Total hip arthroplasty with subtrochanteric shortening osteotomy for Crowe grade 4 dysplasia using the direct anterior approach.

Between September 2006 and June 2011, 1521 primary total hip arthroplasties were performed using the direct anterior approach on a standard surgical table. In 12 hips, subtrochanteric shortening osteotomy was required. Full weight bearing was allowed 1 week after surgery. The mean follow-up period was 3.7 years. All patients limped preoperatively, but no patient had a positive Trendelenburg or Duchenne limp at the last follow-up. On the basis of our findings, we believe that the direct anterior approach is a safe and reproducible technique for total hip arthroplasty with subtrochanteric shortening osteotomy in the case of Crowe grade 4 dysplasia. It allows the steady recovery of the abductor muscles, a shorter period to postoperative partial weight bearing, and elimination of limping.