CLINGING LESSER TROCHANTER OSTEOTOMY WITH WAGNER CONE IN TREATMENT OF CROWE TYPE IV DEVELOPMENTAL DYSPLASIA OF THE HIP IN ADULT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUOJiang , ZHANGZhongjie , XIABo , ZHANGCaidong , LILun , LUXiaobo , YANGHongbin ,  TANMeiyun

Department of Bone and Joint Surgery, the Affiliated Hospital of Luzhou Medical College, Luzhou Sichuan, 646000, P. R. China;

Corresponding?author：

TANMeiyun, Email: drtmy@126.com

Keywords：

Developmental dysplastia of the hip; Lesser trochanter osteotomy; Wagner cone femoral prosthesis; Total hip arthroplasty; Adult

DOI：

10.7507/1002-1892.20150094

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Objective To investigate the effectivness of the clinging lesser trochanter osteotomy with the Wagner cone in total hip arthroplasty (THA) for Crowe type ⅠV developmental dysplasia of the hip (DDH) in adult. Methods Between November 2009 and September 2012, 7 female patients (9 hips) with Crowe type ⅠV DDH were treated by THA procedures of clinging lesser trochanter osteotomy with Wagner cone, aged 24-62 years (mean, 42 years). All patients experienced severe pain and claudication. The left hip was involved in 2 cases, the right hip in 3 cases, and bilateral hips in 2 cases. The Harris score of involved hip was 50.00±7.04. The both limps were discrepancy with an average length difference of 3.4 cm (range, 3-4 cm). The results of Trendelenburg sign were positive. X-ray films showed high complete dislocation of the involved hips. Results The incisions healed by first intention. There was no complication such as infection, dislocation, prosthesis loosening, neurovascular injury. The average follow-up was 36.4 months (range, 25-48 months). Pain and claudication were improved and all patients could restore to work. The Harris score was improved to 83.42±6.47, showing significant difference when compared with preoperative score (t=8.90, P=0.00). The results of Trendelenburg sign were negative. X-ray films showed that all patients got a bony union at osteotomy site of greater trochanter at 3-6 months after operation. And the interface between prosthesis and bone was stable. There was no prosthesis loosening or sinking during the follow-up. Conclusion Clinging lesser trochanter osteotomy with Wagner cone could be an option to shorten the femur in THA for patients with Crowe type ⅠV DDH. It is effective in decreasing the risk of neurovascular injury.

Citation： GUOJiang, ZHANGZhongjie, XIABo, ZHANGCaidong, LILun, LUXiaobo, YANGHongbin, TANMeiyun. CLINGING LESSER TROCHANTER OSTEOTOMY WITH WAGNER CONE IN TREATMENT OF CROWE TYPE IV DEVELOPMENTAL DYSPLASIA OF THE HIP IN ADULT. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(4): 435-438. doi: 10.7507/1002-1892.20150094 Copy

