Total hip arthroplasty with a monoblock conical stem and subtrochanteric transverse shortening osteotomy in Crowe type IV dysplastic hips.

PURPOSE: This series assessed the clinical and radiographic outcomes of total hip arthroplasty (THA) with femoral shortening osteotomy for the management of patients with Crowe type IV hip dysplasia. METHODS: Only patients with Crowe type IV hip dysplasia who underwent primary THA combined with a subtrochanteric transverse osteotomy with an uncemented monoblock conical stem were included. The clinical and radiographic evaluations were performed before and immediately after surgery, and at last follow-up. The hip function was assessed with the Harris Hip Score (HHS). RESULTS: Seventy-four patients (102 hips) with a mean age of 53.9 (range, 20-83) were evaluated at an average follow-up of 11.3 years (range, 5-25). Stem revision occurred in two (1.9%) cases, with a survivorship of 95.9% (95%IC, 91.9-99.9%) at ten years. The average HHS increased from 44 (range, 15-78) pre-operatively to 90.3 (range, 62-100) at last follow-up (p < 0.001). Osteotomy site non-union and early dislocation were observed in 3.9 and 3.8%, respectively. No cases of nerve palsy were reported. CONCLUSIONS: THA with a monoblock conical stem associated with subtrochanteric transverse osteotomy provides good long-term survival, clinical and radiographic results. It may be considered an effective management of patients with Crowe IV hip dysplasia.

Trabecular Metal Augments for the Management of Paprosky Type III Defects Without Pelvic Discontinuity.

Fifty-five hips undergoing acetabular reconstruction with trabecular metal (TM)-coated cup and TM augments were reviewed at an average follow up of 53.7 months (36-91). Bony defects were Paprosky type IIIA in 42 and type IIIB without pelvic discontinuity in 13 hips. The average HHS increased from 40 (27-52) preoperatively to 90.5 (61-100) postoperatively (P<0.0001). Four (7.3%) of 55 hips underwent acetabular components revision: three cases of loosening (5.4%), and one of recurrent instability (1.8%) were reported. Survival rate at 2 and 5 years was 96.4% and 92.8%. In conclusion, the use of TM-coated cups and augments could be considered an effective management of Paprosky type III defects without pelvic discontinuity providing good clinical and radiographic outcomes in the mid term.

Double-trabecular metal cup technique for the management of Paprosky type III defects without pelvic discontinuity.

INTRODUCTION:: Modular reconstruction systems based on trabecular metal (TM) prosthetic components have been increasingly used in the last decade for the management of severe acetabular bone defects. The aim of this study was to assess the clinical and radiographic outcomes of double-cup technique for the management of Paprosky type III defects without pelvic discontinuity. METHODS:: A retrospective review was performed for all patients undergoing acetabular reconstruction with 2 TM cups at a tertiary referral centre between 2010 and 2015. Harris Hip Scores (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and at the latest follow-up. Radiographic assessment of the hip centre of rotation (COR) position and leg length discrepancy (LLD) was performed preoperatively and postoperatively. Osteolysis and radiolucencies, loosening of the implants, and heterotopic ossifications were evaluated with the latest follow-up radiographs. RESULTS:: Patients included 5 men and 11 women (16 hips) with an average age of 68 (45-81) years. Acetabular bone defects included 9 Paprosky type IIIB and 7 type IIIA defects. No pelvic discontinuities were registered. The mean follow-up was 34 (24-72) months. HHS and WOMAC scores, LLD and COR position significantly improved after surgery. In only 1 (6.3%) hip a not progressive radiolucent line adjacent the acetabular construct was noted. Heterotopic ossifications were found in 2 (12.5%) hips. No patients underwent acetabular components revision surgery for any reason. CONCLUSION:: The double-cup technique could be considered an effective management of selected Paprosky type III defects without pelvic discontinuity providing excellent clinical and radiographic outcomes in the short term.

Joint Instability After Anatomic Reconstruction of Severe, Chronic Slipped Capital Femoral Epiphysis: A Report of 3 Cases, with High Femoral Anteversion in 1 and Adaptive Acetabular Roof Deformation in 3.

CASES: Joint instability after slipped capital femoral epiphysis (SCFE) reorientation through the physis has been attributed to a combination of capsulotomy and chondrolabral rim damage. We report on 3 hips with severe SCFE with closed physes, in which anatomic correction with femoral neck osteotomy led to joint instability. All 3 had acetabular roof flattening; 1 showed slight additional acetabular retroversion but also increased femoral anteversion. CONCLUSION: We speculate that the slight roof flattening in all 3 cases and/or the high femoral anteversion in 1 case had contributed to joint instability. Femoral derotation osteotomy was performed in 1 and periacetabular osteotomy was performed in 2 for joint restabilization.