Double-chevron subtrochanteric shortening derotational femoral osteotomy combined with total hip arthroplasty for the treatment of complete congenital dislocation of the hip in the adult. Preliminary report and description of a new surgical technique.

Abstract

Total hip arthroplasty for the treatment of complete congenital dislocation of the hip in the adult has been associated with high rates of complications, including acetabular component loosening, femoral or sciatic nerve palsy, and prosthetic dislocation. Placement of the acetabular component in the true acetabulum has yielded the most durable results, but leads to significant limb lengthening, which is associated with sciatic and femoral nerve palsy. Femoral shortening with a transverse osteotomy tends to be torsionally unstable. Increased femoral anteversion complicates femoral component placement and, if not corrected, can lead to postoperative anterior instability and component dislocation. A new surgical technique that combines total hip arthroplasty with a femoral subtrochanteric shortening derotational double-chevron osteotomy in complete congenital hip dislocation using standard components is described. This procedure has been successfully performed in seven hips.