Abstract

FERRAZ, Diogo; MIRO, Rafael Llopis  and  NEIRA, Maria Imaculada. Artroplastia total da anca com osteotomia de encurtamento subtrocantérica para a doença de desenvolvimento da anca Tipo IV de Crowe. Rev. Port. Ortop. Traum. [online]. 2013, vol.21, n.4, pp.525-534. ISSN 1646-2122.

Objective: describe a surgical technique and to evaluate the results of cementless arthroplasty with a simultaneous subtrochanteric shortening osteotomy in a patient with bilateral Crowe type - IV developmental dysplasia of the hip. Methods: a 62 year old woman with a known history of untreated bilateral Developmental Displacement of the Hip. Pain and dysfunction resistants’ to nonoperative measures. Conventional radiology confirmed bilateral dislocation of the hips more than 100%. History of joint replacement with transverse subtrochanteric osteotomy at left hip. Subsequently right hip arthroplasty with femoral shortening osteotomy by Mayo Clinic technique. Results: the follow up period was 25 months for transverse sub trochanteric osteotomy procedure and 17 months for the Mayo Clinic technique. Both surgical acts occurred with proper technical execution, and there were no complications. Were not observed during follow-up criteria of heterotopic ossification or components loosening. The Harris Hip Score initial stood in values of 40 having evolved after the two surgical procedures for values greater than 80. The initial pain described as severe and persistent improved to mild or occasional. Conclusions: joint replacement for high dislocations (Crowe type IV) implies with regularly a shortening femoral osteotomy to prevent neurological damage by stretching the sciatic nerve. The procedure of sub trochanteric osteotomy allows prevent nonunion after advancement osteotomy of the greater trochanter as well as the weakening of the abductor muscles. The technique of Mayo Clinic adds a superior contact bone - bone at the osteotomy site and setting intraoperative limb length.

Keywords : Total Hip Arthroplasty; shortening subtrochanteric osteotomy; Crowe type - IV developmental dysplasia.

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