Femoral shortening and cementless arthroplasty in Crowe type 4 congenital dislocation of the hip

Abstract

Purpose In reconstruction of congenital hip dislocation by total hip arthroplasty (THA), positioning of the acetabular component in the true acetabulum is sometimes accompanied by shortening of the femur. Shortening of the femur is of importance for minimising risk of damaging neurovascular structures due to excessive limb lengthening. Furthermore, reduction of the femoral head into the true acetabulum remains challenging without shortening of the femur. Methods We performed a consecutive case series of cementless THA with femoral shortening and Crowe type 4 congenital dislocation. All acetabular cups were placed in their original anatomical location. In all cases a proximal diaphyseal step-cut shortening osteotomy was performed and stabilised with two to three titanium cerclage bands. Results At an average of 60 months follow-up (range 36–96), 12 patients (13 THA) were scored clinically by the Merle D’Aubigne and Harris hip scores. In ten cases good to excellent outcome scores were observed. During the follow-up period no cases of aseptic loosening, nerve palsy, nonunions or dislocations were found. Conclusions This technique seems to be an excellent treatment option in the case of Crowe type 4 hips presenting with endstage osteoarthritis.