Subtrochanteric Osteotomy in Direct Anterior Approach Total Hip Arthroplasty for Crowe IV Dysplasia—Surgical Technique and Literature Review
For Crowe IV dysplasia, the clinical efficacy and surgical technique of subtrochanteric osteotomy (SO) within the direct anterior approach total hip arthroplasty (DAA‐THA) was a subject of debate. This study aimed to describe the surgical technique and clinical outcomes in 11 cases of SO in DAA‐THA...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-03-01
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| Series: | Orthopaedic Surgery |
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| Online Access: | https://doi.org/10.1111/os.13996 |
| _version_ | 1797266491878408192 |
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| author | Zhiming Lu Qinghuang Chen Yiping Lan Shiwei Xie Feitai Lin Eryou Feng |
| author_facet | Zhiming Lu Qinghuang Chen Yiping Lan Shiwei Xie Feitai Lin Eryou Feng |
| author_sort | Zhiming Lu |
| collection | DOAJ |
| description | For Crowe IV dysplasia, the clinical efficacy and surgical technique of subtrochanteric osteotomy (SO) within the direct anterior approach total hip arthroplasty (DAA‐THA) was a subject of debate. This study aimed to describe the surgical technique and clinical outcomes in 11 cases of SO in DAA‐THA and to summarize the relevant literature on this topic. Between June 2016 and June 2023, we retrospectively evaluated patients diagnosed with Crowe IV hip dysplasia at our institution. Criteria identified 11 patients who underwent SO during DAA‐THA. Comprehensive data encompassing demographic information, radiological data, prosthetic implant type, and surgical intricacies were collected. In addition, an exhaustive review of existing case series literature was undertaken utilizing the PubMed databases. There were no revisions, deaths, dislocations, or infections. One hip (9.09%) had an intraoperative proximal split fracture, two hips (18.2%) had lower limb deep vein thrombosis, and one hip (9.09%) had symptoms of femoral nerve injury. Radiological data showed improved bilateral femoral offset, leg length discrepancy, and anatomical acetabular. During the mean follow‐up of 2.18(1.06‐2.46) years, patients demonstrated enhanced functional outcomes, with average changes of 25.2 in the Harris hip score and 47 in the WOMAC score. Reviewing the literature, most studies have favored S‐ROM prostheses and transverse osteotomy techniques. Intraoperative fractures were notably frequent, with rates peaking at 25%. Nonunion and nerve injury were secondary common complications. SO via DAA‐THA may offer satisfactory clinical and radiographic outcomes, but the literature review underscores the need for heightened awareness of intraoperative fracture risk. Proximal detachment of the vastus intermedius plays a pivotal role in SO exposure through the DAA. |
| first_indexed | 2024-04-25T01:01:33Z |
| format | Article |
| id | doaj.art-5a8ce2ca879e4ffd921e19c168dff1df |
| institution | Directory Open Access Journal |
| issn | 1757-7853 1757-7861 |
| language | English |
| last_indexed | 2024-04-25T01:01:33Z |
| publishDate | 2024-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Orthopaedic Surgery |
| spelling | doaj.art-5a8ce2ca879e4ffd921e19c168dff1df2024-03-11T02:14:06ZengWileyOrthopaedic Surgery1757-78531757-78612024-03-0116376677410.1111/os.13996Subtrochanteric Osteotomy in Direct Anterior Approach Total Hip Arthroplasty for Crowe IV Dysplasia—Surgical Technique and Literature ReviewZhiming Lu0Qinghuang Chen1Yiping Lan2Shiwei Xie3Feitai Lin4Eryou Feng5Department of Arthrosis Surgery Fujian Medical University Union Hospital Fuzhou ChinaDepartment of Orthopedic Anxi County Hospital Quanzhou ChinaFuzhou Second Hospital Fuzhou ChinaFuzhou Second Hospital Fuzhou ChinaFuzhou Second Hospital Fuzhou ChinaDepartment of Arthrosis Surgery Fujian Medical University Union Hospital Fuzhou ChinaFor Crowe IV dysplasia, the clinical efficacy and surgical technique of subtrochanteric osteotomy (SO) within the direct anterior approach total hip arthroplasty (DAA‐THA) was a subject of debate. This study aimed to describe the surgical technique and clinical outcomes in 11 cases of SO in DAA‐THA and to summarize the relevant literature on this topic. Between June 2016 and June 2023, we retrospectively evaluated patients diagnosed with Crowe IV hip dysplasia at our institution. Criteria identified 11 patients who underwent SO during DAA‐THA. Comprehensive data encompassing demographic information, radiological data, prosthetic implant type, and surgical intricacies were collected. In addition, an exhaustive review of existing case series literature was undertaken utilizing the PubMed databases. There were no revisions, deaths, dislocations, or infections. One hip (9.09%) had an intraoperative proximal split fracture, two hips (18.2%) had lower limb deep vein thrombosis, and one hip (9.09%) had symptoms of femoral nerve injury. Radiological data showed improved bilateral femoral offset, leg length discrepancy, and anatomical acetabular. During the mean follow‐up of 2.18(1.06‐2.46) years, patients demonstrated enhanced functional outcomes, with average changes of 25.2 in the Harris hip score and 47 in the WOMAC score. Reviewing the literature, most studies have favored S‐ROM prostheses and transverse osteotomy techniques. Intraoperative fractures were notably frequent, with rates peaking at 25%. Nonunion and nerve injury were secondary common complications. SO via DAA‐THA may offer satisfactory clinical and radiographic outcomes, but the literature review underscores the need for heightened awareness of intraoperative fracture risk. Proximal detachment of the vastus intermedius plays a pivotal role in SO exposure through the DAA.https://doi.org/10.1111/os.13996Crowe IV hip dysplasiaDirect anterior approachLiterature reviewSubtrochanteric osteotomyTotal hip arthroplasty |
| spellingShingle | Zhiming Lu Qinghuang Chen Yiping Lan Shiwei Xie Feitai Lin Eryou Feng Subtrochanteric Osteotomy in Direct Anterior Approach Total Hip Arthroplasty for Crowe IV Dysplasia—Surgical Technique and Literature Review Orthopaedic Surgery Crowe IV hip dysplasia Direct anterior approach Literature review Subtrochanteric osteotomy Total hip arthroplasty |
| title | Subtrochanteric Osteotomy in Direct Anterior Approach Total Hip Arthroplasty for Crowe IV Dysplasia—Surgical Technique and Literature Review |
| title_full | Subtrochanteric Osteotomy in Direct Anterior Approach Total Hip Arthroplasty for Crowe IV Dysplasia—Surgical Technique and Literature Review |
| title_fullStr | Subtrochanteric Osteotomy in Direct Anterior Approach Total Hip Arthroplasty for Crowe IV Dysplasia—Surgical Technique and Literature Review |
| title_full_unstemmed | Subtrochanteric Osteotomy in Direct Anterior Approach Total Hip Arthroplasty for Crowe IV Dysplasia—Surgical Technique and Literature Review |
| title_short | Subtrochanteric Osteotomy in Direct Anterior Approach Total Hip Arthroplasty for Crowe IV Dysplasia—Surgical Technique and Literature Review |
| title_sort | subtrochanteric osteotomy in direct anterior approach total hip arthroplasty for crowe iv dysplasia surgical technique and literature review |
| topic | Crowe IV hip dysplasia Direct anterior approach Literature review Subtrochanteric osteotomy Total hip arthroplasty |
| url | https://doi.org/10.1111/os.13996 |
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