Ain Shams University, Egypt
Dr Haytham Abdelazim is an assistant professor of orthopedic surgery in Ain Shams University Faculty of medicine. He has his expertise in joint replacement surgeries. He has years of experience in research, teaching and administration both in hospital and education institutions..
Statement of the Problem: Total hip replacement in patients with a dysplastic hip is challenging. The normal anatomy about the hip joint is distorted in the presence of congenital hip dislocation and proximal migration of the femur. It is a technically demanding procedure in which several problems and complications can be encountered. Restoring the anatomic center of hip rotation may require femoral osteotomy.
Methodology & Theoretical Orientation: The aim of this study was to determine the rate of union, complications and functional results in a series of patients with Crowe III and IV dysplastic hips who underwent single stage THA with or without simultaneous subtrochanteric femoral shortening osteotomy. A retrospective study was designed in a series of 20 patients (20hips). Patients were reviewed clinically and radiographically with a minimum follow-up of one year. Harris Hip Score (HHS) was recorded pre-operatively and at six weeks, six months and 12 months postoperatively. Results: Hip center was restored at the anatomic center in 95% and near anatomic center in 5% of cases, subtrochanteric femoral osteotomy was needed in 11 cases (55%), intraoperative femoral cracks were encountered in 3 cases (15%), union occurred in all cases with subtrochanteric shortening (100%) Mean HHS improved from 36.31 preoperatively to 87.13 at 6 months and 88.60 at 12 months. Infection and dislocation occurred in 1 case (5%) and sciatic nerve injury occurred in 1 case (5%). No cases required revision till last follow up and no patients encountered postoperative DVT or aseptic loosening.
Conclusion & Significance: Single stage THA for dysplastic hip Crowe III or IV is technically demanding and proved to be safe and effective with or without subtrochanteric femoral shortening osteotomy with restoration of anatomic hip center.