Leg Length Change in Total Hip Arthroplasty With Subtrochanteric Femoral Shortening Osteotomy for Crowe Type IV Developmental Hip Dysplasia

Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
The Journal of arthroplasty (Impact Factor: 2.67). 04/2012; 27(6):1019-22. DOI: 10.1016/j.arth.2012.01.032
Source: PubMed


Primary total hip arthroplasties were performed in 70 hips for the treatment of Crowe type IV developmental dysplasia of the hip. The patients were subdivided into 2 groups with or without iliofemoral osteoarthritis. Leg length change was measured radiographically. Preoperative hip motion was reviewed from medical records and defined as either higher or lower motion groups. The leg length change in patients without iliofemoral osteoarthritis was significantly greater than that in patients with iliofemoral osteoarthritis, and the higher hip motion group had greater leg length change in total hip arthroplasty than the lower motion group. The current study identifies several features that might help predict leg length change during the preoperative planning of total hip arthroplasty for Crowe type IV developmental hip dysplasia.

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    • "Therefore, how much the gluteus medius muscle could be released and lengthened needs to be further evaluated. The contracture extent of soft tissue around the hip was thought to be an important factor for limb elongation length [31] in patients with DDH. "
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    ABSTRACT: The gluteus medius muscle is essential for gait and hip stability. Changes that occur in the gluteus medius muscles in patients with developmental dysplasia of the hip (DDH) are not well understood. A better understanding of DDH related changes will have positive repercussions toward hip soft tissue reconstruction. 19 adult patients with unilateral DDH scheduled for total hip arthroplasty were assessed for: cross-sectional area (CSA), radiological density (RD) and the length of gluteus medius using computed tomograhpy(CT) (scanned before THA). Hip abductor moment arm and gluteus medius activation angle were also measured via hip anteroposterior radiographs. Both CSA and RD of gluteus medius muscle were significantly reduced (p < 0.05) in the affected hip compared to the control. In the affected hip, the length of the gluteus medius muscle was reduced by 8-11% (p < 0.05) while the gluteus medius activation angle was significantly increased (p < 0.05) and the hip abductor moment arm was decreased (p < 0.05). The gluteus medius showed substantial loss of CSA, RD as well as decreased length in patients with DDH in the affected hip. These changes should be considered in both hip reconstruction and postoperative rehabilitation training in patients with DDH.
    BMC Musculoskeletal Disorders 06/2012; 13(13):101. DOI:10.1186/1471-2474-13-101 · 1.72 Impact Factor
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    ABSTRACT: Purpose: The study was designed to evaluate the efficacy and safety of lesser trochanteric osteotomy for femoral shortening in total hip arthroplasty in treatment of 28 cases of CROWE IV developmental dysplasia of the hip (DDH). Methods: Patients underwent progressive femoral shortening at the level of lesser trochanteric to make reduction possible into the anatomical acetabulum in all hips. The results were collected and evaluated clinically and radiographically. Results: The mean follow-up period was 55.3 months. The average postoperative leg length discrepancy was eight millimetres for unilateral THA patients. A modified Merle d'Aubigné scale was improved from 9.3 preoperatively to 15.9 postoperatively. Sciatic nerve palsy was confirmed in two hips which resolved completely in six months. The Trendelenburg sign was positive in two hips at the final follow-up. No revision surgery was required by the final follow-up. Conclusion: Lesser trochanteric osteotomy proved to be safe and effective in femoral shortening for treatment of CROWE IV DDH without the problem of nonunion at the site of osteotomy.
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    ABSTRACT: Hip range of motion (ROM) may be an important preoperative variable, however, measurement of hip ROM can be affected by various factors. The purposes of this study were to compare conventional preoperative ROM measurements with those measurements obtained under general anaesthesia, and to better define the associations between preoperative hip ROM, and demographic, functional, and diagnostic variables. Conventional preoperative hip ROM and ROM under general anaesthesia were prospectively measured in 471 hips. Harris pain score, the Crowe classification, and the diagnosis were also investigated. The hip ROM in all directions under general anaesthesia was significantly greater than conventional preoperative hip ROM. There were correlations between conventional preoperative hip ROM and the Harris hip pain score. Hip ROM with Crowe type I deformity under anaesthesia was significantly greater than in hips with type II, III or IV. ROM under anaesthesia of osteonecrosis hips was significantly greater than osteoarthritis and dislocated hips. Conventional preoperative ROM in men was greater in flexion and external rotation compared to women. Internal rotation motion in women in both conventional preoperative ROM and ROM under anaesthesia was greater than in men. Hip pain, Crowe classification and diagnosis could influence preoperative hip ROM. Measurement of hip ROM under general anaesthesia could better reflect true ROM compared to measurement without anaesthesia.
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