Total Hip Arthroplasty With Subtrochanteric Shortening Osteotomy in Patients With High Hip Dislocation Secondary to Childhood Septic Arthritis: A Matched Comparative Study With Crowe IV Developmental Dysplasia |
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| Institution: | 1. Department of Orthopedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan;2. Department of Orthopedic Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;1. Department of Rheumatology, Japanese Red Cross Tottori Hospital, Tottori, Japan;2. Department of Orthopedic Surgery, Japanese Red Cross Tottori Hospital, Tottori, Japan;3. Department of Rehabilitation, Japanese Red Cross Tottori Hospital, Tottori, Japan;1. Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea;2. Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, Busan, South Korea;1. Chapel Hill Orthopedics Surgery & Sports Medicine, Chapel Hill, NC;2. Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medical Center, Chicago, IL;1. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom;2. MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, United Kingdom;3. Musculoskeletal Research Unit, University of Bristol School of Clinical Sciences, Bristol, United Kingdom;4. Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), Chapel Allerton Hospital, Leeds, United Kingdom |
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| Abstract: | BackgroundTotal hip arthroplasty (THA) with subtrochanteric shortening osteotomy (SSO) is performed to manage hips with high dislocations. We compared outcomes of THA with SSO in patients with high hip dislocation resulting from childhood septic arthritis and Crowe IV developmental dysplasia of the hip (DDH).MethodsWe reviewed 60 THAs with SSO performed between May 1996 and December 2013. Thirty-one cases were classified as sequelae of childhood infection and 29 as DDH. Twenty-five hips were selected for each group after the propensity score was matched with preoperative demographics and leg length discrepancy (LLD). Clinical scores, complication and reoperation rates, radiographic results, and survivorships were compared. The mean duration of follow-up was 12.3 (range 5-22) years.ResultsThe average correction in LLD was 2.5 cm for childhood infection and 3.6 cm for DDH (P = .002). The infection group received more transfusions (mean 3.3 vs 2.0 units, P = .002), required more time for union of osteotomy site (mean 6.8 vs 5.2 months, P = .042), and reported lower Harris Hip Score (mean 85.1 vs 91.3, P = .017). Reoperations were performed in 11 (44%) previously infected hips and 3 (12%) DDHs (P = .012). Kaplan-Meier survivorship with an endpoint of revision for any reason was lower in the infection group (83.6%) than in the DDH group (100%) at 10 years (log rank, P = .040).ConclusionTHA with SSO in high hip dislocation secondary to childhood septic arthritis demonstrated less favorable clinical outcomes with increased risks of complication, compared with those performed in Crowe IV DDH with similar degree of chronic dislocation. |
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| Keywords: | total hip arthroplasty subtrochanteric shortening osteotomy high dislocation childhood septic arthritis Crowe IV developmental dysplasia |
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