THA with Subtrochanteric Shortening Osteotomy for Crowe Group IV Dislocated Hips

Total hip arthroplasty (THA) for Crowe group IV dislocated hips is a difficult procedure because of the high incidence of complications, such as cup loosening due to a hypoplastic acetabulum, stem loosening due to a narrow and straight femoral medullary canal, limping due to residual leg length difference or non-union of the osteotomized greater trochanter, nerve palsy due to intraoperative manipulation or excess leg lengthening, and postoperative dislocation. In the 1990s, THA with subtrochanteric femoral shortening osteotomy was reported to achieve stable cup placement in the original acetabular position, prevent over-lengthening of the leg, produce good rotational stability of the stem by preserving the proximal femur, and offer appropriate restoration of the abductor muscle function by avoiding pseudoarthrosis of the greater trochanter. In Japan, this procedure has been widely performed with good mid- to long-term results. Before the implementation of a nationwide screening for hip dislocation during infant health checkups in Japan in the 1970s, many cases of hip dislocation were left untreated. Thus, many clinical outcomes and surgical techniques for THA of highly dislocated hips have been reported. In the future, the number of cases is expected to decrease; however, the health examination system has become weaker with the decrease in the number of infant hip dislocation cases, whereas the number of diagnosed cases of hip dislocation after the start of walking is increasing. A 2-year nationwide survey conducted by the Japanese Pediatric Orthopedics Association Multi-Center Study Committee in 2011 revealed that nearly 100 cases were diagnosed annually after the start of walking. Therefore, THA combined with subtrochanteric femoral shortening osteotomy is a necessary surgical technique for some patients with highly dislocated hips. However, imparting surgical techniques to the next generation could be difficult because of the decline in cases of hip dislocations. This section summarizes the indications, tips, key points, clinical outcomes, and implant selection for THA with subtrochanteric femoral shortening osteotomy.