Objective: Determining the optimal osteotomy length for patients with unilateral Crowe-IV developmental dysplasia of the hip undergoing subtrochanteric osteotomy remains challenging due to the significant variability in pelvic and spinal alignment. Incorrect osteotomy length, compounded by pelvic or spinal tilt, can adversely affect postoperative gait and long-term outcomes. Therefore, this study could introduce a method to calculate the osteotomy length for patients with unilateral Crowe-IV developmental dysplasia of the hip, correcting spinal and pelvic tilt, and improving patient gait.
Methods: This is a retrospective study that included 28 patients with unilateral Crowe-IV developmental dysplasia of the hip collected from June 2019 to June 2020, who underwent total hip arthroplasty with measured subtrochanteric osteotomy technique. The average follow-up period was 4.3 years (last follow-up). Harris scores, pelvic tilt angles represented by iliac obliquity angle (IO) and sacral obliquity angle (SO), and postoperative complications were recorded. Statistical analysis was performed using independent sample t-tests for normally distributed data and the Mann–Whitney U test for non-normally distributed data.
Results: Postoperatively, pelvic tilt angles improved significantly. The comparison of preoperative and postoperative 3-month IO angles (8.77° ± 3.31° vs. 5.28° ± 2.29°, p = 0.00), and postoperative 3-month and last follow-up (5.28° ± 2.29° vs. 2.88° ± 1.39°, p = 0.00) showed statistically significant differences. Similarly, the comparison of preoperative and postoperative 3-month SO angles (9.56° ± 3.1° vs. 5.81° ± 2.78°, p = 0.00), and postoperative 3-month and last follow-up (5.81 °± 2.78° vs. 3.59° ± 1.72°, p = 0.00) showed statistically significant differences. Harris scores significantly improved from preoperative to 1-year postoperative (47.35 ± 12.32 vs. 80.5 ± 7.81, p = 0.00), and from 1-year postoperative to last follow-up (80.5 ± 7.81 vs. 90.78 ± 2.86, p = 0.00) with statistical significance. There were no significant differences in adverse event rates between the two groups.
Conclusion: Total hip arthroplasty combined with measurement subtrochanteric osteotomy technique improves pelvic tilt and Harris scores in Crowe-IV developmental dysplasia patients. This technique may serve as a guideline for determining resection length.
| [1] |
J. R. MacKenzie, S. S. Kelley, and R. C. Johnston, “Total Hip Replacement for Coxarthrosis Secondary to Congenital Dysplasia and Dislocation of the Hip. Long-Term Results,” Journal of Bone and Joint Surgery (American Volume) 78, no. 1 (1996): 55–61.
|
| [2] |
C. Ors, R. Caylak, and E. Togrul, “Total Hip Arthroplasty With the Wagner Cone Femoral Stem in Patients With Crowe IV Developmental Dysplasia of the Hip: A Retrospective Study,” Journal of Arthroplasty 37, no. 1 (2022): 103–109.
|
| [3] |
M. Poursalehian, A. Hassanzadeh, S. H. Shafiei, and S. M. J. Mortazavi, “Mid-Term to Long-Term Outcomes and Complications of Total Hip Arthroplasty in Patients Who Have Crowe IV Developmental Dysplasia of the Hip: A Systematic Review and Meta-Analysis,” Journal of Arthroplasty (2024).
|
| [4] |
L. B. Engesaeter, O. Furnes, and L. I. Havelin, “Developmental Dysplasia of the Hip—Good Results of Later Total Hip Arthroplasty,” Journal of Arthroplasty 23, no. 2 (2008): 235–240.
|
| [5] |
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.
|
| [6] |
J. Numair, A. B. Joshi, J. C. Murphy, M. L. Porter, and K. Hardinge, “Total Hip Arthroplasty for Congenital Dysplasia or Dislocation of the Hip. Survivorship Analysis and Long-Term Results,” Journal of Bone and Joint Surgery (American Volume) 79, no. 9 (1997): 1352–1360.
