Clinical and Radiological Results of Crowe Type 3 or 4 Dysplasia Patients Operated on With Total Hip Arthroplasty Using a Cementless Rectangular Femoral Component Without Fixating or Grafting the Transverse Osteotomy Site

Total hip arthroplasty (THA) involving shortening osteotomy for patients with Crowe type 3 or 4 dysplasia is a challenging surgical procedure. This study aims to demonstrate that rectangular femoral component use in anatomical reconstructions with THA and transverse shortening osteotomy yields successful results without the use of bone graft or any fixation material at the osteotomy site.

Fifty hips from 41 patients were identified retrospectively as per study objectives. All patients were evaluated using the Harris Hip Score and Visual Analog Scale for pain. Complications were reported. Radiological evaluation criteria were then evaluated, including leg length discrepancy, degree of trochanter caudalization and stem subsidence, radiolucent and radiodense lines for both components and bone atrophy or hypertrophy around the stem according to Gruen zones, and the canal fill ratio of the stem.

Postoperative Harris Hip Score was excellent for 68% of patients. No patient had poor results. Complication rate was 32%. One patient had nonunion (2%). The mean postoperative leg length discrepancy was 0.8(±0.6) cm. No patient had a subsidence of more than 5 mm. Radiolucent and radiodense lines were present in up to 34% of patients, and bone atrophy was present in the proximal femur in up to 96% of patients. No patient had osteolysis or loosening in neither component.

Successful clinical and radiological results can be obtained from Crowe type 3 and 4 dysplastic hips operated on with THA using a rectangular femoral component and transverse shortening osteotomy technique. The use of graft or any fixation material at the osteotomy site is not mandatory.