1.	沈彬, 裴福興, 楊靜, 等. 全髖關節置換術治療成人先天性髖關節脫位. 中華骨科雜志, 2002, 22(4):212-215.
2.	Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg (Am), 1979, 61(1):15-23.
3.	Rosenstein AD, Diaz RJ. Challenges and solutions for total hip arthroplasty in treatment of patients with symptomatic sequelae of developmental dysplasia of the hip. Am J Orthop (Belle Mead NJ), 2011, 40(2):87-91.
4.	Rogers BA, Garbedian S, Kuchinad RA, et al. Total hip arthroplasty for adult hip dysplasia. J Bone Joint Surg, 2012, 94(19):1809-1821.
5.	Takao M, Ohzono K, Nishii T, et al. Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia. J Bone Joint Surg, 2011, 93(6):548-555.
6.	Antoniades J, Pellegrini VD Jr. Cross-sectional anatomy of the illum:implications for acetabular compoment placement in total hip arthroplasty. Clin Orthop Relat Res, 2012, 470(12):3537-3541.
7.	Moskal JK, Capps SG, Scanelli JA. Improving the accuracy of acctabular component orientation:avoiding malpositioning. J Bone Joint Surg (Am), 2013, 95(11):e76.
8.	沈彬, 裴福興, 楊靜. 髖關節發育不良的髖臼重建. 中華外科雜志, 2004, 42(16):1001-1005.
9.	彭陽, 楊柳, 陳光興, 等. CroweⅢ及Ⅳ型髖關節發育不良全髖關節置換術中髖臼骨缺損的重建. 中華外科雜志, 2014, 52(1):25-29.
10.	潘浩, 胡慶豐, 朱杭, 等. 非股骨短縮截骨全髖關節置換術治療Crowe Ⅳ型髖關節發育不良.中醫正骨, 2014, 26(10):778-780.
11.	史振才, 李子榮, 孫偉. 髖關節發育不良患者全髖關節置換術的髖臼中心化.中華外科雜志, 2004, 42(23):1412-1415.
12.	Linde F, Jensen J. Socket loosening in arthroplasty for congenital dislocation of the hip. Acta Orthop Scand, 1988, 59(3):254-257.
13.	Garvin KL, Bowen MK, Salvati EA, et al. long-term results of total hip arthroplasty in congenitial dislocation and dysplasia of the hip. A follow-up note. J Bone Joint Surg (Am), 1991, 73(9):1348-1354.
14.	Kili?o?lu OI, Türker M, Akgul T, et al. Cementless total hip arthroplasty with modified oblique femoral shortening osteotomy in Crowe type ⅠV congenital hip dislocation. J Arthroplasty, 2013, 28(1):117-125.
15.	Sanchez-Sotelo J, Berry DJ, Trousdale RT, et al. Surgical treatment of developmental dysplasia of the hip in adults:Ⅱ. Arthroplasty options. J Am Acad Orthop Surg, 2002, 10(5):334-344.
16.	Sener N, T?zün IR, A?ik M. Femoral shortening and cementless arthroplasty in high congenital dislocation of the hip. J Arthroplasty, 2002, 17(1):41-48.
17.	Li C, Zhang C, Zhang M, et al. Comparison of transverse and modified subtrochanteric femoral shortening osteotomy in total hip arthroplasty for developmental dysplasia of hip:a meta-analysis. BMC Musculoskelet Disord, 2014, 15:331.
18.	Akiyama H, Kawanabe K, Yamamoto K, et al. Cemented total hip arthroplasty with subtrochanteric femoral shortening transverse osteotomy for severely dislocated hips:outcome with a 3- to 10-year follow-up period. J Orthop Sci, 2011, 16(3):270-277.
19.	Reiker?s O, Haaland JE, Lereim P. Femoral shortening in total hip arthroplasty for high developmental dysplasia of the hip. Clin Orthop Relat Res, 2010, 468(7):1949-1955.
20.	楊述華, 許偉華, 葉樹楠, 等. 髖臼重建及股骨轉子下短縮截骨全髖關節置換治療CroweⅣ型髖關節發育不良. 中華骨科雜志, 2013, 33(9):888-894.
21.	Sanchez-Sotelo J, Berry DJ, TrousdaIe RT, et al. SurgicaI treatment of deveIopmental dyspIasia of the hip in aduIts:Ⅱ. ArthropIasty options. J Am Acad Orthop Surg, 2002, 10(5):334-344.
22.	朱振安, 戴尅戎, 王友, 等. 全髖關節置換術治療成人Crowe Ⅳ型先天性髖關節脫位的臨床研究. 中外外科雜志, 2006, 44(20):1403-1406.
23.	史占軍, 金大地, 景宗森, 等. 股骨距切除替代轉子下截骨在成人髖關節發育不良全髖關節置換術中的應用. 中華關節外科雜志(電子版), 2007, 1(2):76-81.
24.	Claramunt RT1, Marqués F, León A, et al. Total hip replacement with an uncemented Wagner cone stem for patients with congenital hip dysplasia. Int Orthop, 2011, 35(12):1767-1770.
25.	Schuh A, Schraml A, Hohenberger G. Long-term results of the Wagner cone prosthesis. Int Orthop, 2009, 33(1):53-58.

