Patient Satisfaction and Outcomes at a Mean 11-Year Follow-Up Following Total Hip Arthroplasty With Subtrochanteric Osteotomy for Dislocated Hips After Schanz Osteotomy
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Published on: September 7, 2022
Masanori Fujii1, Shunsuke Kawano2, Masaya Ueno1
1Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan.
Background:
Total hip arthroplasty (THA) for chronically dislocated hips after Schanz osteotomy is technically demanding, with limited data on outcomes and patient satisfaction. This study aimed to determine clinical outcomes, implant survivorship, and factors associated with poor functional outcome and dissatisfaction after THA with subtrochanteric osteotomy.
Methods:
We retrospectively reviewed 73 patients (93 hips) who had Crowe IV dislocation treated with Schanz osteotomy and who underwent THA with subtrochanteric osteotomy. Implant survival (revision for any reason as the end point) and predictors of poor functional outcome (Japanese Orthopaedic Association hip score less than 70) were analyzed. Factors associated with dissatisfaction (visual analog scale less than 50) were analyzed in patients who completed patient-reported outcome measure (PROM) questionnaires (55 patients, 71 hips; 75% response rate). Multivariate analyses used bias-reduced logistic regression models for limited events.
Results:
The median Japanese Orthopaedic Association score improved from 49 (interquartile range, 41 to 62) to 86 (interquartile range, 76 to 93) at a mean follow-up of 11 years (range, 2.0 to 21; P < 0.001). Kaplan-Meier implant survivorship was 88.9% (95% confidence interval [CI], 82.0 to 95.9) at both 10 and 20 years, with no revisions beyond 8.4 years postoperatively. Multivariate analyses showed that preoperative mobility aid use was associated with poor functional outcome (odds ratio, 12.21; 95% CI, 1.35 to 1,615.31; P = 0.013). In the PROM cohort, 64 of 71 hips (90%) were satisfied, and preoperative mobility aid use was associated with dissatisfaction (odds ratio, 13.08; 95% CI, 1.28 to 1,774.59; P = 0.016).
Conclusions:
A THA for Crowe IV dislocation after Schanz osteotomy improved function and patient satisfaction, with acceptable implant survivorship; however, complication and revision rates remained substantial. Preoperative mobility aid use was associated with poor outcomes, although estimates showed limited precision. The retrospective design and incomplete PROM follow-up warrant prospective multicenter validation.