A new technique of subtrochanteric shortening in total hip arthroplasty - Surgical technique and results of 9 cases

Total hip arthroplasty for severe chronic proximal femoral migration, most commonly seen in congenital dislocation of the hip, has been associated wit h high rates of complications. A new technique of femoral subtrochanteric s hortening osteotomy with the prosthesis in situ is described. This techniqu e minimizes the potential complications, allows for correction of severe fe moral neck anteversion, and gives excellent rotational stability, while pre serving the proximal femur for better press-fit cementless fixation. In thi s series, there were 9 cases: 6 women and 2 men with a mean age of 53 years (range, 26-77 years). The average follow-up period was 56 months (range, 6 -86 months). The mean preoperative Harris Hip Score was 31 (range, 20-35), and the mean postoperative score was 81 (range, 60-98). At follow-up, all p atients reported significant pain relief and functional improvement. All os teotomies appeared to be healed on radiographs by 12 weeks. There were 3 co mplications. The first complication was a recurrent dislocation resulting f rom muscle incompetence, which was revised using a constrained liner and a 32-mm head with no further dislocations. The second complication was a brea ch of the femoral shaft, which was treated operatively using a longer stem. The third complication was a proximal femoral shaft split, which was treat ed by leaving the cerclage wire in situ. This technique should be considere d in cases of congenital dislocation of the hip and when femoral shortening is needed.