[Becker V-shaped lateral rotation osteotomy in total hip arthroplasty for Crowe type IV development dislocation of...

To summarize the surgical technique and the effectiveness of Becker V-shaped lateral rotation osteotomy in total hip arthroplasty (THA) for Crowe type IV development dislocation of the hip (DDH).

Between January 2000 and December 2009, 18 patients (22 hips) with Crowe type IV DDH underwent THA. There were 3 males and 15 females with an average age of 54 years (range, 41-75 years). The unilateral hip was involved in 14 cases and bilateral hips in 4 cases. All patients had over anteversion of the femoral neck, with the acetabular anteversion angle of (21.28 +/- 4.87) degrees, the femoral neck anteversion angle of (59.06 +/- 1.44) degrees, and combined anteversion angle of (80.33 +/- 1.55) degrees. All the patients had limb-length discrepancy, ranged from 1.0 to 3.5 cm (mean, 2.5 cm). Before operation, gluteus medius muscle strength was grade 2 in 17 hips and grade 3 in 5 hips; severe or moderate claudication was observed in 13 and 5 patients, respectively. Trendelenburg sign was positive in all patients. Preoperative Harris score was 30.00 +/- 6.32. Cementless prosthesis was used. Becker V-shaped lateral rotation osteotomy and subtrochanteric shortening with overlapping femoral resection were performed, and proximal femoral shaft splitting was performed on 21 hips having narrow bone marrow cavity.

All the cases achieved primary healing of incision. No complication of anterior dislocation, deep infection, nerve traction injury, or femoral uncontrolled fracture occurred. All the cases were followed up 3-12 years (mean, 8 years). Postoperative X-ray films showed that the initial fixation result of femoral prosthesis was excellent in 18 hips and good in 4 hips. Bone healing of osteotomy stump was obtained at 3-6 months (mean, 5 months) after operation. Affected limb prolonged for 2.5-3.5 cm (mean, 3.0 cm) at 1 year after operation; limb-length discrepancy was 0.5-1.5 cm (mean, 1.0 cm). The gluteus medius muscle strength was restored to grade 4 in 5 hips and grade 5 in 17 hips. At last follow-up, 13 patients had no claudication, and 5 patients had mild claudication; Trendelenburg sign was negative in 15 cases and was positive in 3 cases; the Harris score was significantly improved to 91.89 +/- 3.22; all showing significant difference when compared with preoperative ones (P < 0.05). At last follow-up, the acetabular anteversion angle, the femoral neck anteversion angle, and combined anteversion angle were (19.33 +/- 4.49), (13.33 +/- 5.70), and (32.67 +/- 5.35) degrees, respectively, all showing significant differences when compared with preoperative ones (P < 0.05). No aseptic loosening, osteolysis, or rediolucent line was found around the femoral component. No implant subsidence, stem varus, or revision occurred.

Becker V-shaped lateral rotation osteotomy is a safe and predictable method to treat type Crowe type IV DDH.