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The Effect of Graft Positions on the Stability of Total Hip Arthroplasty with Different Types of Subtrochanteric Shortening[*]Article in several languages: português | English
29 September 2018
06 November 2018
20 August 2019 (online)
Objective The aim of the present study is to investigate the biomechanical stability of different subtrochanteric osteotomy types and graft positions in cases of dysplastic coxarthrosis that require total hip arthroplasty with shortening osteotomy, as well as to find out the most effective osteotomy type and graft position.
Method Femur sawbones were used to compare different types of femoral shortening osteotomy (transverse, oblique, and step-cut). Strut grafts, which were prepared at the side of the subtrochanteric shortening osteotomy, were fixed in different positions (anterolateral, mediolateral, and anteroposterior). The fixation of the strut grafts was performed using two steel cables (with 2.0 mm of thickness) with the same strength. The failure values of composite femurs were recorded for axial and rotational loadings.
Results Biomechanically, there were no statistically significant differences between the types of femoral subtrochanteric shortening osteotomy and the positions of the applied strut graft.
Conclusion No superiority was observed between the types of femoral subtrochanteric shortening osteotomy regarding stability. Additionally, against stress, similar results were obtained for different strut graft positions. In conclusion, we believe that using the method in which the surgeon is experienced and that is the easiest to apply would be the best choice.
Keywordsosteotomy - bone transplantation - coxarthrosis - arthroplasty, replacement, hip - hip dislocation
* Study conducted at the Department of Orthopedic Surgery, Fatih Sultan Mehmet Training and Research Hospital, Omer Halis Demir University Hospital, Nigde, Turkey.
- 1 Ganey TM, Ogden JA. Pre and postnatal development of the hip. In: Callaghan JJ, Rosenberg AG, Rubash HE. , editores. The adult hip. 2. ed. Filadélfia: Lippincott Williams & Wilkins; 2007: 35
- 2 Barrack RL, Newland CC. Uncemented total hip arthroplasty with superior acetabular deficiency. Femoral head autograft technique and early clinical results. J Arthroplasty 1990; 5 (02) 159-167
- 3 Steel HH. Triple osteotomy of the innominate bone. J Bone Joint Surg Am 1973; 55 (02) 343-350
- 4 Wedge JH, Wasylenko MJ. The natural history of congenital disease of the hip. J Bone Joint Surg Br 1979; 61-B (03) 334-338
- 5 Trousdale RT, Cabanela ME. Lessons learned after more than 250 periacetabular osteotomies. Acta Orthop Scand 2003; 74 (02) 119-126
- 6 Charnley J. Anchorage of the femoral head prosthesis to the shaft of the femur. J Bone Joint Surg Br 1960; 42-B: 28-30
- 7 Bobyn JD, Pilliar RM, Cameron HU, Macnab I. Porous surfaced layered prosthetic devices. J Biomed Eng 1975; 10 (04) 126-131
- 8 Bonfiglio M, Voke EM. Aseptic necrosis of the femoral head and nonunion of the femoral neck. J Bone Joint Surg Am 1968; 50 (01) 48-66
- 9 Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am 1979; 61 (01) 15-23
- 10 Doğan A, Zorer G, Ozer UE. [Treatment of acetabular dysplasia by triple pelvic osteotomy and its short-term results]. Acta Orthop Traumatol Turc 2007; 41 (05) 355-366
- 11 Tönnis D, Arning A, Bloch M, Heinecke A, Kalchschmidt K. Triple pelvic osteotomy. J Pediatr Orthop B 1994; 3: 54-67
- 12 Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res 1988; (232) 26-36
- 13 Akman Ş, Şen C, Şener N, Tözün R. Doğuştan kalça çıkığı ve displazisinde total kalça artroplastisi. Acta Orthop Traumatol Turc 2000; 34: 176-182
- 14 Muratli KS, Karatosun V, Uzun B, Celik S. Subtrochanteric shortening in total hip arthroplasty: biomechanical comparison of four techniques. J Arthroplasty 2014; 29 (04) 836-842
- 15 Charnley J, Feagin JA. Low-friction arthroplasty in congenital subluxation of the hip. Clin Orthop Relat Res 1973; (91) 98-113
- 16 Harris WH. Total hip arthroplasty in the management of the congenital hip dislocation. In: Callaghan JJ, Rosenberg AG, Rubash HE. , editores. The adult hip. Filadélfia: Lippincott-Rawen; 1988: 1651-1682
- 17 Chougle A, Hemmady MV, Hodgkinson JP. Long-term survival of the acetabular component after total hip arthroplasty with cement in patients with developmental dysplasia of the hip. J Bone Joint Surg Am 2006; 88 (01) 71-79
- 18 Kiliçoğlu OI, Türker M, Akgül T, Yazicioğlu O. Cementless total hip arthroplasty with modified oblique femoral shortening osteotomy in Crowe type IV congenital hip dislocation. J Arthroplasty 2013; 28 (01) 117-125
- 19 Symeonides PP, Pournaras J, Petsatodes G, Christoforides J, Hatzokos I, Pantazis E. Total hip arthroplasty in neglected congenital dislocation of the hip. Clin Orthop Relat Res 1997; (341) 55-61
- 20 Dunn HK, Hess WE. Total hip reconstruction in chronically dislocated hips. J Bone Joint Surg Am 1976; 58 (06) 838-845
- 21 Paavilainen T, Hoikka V, Solonen KA. Cementless total replacement for severely dysplastic or dislocated hips. J Bone Joint Surg Br 1990; 72 (02) 205-211
- 22 Paavilainen T, Hoikka V, Paavolainen P. Cementless total hip arthroplasty for congenitally dislocated or dysplastic hips. Technique for replacement with a straight femoral component. Clin Orthop Relat Res 1993; (297) 71-81
- 23 Togrul E, Ozkan C, Kalaci A, Gülşen M. A new technique of subtrochanteric shortening in total hip replacement for Crowe type 3 to 4 dysplasia of the hip. J Arthroplasty 2010; 25 (03) 465-470
- 24 Reikeraas O, Lereim P, Gabor I, Gunderson R, Bjerkreim I. Femoral shortening in total arthroplasty for completely dislocated hips: 3-7 year results in 25 cases. Acta Orthop Scand 1996; 67 (01) 33-36
- 25 Davy DT, Kotzar GM, Brown RH. , et al. Telemetric force measurements across the hip after total arthroplasty. J Bone Joint Surg Am 1988; 70 (01) 45-50
- 26 Lim LA, Carmichael SW, Cabanela ME. Biomechanics of total hip arthroplasty. Anat Rec 1999; 257 (03) 110-116
- 27 Bruce WJ, Rizkallah SM, Kwon YM, Goldberg JA, Walsh WR. A new technique of subtrochanteric shortening in total hip arthroplasty: surgical technique and results of 9 cases. J Arthroplasty 2000; 15 (05) 617-626
- 28 Sun JY, Wei L. Subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty for Crowe type IV adult dislocation of the hip. Orthop Surg 2009; 1 (03) 207-211
- 29 Bernasek TL, Haidukewych GJ, Gustke KA, Hill O, Levering M. Total hip arthroplasty requiring subtrochanteric osteotomy for developmental hip dysplasia: 5- to 14-year results. J Arthroplasty 2007; 22 (06) (Suppl. 02) 145-150
- 30 Götze C, Winkelmann W, Gosheger G, Rödl R. [Is there a need of an additional extramedullary fixation in transverse subtrochanteric shortening in primary total hip arthroplasty for patients with severe hip dysplasia? Short-term experience in seven patients with congenital dislocation]. Z Orthop Unfall 2007; 145 (05) 568-573