Total Hip Arthroplasty without Subtrochanteric Shortening Osteotomy in a Neglected Posterior Hip Dislocation: A Case Report.

INTRODUCTION: Neglected posterior hip dislocation is uncommon and can cause soft-tissue contracture, proximal migration of the femur, limb length discrepancy, and secondary degenerative changes. In chronic cases with joint destruction, total hip arthroplasty is often the preferred reconstructive option. However, reduction can be difficult and may require additional procedures, such as femoral shortening osteotomy.

CASE REPORT: A 41-year-old male presented with right hip pain for 2 years and difficulty in walking for 18 months following a road traffic accident. Imaging showed neglected posterior dislocation of the right hip with superior migration of the proximal femur, near-complete femoral head resorption, and pseudoarthrosis. The patient underwent 3 weeks of pre-operative skin traction followed by total hip arthroplasty through a posterior approach using Ganz-type greater trochanteric osteotomy and abductor pie-crusting without subtrochanteric shortening osteotomy. At 6 months follow-up, the patient was pain-free, walking full weight-bearing, with no limb length discrepancy, no neurological deficit, and radiological union of the trochanteric osteotomy site.

CONCLUSION: In selected cases of neglected posterior hip dislocation, pre-operative traction, soft-tissue balancing, and Ganz-type trochanteric osteotomy may allow reduction without subtrochanteric shortening osteotomy. This approach may reduce the risk of nerve stretch injury, preserve femoral bone stock, and allow use of a primary femoral implant.