assisted THA Can Achieve Precise Cup Positioning in Developmental Dysplasia of the Hip: A Case Control Study,” Bone & Joint Research 10, no. 10 (2021): 629–638.
|
| [24] |
T. Morimoto, T. Kobayashi, M. Tsukamoto, et al., “Sagittal-Spinopelvic Alignment Improves in Patients With Bilateral Highly Dislocated Hip (Crowe Type IV) After Subtrochanteric Shortening Total Hip Arthroplasty: A Retrospective Radiographic Study,” Medicine (Baltimore) 103, no. 3 (2024): e36966.
|
RIGHTS & PERMISSIONS
2026 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
PDF
(1227KB)
