Hayama Tetsuo, Takahashi Motoi, Otani Takuya, Fujii Hideki, Kawaguchi Yasuhiko, Abe Toshiomi, Saito Mitsuru
Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Department of Orthopaedic Surgery, Kyoto Kuno Hospital, Kyoto, Japan.
Orthop Surg. 2025 Aug 19. doi: 10.1111/os.70154.
High dislocation due to developmental dysplasia of the hip (DDH), classified as Crowe type III or IV, presents significant challenges in total hip arthroplasty (THA), particularly in preventing nerve complications while restoring leg length.
This study aimed to evaluate the clinical and radiographic outcomes of primary THA using an S-ROM-A modular stem with oblique subtrochanteric shortening osteotomy in patients with high hip dislocation; to identify the advantages, limitations, and possible countermeasures of this surgical approach.
Subjects were 45 hips (37 patients) with high hip dislocation (Crowe III/IV) treated by primary THA using an S-ROM-A stem, with femoral shortening osteotomy performed at our institution. Outcomes 3 years after surgery were examined in 100% of the subjects. Postoperative complications and functional and radiographic outcomes were investigated.
The mean age at surgery was 65 years and the mean duration of postoperative follow-up was 10.7 ± 3.4 years. There were no cases of postoperative infection, symptomatic pulmonary embolism, or neurological complications in the legs. Early postoperative dislocation occurred in two hips (4%, resolved conservatively) and osteotomy site nonunion in one hip (2%). Repeat surgery was required in only this case of nonunion (2%). The hip function score was significantly improved postoperatively. Leg lengthening after surgery was 0-56 mm (mean, 28 mm). Examination of radiographs revealed that it took 12 weeks for bone union at the osteotomy site in all hips except for the one hip with nonunion. No stem subsidence was found postoperatively, and "fixation by bone ingrowth" was achieved at the final follow-up examination in all hips (100%), including the one that required repeat surgery.
THA using an S-ROM-A modular stem with oblique subtrochanteric shortening osteotomy provided favorable mid-term outcomes in patients with Crowe III/IV DDH. No neurological complications occurred, and functional and radiographic improvements were substantial. Our method, which emphasizes intraoperative sciatic nerve palpation for individualized leg lengthening, may serve as a practical and safe alternative to more complex monitoring systems. Further research incorporating objective intraoperative monitoring may help standardize this approach.
发育性髋关节发育不良（DDH）导致的高位脱位，分类为Crowe III型或IV型，在全髋关节置换术（THA）中带来重大挑战，尤其是在恢复肢体长度的同时预防神经并发症。
本研究旨在评估使用S-ROM-A模块化柄及股骨转子下斜行缩短截骨术进行初次THA治疗高位髋关节脱位患者的临床和影像学结果；确定这种手术方法的优点、局限性及可能的应对措施。
研究对象为45例髋关节（37例患者）高位髋关节脱位（Crowe III/IV型），采用S-ROM-A柄进行初次THA治疗，并在本机构进行股骨缩短截骨术。对100%的研究对象进行术后3年的结果检查。调查术后并发症以及功能和影像学结果。
手术时的平均年龄为65岁，术后平均随访时间为10.7±3.4年。未发生术后感染、有症状的肺栓塞或下肢神经并发症病例。术后早期有2例髋关节发生脱位（4%，经保守治疗后缓解），1例髋关节发生截骨部位不愈合（2%）。仅该例不愈合病例（2%）需要再次手术。术后髋关节功能评分显著改善。术后肢体延长0 - 56毫米（平均28毫米）。X线片检查显示，除1例不愈合的髋关节外，所有髋关节的截骨部位均在12周时实现骨愈合。术后未发现柄下沉，所有髋关节（100%）包括需要再次手术的髋关节在末次随访时均实现了“骨长入固定”。
使用S-ROM-A模块化柄及股骨转子下斜行缩短截骨术进行THA为Crowe III/IV型DDH患者提供了良好的中期结果。未发生神经并发症，功能和影像学改善显著。我们强调术中触诊坐骨神经以个体化延长肢体的方法，可能是一种比更复杂的监测系统更实用、安全的替代方法。纳入客观术中监测的进一步研究可能有助于规范这种方法。