|
| [7] |
A. A. Stans, M. W. Pagnano, W. J. Shaughnessy, and A. D. Hanssen, “Results of Total Hip Arthroplasty for Crowe Type III Developmental Hip Dysplasia,” Clinical Orthopaedics and Related Research 348 (1998): 149–157.
|
| [8] |
W. Pagnano, A. D. Hanssen, D. G. Lewallen, and W. J. Shaughnessy, “The Effect of Superior Placement of the Acetabular Component on the Rate of Loosening After Total Hip Arthroplasty,” Journal of Bone and Joint Surgery (American Volume) 78, no. 7 (1996): 1004–1014.
|
| [9] |
S. A. Yoder, R. A. Brand, D. R. Pedersen, and T. W. O’Gorman, “Total Hip Acetabular Component Position Affects Component Loosening Rates,” Clinical Orthopaedics and Related Research 228 (1988): 79–87.
|
| [10] |
D. Hameed, J. A. Dubin, S. S. Bains, M. C. Moore, S. C. Standard, and M. A. Mont, “Innovative Hip Distraction Approaches for Total Hip Arthroplasty in Crowe IV Developmental Dysplasia or Similar High-Riding Patients,” Journal of Arthroplasty 39, no. 9s1 (2024): S124–s130.
|
| [11] |
J. Charnley and J. A. Feagin, “Low-Friction Arthroplasty in Congenital Subluxation of the Hip,” Clinical Orthopaedics and Related Research 91 (1973): 98–113.
|
| [12] |
W. J. Bruce, S. M. Rizkallah, Y. M. Kwon, J. A. Goldberg, and W. R. Walsh, “A New Technique of Subtrochanteric Shortening in Total Hip Arthroplasty: Surgical Technique and Results of 9 Cases,” Journal of Arthroplasty 15, no. 5 (2000): 617–626.
|
| [13] |
P. P. Symeonides, J. Pournaras, G. Petsatodes, J. Christoforides, I. Hatzokos, and E. Pantazis, “Total Hip Arthroplasty in Neglected Congenital Dislocation of the Hip,” Clinical Orthopaedics and Related Research 341 (1997): 55–61.
|
| [14] |
N. Turgut, M. Erdem, A. C. Erdem, et al., “Is Step-Cut Shortening Osteotomy a Better Choice Than Transverse Osteotomy for Total Hip Arthroplasty for Crowe Type III-IV Hip Dysplasia?,” Orthopaedics & Traumatology, Surgery & Research 110, no. 6 (2024): 103883.
|
| [15] |
E. Ahmed, G. Ibrahim el, and B. Ayman, “Total Hip Arthroplasty With Subtrochanteric Osteotomy in Neglected Dysplastic Hip,” International Orthopaedics 39, no. 1 (2015): 27–33.
|
| [16] |
T. Liu, S. Wang, G. Huang, and W. Wang, “Treatment of Crowe IV Developmental Dysplasia of the Hip With Cementless Total Hip Arthroplasty and Shortening Subtrochanteric Osteotomy,” Journal of International Medical Research 47, no. 7 (2019): 3223–3233.
|
| [17] |
X. Zhou, Q. Wang, X. Zhang, Y. Chen, H. Shen, and Y. Jiang, “Effect of Pelvic Obliquity on the Orientation of the Acetabular Component in Total Hip Arthroplasty,” Journal of Arthroplasty 27, no. 2 (2012): 299–304.
|
| [18] |
R. C. Johnston, R. H. Fitzgerald, Jr., W. H. Harris, R. Poss, M. E. Müller, and C. B. Sledge, “Clinical and Radiographic Evaluation of Total Hip Replacement. A Standard System of Terminology for Reporting Results,” Journal of Bone and Joint Surgery (American Volume) 72, no. 2 (1990): 161–168.
|
| [19] |
S. Wang, Y. Zhou, H. Ma, Y. Du, S. Piao, and W. Wu, “Mid-Term Results of Total Hip Replacement With Subtrochanteric Osteotomy, Modular Stem, and Ceramic Surface in Crowe IV Hip Dysplasia,” Arthroplast Today 4, no. 3 (2018): 363–369.