1. 沈彬, 裴福興, 楊靜, 等. 全髖關節置換術治療成人先天性髖關節脫位. 中華骨科雜志, 2002, 22(4):212-215.
2. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg (Am), 1979, 61(1):15-23.
3. Rosenstein AD, Diaz RJ. Challenges and solutions for total hip arthroplasty in treatment of patients with symptomatic sequelae of developmental dysplasia of the hip. Am J Orthop (Belle Mead NJ), 2011, 40(2):87-91.
4. Rogers BA, Garbedian S, Kuchinad RA, et al. Total hip arthroplasty for adult hip dysplasia. J Bone Joint Surg, 2012, 94(19):1809-1821.
5. Takao M, Ohzono K, Nishii T, et al. Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia. J Bone Joint Surg, 2011, 93(6):548-555.
6. Antoniades J, Pellegrini VD Jr. Cross-sectional anatomy of the illum:implications for acetabular compoment placement in total hip arthroplasty. Clin Orthop Relat Res, 2012, 470(12):3537-3541.
7. Moskal JK, Capps SG, Scanelli JA. Improving the accuracy of acctabular component orientation:avoiding malpositioning. J Bone Joint Surg (Am), 2013, 95(11):e76.
8. 沈彬, 裴福興, 楊靜. 髖關節發育不良的髖臼重建. 中華外科雜志, 2004, 42(16):1001-1005.
9. 彭陽, 楊柳, 陳光興, 等. CroweⅢ及Ⅳ型髖關節發育不良全髖關節置換術中髖臼骨缺損的重建. 中華外科雜志, 2014, 52(1):25-29.
10. 潘浩, 胡慶豐, 朱杭, 等. 非股骨短縮截骨全髖關節置換術治療Crowe Ⅳ型髖關節發育不良.中醫正骨, 2014, 26(10):778-780.
11. 史振才, 李子榮, 孫偉. 髖關節發育不良患者全髖關節置換術的髖臼中心化.中華外科雜志, 2004, 42(23):1412-1415.
12. Linde F, Jensen J. Socket loosening in arthroplasty for congenital dislocation of the hip. Acta Orthop Scand, 1988, 59(3):254-257.
13. Garvin KL, Bowen MK, Salvati EA, et al. long-term results of total hip arthroplasty in congenitial dislocation and dysplasia of the hip. A follow-up note. J Bone Joint Surg (Am), 1991, 73(9):1348-1354.
14. Kili?o?lu OI, Türker M, Akgul T, et al. Cementless total hip arthroplasty with modified oblique femoral shortening osteotomy in Crowe type ⅠV congenital hip dislocation. J Arthroplasty, 2013, 28(1):117-125.
15. Sanchez-Sotelo J, Berry DJ, Trousdale RT, et al. Surgical treatment of developmental dysplasia of the hip in adults:Ⅱ. Arthroplasty options. J Am Acad Orthop Surg, 2002, 10(5):334-344.
16. Sener N, T?zün IR, A?ik M. Femoral shortening and cementless arthroplasty in high congenital dislocation of the hip. J Arthroplasty, 2002, 17(1):41-48.
17. Li C, Zhang C, Zhang M, et al. Comparison of transverse and modified subtrochanteric femoral shortening osteotomy in total hip arthroplasty for developmental dysplasia of hip:a meta-analysis. BMC Musculoskelet Disord, 2014, 15:331.
18. Akiyama H, Kawanabe K, Yamamoto K, et al. Cemented total hip arthroplasty with subtrochanteric femoral shortening transverse osteotomy for severely dislocated hips:outcome with a 3- to 10-year follow-up period. J Orthop Sci, 2011, 16(3):270-277.
19. Reiker?s O, Haaland JE, Lereim P. Femoral shortening in total hip arthroplasty for high developmental dysplasia of the hip. Clin Orthop Relat Res, 2010, 468(7):1949-1955.
20. 楊述華, 許偉華, 葉樹楠, 等. 髖臼重建及股骨轉子下短縮截骨全髖關節置換治療CroweⅣ型髖關節發育不良. 中華骨科雜志, 2013, 33(9):888-894.
21. Sanchez-Sotelo J, Berry DJ, TrousdaIe RT, et al. SurgicaI treatment of deveIopmental dyspIasia of the hip in aduIts:Ⅱ. ArthropIasty options. J Am Acad Orthop Surg, 2002, 10(5):334-344.
22. 朱振安, 戴尅戎, 王友, 等. 全髖關節置換術治療成人Crowe Ⅳ型先天性髖關節脫位的臨床研究. 中外外科雜志, 2006, 44(20):1403-1406.
23. 史占軍, 金大地, 景宗森, 等. 股骨距切除替代轉子下截骨在成人髖關節發育不良全髖關節置換術中的應用. 中華關節外科雜志(電子版), 2007, 1(2):76-81.
24. Claramunt RT1, Marqués F, León A, et al. Total hip replacement with an uncemented Wagner cone stem for patients with congenital hip dysplasia. Int Orthop, 2011, 35(12):1767-1770.
25. Schuh A, Schraml A, Hohenberger G. Long-term results of the Wagner cone prosthesis. Int Orthop, 2009, 33(1):53-58.

Chinese Journal of Reparative and Reconstructive Surgery

CLINGING LESSER TROCHANTER OSTEOTOMY WITH WAGNER CONE IN TREATMENT OF CROWE TYPE IV DEVELOPMENTAL DYSPLASIA OF THE HIP IN ADULT

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