Artroplastia de cadera con osteotomía de acortamiento femoral en cadera displásica Crowe IV. [Hip arthroplasty with femoral shortening osteotomy in dysplastic hip Crowe IV.]

Objective The reconstruction of the anatomic center of rotation (COR) is one of the main purposes in Crowe grade IV developmental dysplasia of the hip (DDH). Among the alternatives to achieve this reconstruction has emerged subtrochanteric shortening osteotomy (SSO). The aim of this paper is to analyze the clinical and radiological results as the complications obtained with this surgical technique. Material Ten cases were evaluated in 8 patients with grade IV DHD who were performed SSO. All were female, 6 of them were unilateral and 2 bilateral. The average age was 42.2 years (range 36-55). Preoperative lower limb discrepancy was in average of 41 mm. All patients were operated through a posterolateral approach. In 7 cases uncemented stems were implanted with modular metaphyseal fixation (S-ROM) and in 3 cases we implanted polished cemented stems (2 Exeter and one C-Stem). Results At an average follow-up of 38 months (range 12-63 months), all the cases showed radiological healed osteotomies. The postoperative COR was lowered an average of 42 mm (range 35-52 mm). Postoperative limb discrepancy was 6 mm (range 3-12 mm). Complications were: one aseptic femoral loosening, one subluxation due to excessive femoral anteversion, one dislocation, one acute infection and one acute femoral neuropraxia. Conclusion In these series of patients with Crowe IV dysplastic hips, the SSO technique was associated with a high rate of consolidation, correction of the COR limb lenght compensation.