Subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty for Crowe type IV adult dislocation of the hip

Objective: To summarize the surgical technique and clinical outcomes of subtrochanteric shortening with overlapping femoral resection in primary total hip arthroplasty (THA) for Crowe type IV adult dislocation of the hip (ADH).

Methods: From January 2000 to December 2005, 12 patients with ADH (15 hips) were treated with primary cementless hip arthroplasty using the method of subtrochanteric shortening with overlapping femoral resection. There were three male and nine female patients (nine unilateral and three bilateral hips) with an average age of 56 years (range, 41-75). Subtrochanteric shortening with overlapping femoral resection and 'V' shaped derotational osteotomy were performed in all cases without soft tissue cutting release. Proximal femoral shaft splitting was performed as an adjunct in 10 hips.

Results: The mean follow-up time was 6 years (range, 3-8). There were no infections, nonunion, malunion, dislocation or nerve injury of traction. Postoperative X-ray films showed that the acetabular cups were placed in anatomical position with 95% coverage of the acetabulum. Furthermore, initial stability of the femoral stem fixation was satisfactory and all osteotomies healed in 10-15 weeks. The Harris hip score had improved from 25-32 to 88-98 at one year after surgery (P < 0.01). All acetabular and femoral components were judged to be osteointegrated and well-fixed during follow-up. No components have needed revision.

Conclusions: Subtrochanteric shortening osteotomy is a safe and predictable method for restoring the anatomic hip center in Crowe type IV ADH. The clinical outcomes of treating Crowe type IV ADH with THA were satisfactory.