Abstract: Background: The subtrochanteric femoral shortening osteotomy (SFO) is a complex surgical procedure. The aim of this study was to describe the novel controlled femoral impaction technique as a safe reduction method to avoid SFO during total hip arthroplasty (THA) and present its results in high dislocated hip patients who undergo THA.
Materials and Method: This retrospective study included 40 Crowe developmental dysplasia of the hip (DDH) type III/IV patients for whom SFO was not planned in preoperative templating. Patients who were expected to have >4cm lengthening according to the preoperative templating are excluded. Patients were evaluated in respect of functional results with Harris Hip Score (HHS), limb length discrepancy (LLD) and complications. Of the 40 DDH patients who underwent THA without femoral shortening, controlled femoral cracking was performed in 20 cases while no additional procedure was required in 20 cases.
Results: There were 3 male and 37 female patients with a mean age of 53.7±9.54 years. The mean follow-up period was 38±6.54 months (range, 24-66 months). The mean Harris Hip Score (HHS) was 45.96 (range, 38-72) preoperatively and 89.44±6.4 (range, 84-99) postoperatively. LLD was 3.4±0.7 (range, 0-4 cm) cm preoperatively and 0.7±0.5 cm (range, 0-2 cm) postoperatively (p<0.05). There was no significant difference in latest postoperative mean HSS in patients who underwent controlled femoral impaction (88.2±6.3) or not (90.3±6.5) (p=0.740). There was no increase in complications with controlled femoral impaction.
Conclusion: Controlled femoral impaction seems to be a safe technique during THA for DDH patients where more than 4 cm of lengthening is not expected preoperatively. SFO could be avoided with controlled femoral impaction technique without increasing LLD or nerve palsy rate.
