Subtrochanteric Shortening and Derotational Osteotomy in Primary Total Hip Arthroplasty for Patients with Severe Hip Dysplasia: 5-year Follow-up

Twenty-one primary hip arthroplasties were performed in Crowe grade 3 or 4 hip dysplasia using a subtrochanteric shortening osteotomy. Average patient age was 48.2 years. Average follow-up was 5.8 years (minimum, 2 years). Femoral fixation was cemented in 10 hips and uncemented in 11 hips. All acetabular components were uncemented, with 33% requiring structural autograft. Ninety-one percent of femoral osteotomies healed without complication. Two osteotomy nonunions required revision. Two acetabular revisions were performed for malposition and polyethylene failure. Three patients experienced postoperative dislocation. One cemented femoral component was revised for loosening. However, no neurologic deficiencies were identified. Harris hip score improved from 32.5 to 73.6. Limp improved in 60% of patients and dependence on assistive walking device improved in 40% of patients. Subtrochanteric shortening osteotomy is a safe and predictable method of restoring the anatomic hip center in high developmental hip dislocation. However, the complication rate in these patients is higher than primary hip arthroplasty for osteoarthritis.