An oblique osteotomy is better for subtrochanteric shortening in total hip arthroplasty for high hip dislocation: a mechanical comparison of four techniques

Abstract

Background:

Subtrochanteric femoral shortening is used during total hip arthroplasty for high hip dislocation in developmental dysplasia of hip patients.

Methods:

We mechanically tested the stability of various commonly used subtrochanteric osteotomy techniques. As the equivalent of a femoral stem placed in a shortened femur without any stable fixation at the osteotomy line, 2 polyvinylchloride pipes were loosely intertwined. 4 different osteotomies (Z-subtrochanteric osteotomy, oblique-45° osteotomy, double Chevron-90° and 120° subtrochanteric osteotomy) were simulated. Torsional and axial loads were applied, and torsional stiffness was calculated for each test model.

Results:

Z, double Chevron-90° and 120° subtrochanteric osteotomy models demonstrated lower mean torsional stiffness than oblique-45° osteotomy. With the highest torsional stiffness oblique-45° provides the best stability for treatment of high dislocation hips when a subtrochanteric osteotomy is added.

Conclusions:

This matches our previous clinical experience. Oblique osteotomy may also provide higher contact surfaces in the osteotomy lines to promote bone healing.

Keywords

Arthroplasty biomechanics high hip dislocation osteotomy

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References

Kiliçoğlu

Türker

Akgül

, et al. Cementless total hip arthroplasty with modified oblique femoral shortening osteotomy in Crowe type IV congenital hip dislocation. J Arthroplasty 2013; 28: 117–125.

Sanchez-Sotelo

Berry

Trousdale

, et al. Surgical treatment of developmental dysplasia of the hip in adults: II. Arthroplasty options. J Am Acad Orthop Surg 2002; 10: 334–344.

Togrul

Ozkan

Kalaci

, et al. A new technique of subtrochanteric shortening in total hip replacement for Crowe type 3 to 4 dysplasia of the hip. J Arthroplasty 2010; 25: 465–470.

Paavilainen

Hoikka

Solonen

. Cementless total replacement for severely dysplastic or dislocated hips. J Bone Joint Surg Br 1990; 72: 205–211.

Cascio

Thomas

Wilson

. A mechanical comparison and review of transverse, step-cut, and sigmoid osteotomies. Clin Orthop Relat Res 2003; 411: 296–304.

Sener

Tözün

Aşik

. Femoral shortening and cementless arthroplasty in high congenital dislocation of the hip. J Arthroplasty 2002; 17: 41–48.

Huo

Zatorski

Keggi

. Oblique femoral osteotomy in cementless hip arthroplasty. Prospective consecutive series with a 3-year minimum follow-up period. J Arthroplasty 1995; 10: 319–327.

Hotokebuchi

Sonohata

Shigematsu

. A new device for a V-shaped subtrochanteric osteotomy combined with total hip arthroplasty. J Arthroplasty 2006; 21: 135–137.

Muratli

Karatosun

Uzun

, et al. Subtrochanteric shortening in total hip arthroplasty: biomechanical comparison of four techniques. J Arthroplasty 2014; 29: 836–842.

10.

Decking

Puhl

Simon

, et al. Changes in strain distribution of loaded proximal femora caused by different types of cementless femoral stems. Clin Biomech (Bristol, Avon) 2006; 21: 495–501.

11.

Tokgozoglu

Caglar

. Total hip replacement in high riding developmental dysplasia of the hip: cementless total hip arthroplasty with femoral shortening using subtrochanteric resection. Hip Int 2007; 17(Suppl. 5): S111–S118.

12.

Atlihan

Bozkurt

. Total hip arthroplasty in neglected congenital high dislocation of the hip. A comparison of four different surgical techniques. Hip Int 2002; 12: 308–313.

13.

Heidemann

Gerlach

Gröbel

, et al. Influence of different pilot hole sizes on torque measurements and pullout analysis of osteosynthesis screws. J Craniomaxillofac Surg 1998; 26: 50–55.

14.

Heidemann

Gerlach

Gröbel

, et al. Drill free screws: a new form of osteosynthesis screw. J Craniomax-illofac Surg 1998; 26: 163–168.

15.

Orbay

Frankel

Kummer

. The effect of wire configuration on the stability of the Ilizarov external fixator. Clin Orthop Relat Res 1992; 279: 299–302.

16.

Sarpel

Gulsen

Togrul

, et al. Comparison of mechanical performance among different frame configurations of the Ilizarov external fixator: experimental study. J Trauma 2005; 58: 546–552.

17.

Schmid

Dim

. [Measurements for power transmission with bone screws]. Dtsch Zahnfirztl Z 1980; 35: 28–31.

18.

Götze

Winkelmann

Gosheger

, et al. [Is there a need of an additional extramedul ary fixation in transverse subtrochanteric shortening in primary total hip arthroplasty for patients with severe hip dysplasia? Short-term experience in seven patients with congenital dislocation]. Z Orthop Unfall 2007; 145: 568–573.

19.

Markel

Wood

Bogdanske

, et al. Comparison of al ograft/endoprosthetic composites with a step-cut or transverse osteotomy configuration. J Orthop Res 1995; 13: 639–641.

20.

Markel

Gottsauner-Wolf

Rock

, et al. Mechanical characteristics or proximal femoral reconstruction after 50% resection. J Orthop Res 1993; 10: 339–349.

21.

Aro

Chao

. Bone-healing patterns affected by loading, fracture fragment stability, fracture type, and fracture site compression. Clin Orthop Relat Res 1993; 293: 8–17.

22.

Park

O’Connor

McKellop

, et al. The influence of active shear or compressive motion on fracture healing. J Bone Joint Surg Am 1998; 80: 868–878.