|
| [20] |
T. L. Bernasek, G. J. Haidukewych, K. A. Gustke, O. Hill, and M. Levering, “Total Hip Arthroplasty Requiring Subtrochanteric Osteotomy for Developmental Hip Dysplasia: 5-To 14-Year Results,” Journal of Arthroplasty 22, no. 6 Suppl 2 (2007): 145–150.
|
| [21] |
R. Caylak, C. Ors, and E. Togrul, “Minimum 10-Year Results of Cementless Ceramic-on-Ceramic Total Hip Arthroplasty Performed With Transverse Subtrochanteric Osteotomy in Crowe Type IV Hips,” Journal of Arthroplasty 36, no. 10 (2021): 3519–3526.
|
| [22] |
D. A. Becker and R. B. Gustilo, “Double-Chevron Subtrochanteric Shortening Derotational Femoral Osteotomy Combined With Total Hip Arthroplasty for the Treatment of Complete Congenital Dislocation of the Hip in the Adult. Preliminary Report and Description of a New Surgical Technique,” Journal of Arthroplasty 10, no. 3 (1995): 313–318.
|
| [23] |
K. Chareancholvanich, D. A. Becker, and R. B. Gustilo, “Treatment of Congenital Dislocated Hip by Arthroplasty With Femoral Shortening,” Clinical Orthopaedics and Related Research 360 (1999): 127–135.
|
| [24] |
J. L. Masonis, J. V. Patel, A. Miu, et al., “Subtrochanteric Shortening and Derotational Osteotomy in Primary Total Hip Arthroplasty for Patients With Severe Hip Dysplasia: 5-Year Follow-Up,” Journal of Arthroplasty 18, no. 3 Suppl 1 (2003): 68–73.
|
| [25] |
O. Reikeraas, P. Lereim, I. Gabor, R. Gunderson, and I. Bjerkreim, “Femoral Shortening in Total Arthroplasty for Completely Dislocated Hips: 3-7 Year Results in 25 Cases,” Acta Orthopaedica Scandinavica 67, no. 1 (1996): 33–36.
|
| [26] |
A. Eskelinen, I. Helenius, V. Remes, P. Ylinen, K. Tallroth, and T. Paavilainen, “Cementless Total Hip Arthroplasty in Patients With High Congenital Hip Dislocation,” Journal of Bone and Joint Surgery (American Volume) 88, no. 1 (2006): 80–91.
|
| [27] |
Y. S. Zhu, T. T. Mo, J. N. Zhang, and C. Jiang, “The Use of Mako Robot-Assisted Total Hip Arthroplasty in the Treatment of Crowe IV Developmental Dysplasia of the Hip,” Asian Journal of Surgery 45, no. 6 (2022): 1333–1335.
|
| [28] |
R. M. Tikhilov, A. A. Dzhavadov, D. R. Ziganshin, N. S. Zakhmatov, R. R. Alekberov, and I. I. Shubnyakov, “Cementless Total Hip Arthroplasty With Paavilainen Femoral Shortening Osteotomy Can Provide Good Results at 10 Years in Patients Who Have Crowe IV Developmental Dysplasia of the Hip,” Journal of Arthroplasty 39, no. 9 (2024): 2316–2322.
|
| [29] |
N. Bao, J. Meng, L. Zhou, T. Guo, X. Zeng, and J. Zhao, “Lesser Trochanteric Osteotomy in Total Hip Arthroplasty for Treating CROWE Type IV Developmental Dysplasia of Hip,” International Orthopaedics 37, no. 3 (2013): 385–390.
|
| [30] |
O. Kiliçoğlu, M. Türker, T. Akgül, and O. Yazicioğlu, “Cementless Total Hip Arthroplasty With Modified Oblique Femoral Shortening Osteotomy in Crowe Type IV Congenital Hip Dislocation,” Journal of Arthroplasty 28, no. 1 (2013): 117–125.
|
RIGHTS & PERMISSIONS
2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
PDF
