Application of proximal femoral shaft splitting at sagittal view in total hip arthroplasty / 中华创伤杂志

ABSTRACT

ObjectiveTo summarize the clinical result of the proximal femoral shaft splitting at sagittal view in primary total hip arthroplasty (THA) in treatment of ultimate hip disease combined with femoral metaphyseal stenosis deformity.MethodsA retrospective study was done on 18 patients with proximal femoral deformity (22 hips including 14 patients with unilateral hips and 4 with bilateral hips)treated from January 2000 to December 2009.There were three males and 15 females, at age range of 41-75 years (average 54 years).According to Berry classification system, all patients were indentified as metaphyseal segment abnormality and deformity, including developmental type disease (congenital hip dysplasia) in 17 patients and old tuberculosis of the hip in one.The congenital hip dysplasia was diagnosed as type Ⅳ by using the Crowe classification system.All the patients were treated with the proximal femoral shaft splitting, subtrochanteric shortening with overlapping femoral resection and V-shaped derotational osteotomy.In the meantime, standard biological fixation of the femoral stem prosthesis was performed.ResultsThere found no dislocation, infection, lower extremity nerve stretch injury or uncontrolled proximal femur fractures.X-ray showed that all acetabular cups were placed at the anatomical position and that the initial femoral stem prosthesis fixation was rated as good.All osteotomy areas were healed within 3-6 months.Limb length discrepancy was restored to average 3 cm after surgery.The patients were followed up for 1-10 years (average six years), which showed that the average Harris hip score was improved from preoperative 30 to postoperative 93, with no aseptic loosening or osteolysis or radiolucent line around the femoral component, no prosthesis sinking or varus displacement, or no patients needing revision of the femoral component.ConclusionsThe proximal femoral shaft splitting at sagittal view and standard biological fixation of the femoral stem prosthesis can attain satisfactory result for patients with ultimate hip disease combined with femoral metaphyseal stenosis deformity.