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      Cementless arthroplasty with a distal femoral shortening for the treatment of Crowe type IV developmental hip dysplasia

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          Abstract

          Background:

          Severe developmental dysplasia of the hip is a surgical challenge. The purpose of this study is to describe the cementless arthroplasty with a distal femoral shortening osteotomy for Crowe type IV developmental hip dysplasia and to report the results of this technique.

          Materials and Methods:

          12 patients (2 male and 10 female) of Crowe type IV developmental hip dysplasia operated between January 2005 and December 2010 were included in the study. All had undergone cementless arthroplasty with a distal femoral shortening osteotomy. Acetabular cup was placed at the level of the anatomical position in all the hips. The clinical outcomes were assessed and radiographs were reviewed to evaluate treatment effects.

          Results:

          The mean followup for the 12 hips was 52 months (range 36-82 months). The mean Harris hip score improved from 41 points (range 28-54) preoperatively to 85 points (range 79-92) at the final followup. The mean length of bone removed was 30 mm (range 25-40 mm). All the osteotomies healed in a mean time of 13 weeks (range 10-16 weeks). There were no neurovascular injuries, pulmonary embolism or no infections.

          Conclusion:

          Our study suggests that cementless arthroplasty with a distal femoral shortening is a safe and effective procedure for severe developmental dysplasia of the hip.

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          Most cited references 23

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          Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation.

           Tajie Harris (1969)
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            Radiological demarcation of cemented sockets in total hip replacement.

             J G DeLee,  J Charnley (2015)
            The frequency of radiological demarcation of the cement-bone junction in the acetabulum after total hip replacement has been examined in 141 Charnley low-friction arthroplasties followed for an average of 10.1 years. Sixty-nine per cent showed demarcation of various degrees and 9.2 per cent of the series showed evidence of progressive migration of the socket. The vast majority of cases with demarcation were symptomless. In most cases where demarcation was accompanied by migration the operation notes suggested a technical explanation and in three cases low-grade sepsis was responsible. The fact that nearly 30 per cent of cases showed no demarcation even after 10 years supports the idea that there is no fundamental defect in the principle of employing cement in the acetabulum. Better surgical technique may increase the number of cases showing no demarcation.
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              Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results.

              Total hip replacement using porous-coated cobalt-chrome femoral implants designed for biological fixation has been evaluated in 307 patients after two years and in 89 patients after five years. Histological study of 11 retrieved specimens showed bone ingrowth in nine and fibrous tissue fixation in two. Fixation by bone ingrowth occurred in 93% of the cases in which a press fit of the stem at the isthmus was achieved, but in only 69% of those without a press fit. The clinical results at two years were excellent. The incidence of pain and limp was much lower when there was either a press fit of the stem or radiographic evidence of bone ingrowth. Factors such as age, sex, and the disease process did not influence the clinical results. Most cases showed only slight resorptive remodelling of the upper femur, but in a few cases with a larger, more rigid stem, more extensive bone loss occurred. The results after five years showed no deterioration with time. Fixation by the ingrowth of bone or of fibrous tissue both appeared to be stable, but bone ingrowth gave better clinical results.
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                Author and article information

                Journal
                Indian J Orthop
                Indian J Orthop
                IJOrtho
                Indian Journal of Orthopaedics
                Medknow Publications & Media Pvt Ltd (India )
                0019-5413
                1998-3727
                Jul-Aug 2015
                : 49
                : 4
                : 442-446
                Affiliations
                Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of the People's Liberation Army, Zhangzhou 363000, China
                Author notes
                Address for correspondence: Dr. Zhen-Qi Ding, Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou 363000, China. E-mail: dzqi175@ 123456gmail.com
                Article
                IJOrtho-49-442
                10.4103/0019-5413.159652
                4510799
                Copyright: © Indian Journal of Orthopaedics

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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