Comparison of Outcomes in Total Hip Arthroplasty for Unilateral Crowe Type IV Hip Dislocation With and Without Femoral Shortening Osteotomy: Determining Factors for Shortening.

BACKGROUND

This retrospective study aimed to compare the clinical and radiological outcomes of total hip arthroplasty in patients who had unilateral Crowe type IV hip dysplasia who underwent femoral shortening osteotomy versus those who did not. In addition, the study sought to identify key factors influencing the necessity for femoral shortening.

METHODS

This study included 82 patients who met the inclusion criteria. Patients were divided into two groups: subtrochanteric femoral shortening osteotomy (SFSO) (49 patients), who needed femoral shortening, and non-SFSO (33 patients), who did not. The mean age was 38 years (range, 23 to 66). The mean follow-up period was 5.2 years (range, 2.1 to eight). The clinical and radiological results of the patients were compared, and the factors that influence shortening were identified.

RESULTS

The Harris Hip Scores of both groups improved significantly after surgery (P < 0.001). However, the SFSO group experienced more bleeding and a longer surgery time. There were no significant differences in neurovascular complications between the two groups (P > 0.05). The preoperative vertical index is the most important factor in determining the need for femoral shortening, and it increases 15 times in patients who have a value of 0.81.

CONCLUSIONS

In unilateral Crowe type IV hip arthroplasty, clinical and radiological outcomes were satisfactory and comparable in patients who underwent femoral shortening osteotomy and those who did not, who had a mean follow-up of 5.2 years. Age, presence or absence of a false acetabulum, preoperative leg length discrepancy, and preoperative vertical index predicted the need for shortening.