Mid-term results of total hip arthroplasty with subtrochanteric Z-osteotomy in Crowe type 3-4 developmental hip dysplasia

Background/aim: Total hip arthroplasty (THA) is technically more difficult and has higher complication rates in patients with Crowe type 3–4 developmental dysplasia of the hip (DDH). Due to the difficulties and different treatment options, there is still no consensus on the optimal treatment. We aimed to evaluate the mid-term results of our patients who had undergone subtrochanteric femoral shortening Z-osteotomy. Materials and methods: This study included 37 hips of 29 patients with the diagnosis of Crowe 3-4 DDH between June 2010 and December 2016 and who underwent femoral shortening Z-osteotomy with cementless total hip arthroplasty. Acetabular component was determined according to the patient’s age and functional capacity and all patients were operated with a posterior approach. Functional results, postoperative complications, Harris and visual analogue scale (VAS) scores were evaluated. Results: The average Harris hip score was 41.3 ± 3.1 preoperatively and 84.7 ± 4.3 postoperatively (p < 0.05). The mean preoperative hip pain score on the VAS was 7.9 (range: 6–9) and this was significantly lower at the last follow-up (mean: 3.4; range: 2–4) (p < 0.05). The final mean limb-length discrepancy was 1.3 cm. The average amount of femoral shortening was 3.2 cm. Regarding complications, 3 (10.3%) patients had dislocations. These patients underwent closed reduction. Sciatic palsy developed in 1 (3.4%) patient. The patient was reoperated on for sciatic nerve dissection in the early period. Conclusion: Subtrochanteric shortening Z-osteotomy combined with cementless total hip replacement can be considered an effective and successful method in selected patients with Crowe 3-4 coxarthrosis.