subtrochanteric osteotomy for Crowe IV dysplatic hip

subtrochanteric osteotomy for Crowe IV dysplatic hip - JBJS Am 2009/09

Dysplastic hip: Crowe classification, according to its degree of subluxation (dislocation)

Crowe type IV: complete dislocation

True acetabulum: Better quality for Cup support
Without shortening: difficult reduction, sciatic nerve injury

THA with subtrochanteric shortening osteotomy:
．for cementless proximal ingrowth stem
．avoid change of anatomy of proximal femur

Surgical technique
．osteotomy site: 8 – 10 cm distal to tip of greater trochanter
．transverse subtrochanteric osteotomy
．autogenous cancellous bone graft over osteotomy site
．neck cut region: 1 cm proximal to lesser trochanter

Preparation of femoral canal
．reaming + broaching
．osteotomy
．implantation of stem
．lateral coverage for cup: superolateral femoral head
．osteotomized femoral canal: as cortical strut graft, fixed with Cable wire