Turgut Necmettin, Erdem Mehmet, Erdem Ahmet Can, Bayam Levent, Batar Suat, Sağlam Necdet, Gülabi Deniz
Başkent University, Adana Dr. Turgut Noyan Research and Training Centre, Department of Orthopedics and Traumatology, Adana, Turkey.
Sakarya University Faculty of Medicine, Department of Orthopedics and Traumatology, Sakarya, Turkey.
Orthop Traumatol Surg Res. 2024 Oct;110(6):103883. doi: 10.1016/j.otsr.2024.103883. Epub 2024 Apr 6.
Total hip arthroplasty for developmental hip dysplasia is a challenging surgery due to anatomic abnormalities. Crowe III and Crowe IV hip dysplasia generally necessitates a subtrochanteric shortening osteotomy. Transverse and step-cut osteotomy are the most common procedures for shortening of femur although there is still no consensus which one is a superior method. The objective of this study was to demonstrate whether transverse or step-cut osteotomy is superior in hips who undergo arthroplasty for high riding hip dysplasia.
Our hypothesis was that higher rates of union would be achieved in patients with Crowe III-IV hip dysplasia when the step-cut osteotomy was performed compared to transverse osteotomies.
A total of 99 hips from 90 patients (9 bilateral, 81 unilateral; 79 female, 11 male), each with a minimum follow-up duration of two years, were included in this study. The hips were classified as Crowe III (n=16) or IV (n=83). All hips were implanted cementless. Transverse or step-cut osteotomy was chosen for osteotomy type. The clinical and functional outcomes were assessed using the Harris Hip Score (HHS), limb length discrepancy (LLD), and limping. The complications and management of these were noted. The union rates were compared between osteotomy types.
The mean age at surgery was 48.8 (range, 21-79 years). The follow-up period was 64.3 months in average (range, 24 to 192 months). The mean Harris Hip Score before surgery was 35.6 (range, 18-50), and increased to 88.1 (range, 61-98) points at the most recent follow-up. The preoperative leg length discrepancy (LLD) measured 5.3cm (with a range of 3 to 6.8), while the postoperative LLD reduced to 0.8cm (with a range of 0 to 1.6). There were a total of 38 complications in 35 patients out of 99 cases, resulting in a complication rate of 38.4%. The most frequent complication observed was intraoperative femoral fractures, occurring in 13 cases. Residual limping was seen in 73.7% of all. Step-cut osteotomy was performed in 64 hips (35 CDH stem [Zimmer Biomet, Warsaw, IN, USA], 29 Wagner Cone stem [Zimmer Biomet, Warsaw, IN, USA]) and, transverse in 35 hips (22 CDH, 13 Wagner Cone). Six hips had nonunion problem and all of them were operated with a step-cut osteotomy (z-score: -7.12 and p<0.00001, Mann-Whitney U Test).
Transverse osteotomy may be a better option while performing a shortening subtrochanteric level osteotomy for total hip arthroplasty for Crowe III-IV hips.
Level III; observational retrospective cohort study.
由于解剖结构异常，发育性髋关节发育不良的全髋关节置换术是一项具有挑战性的手术。Crowe III型和Crowe IV型髋关节发育不良通常需要进行转子下缩短截骨术。横断截骨术和阶梯状截骨术是股骨缩短最常用的方法，尽管对于哪种方法更优仍未达成共识。本研究的目的是证明在因高位髋关节发育不良接受关节置换术的髋关节中，横断截骨术或阶梯状截骨术哪种更具优势。
我们的假设是，与横断截骨术相比，对Crowe III-IV型髋关节发育不良患者进行阶梯状截骨术时，骨愈合率更高。
本研究纳入了90例患者的99个髋关节（9例双侧，81例单侧；79例女性，11例男性），每个患者的最短随访时间为两年。这些髋关节被分类为Crowe III型（n = 16）或IV型（n = 83）。所有髋关节均采用非骨水泥植入。根据截骨类型选择横断截骨术或阶梯状截骨术。使用Harris髋关节评分（HHS）、肢体长度差异（LLD）和跛行情况评估临床和功能结果。记录这些情况的并发症及处理方法。比较不同截骨类型的骨愈合率。
手术时的平均年龄为48.8岁（范围为21 - 79岁）。平均随访期为64.3个月（范围为24至192个月）。术前Harris髋关节评分平均为35.6分（范围为18 - 50分），在最近一次随访时增至88.1分（范围为61 - 98分）。术前肢体长度差异（LLD）为5.3厘米（范围为3至6.8厘米），术后LLD降至0.8厘米（范围为0至1.6厘米）。99例中有35例患者共出现38例并发症，并发症发生率为38.4%。观察到最常见的并发症是术中股骨骨折，共13例。所有患者中有73.7%存在残留跛行。64个髋关节采用阶梯状截骨术（35个使用CDH柄[美国印第安纳州华沙市Zimmer Biomet公司]，29个使用Wagner Cone柄[美国印第安纳州华沙市Zimmer Biomet公司]），35个髋关节采用横断截骨术（22个使用CDH柄，13个使用Wagner Cone柄）。6个髋关节存在骨不连问题，且均为采用阶梯状截骨术的患者（z值：-7.12，p < 0.00001，曼-惠特尼U检验）。
对于Crowe III-IV型髋关节的全髋关节置换术，在进行转子下水平缩短截骨术时，横断截骨术可能是更好的选择。
III级；观察性回顾性队列研究。
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