Total hip arthroplasty with subtrochanteric osteotomy for severe developmental dysplasia of the hip: A systematic review and meta-analysis

Tomonori Shigemura; Yohei Yamamoto; Yasuaki Murata

doi:10.1016/j.jor.2025.03.027

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62 (); 197-206

doi:

10.1016/j.jor.2025.03.027

Total hip arthroplasty with subtrochanteric osteotomy for severe developmental dysplasia of the hip: A systematic review and meta-analysis

Tomonori Shigemura , Yohei Yamamoto, Yasuaki Murata

Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan

⁎Corresponding author: Tomonori Shigemura. tshigepon@yahoo.co.jp

Received: 2025-2-4, Accepted: 2025-3-14, Published: 2025-3-18

Professor P K Surendran Memorial Education Foundation

Disclaimer:
This article was originally published by Reed Elsevier India Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Abstract

Total hip arthroplasty (THA) for severe developmental dysplasia of the hip (DDH) is technically difficult because of the anatomical features of dysplasia, such as a hypoplastic and shallow acetabulum, narrow femoral canal, and soft tissue contractures. Subtrochanteric osteotomy (STO) is effective technique to reduce the risk of sciatic nerve palsy while placing the acetabular cup in an anatomical position during THA for severe DDH. Few studies have compared THA performed without STO to THA performed with STO. We performed a systematic literature review and single-arm meta-analysis to integrate the results of studies regarding THA with STO for severe DDH.

A systematic literature review was conducted using relevant original studies from various databases. Pooling of data was performed using RevMan software. A p-value of <0.05 was considered significant. The results are expressed as incidences with 95 % confidence intervals (CIs) for dichotomous data and means with 95 % CI for continuous data. Statistical heterogeneity was assessed based on I² using the standard χ² test. When I² > 50 %, significant heterogeneity was assumed, and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity.

Twelve studies were included in this meta-analysis. The pooled incidence of sciatic nerve palsy, delayed union or nonunion, dislocation, intraoperative femoral fracture, and infection were 2.44 % (95 % CI: 0.86–4.01), 2.74 % (95 % CI: 1.11–4.37), 2.92 % (95 % CI: 1.63–4.20), 2.19 % (95 % CI: 0.95–3.42), and 3.11 % (95 % CI: 0.10–6.12), respectively. Pooling of the data also showed a mean Harris Hip Score (HHS) of 88.33 (95 % CI: 84.95–91.70).

Although THA with STO for severe DDH is a challenging surgical procedure, this meta-analysis showed that the results of THA with STO for severe DDH are favourable.

Level of evidence: Ⅳ (systematic review and meta-analysis).

Keywords

Total hip arthroplasty

Developmental dysplasia of the hip

Subtrochanteric osteotomy

Show Related Articles from PubMed

1 Introduction

Total hip arthroplasty (THA) is one of the most effective treatments for end-stage hip disease.^1–4 However, THA for severe developmental dysplasia of the hip (DDH), especially Crowe type IV or Hartofilakidis type C,⁵^,⁶ is technically difficult because of the anatomical features of dysplasia, such as a hypoplastic and shallow acetabulum,⁷ narrow femoral canal, an excessive anteversion of the proximal femur, and soft tissue contractures.⁸^,⁹ Superior placement of the acetabular cup delays the recovery of abductor muscle moments after THA and affects long-term survival; therefore, the cup should be placed at the level of the true acetabulum when performing THA for severe DDH.^10–12 Subtrochanteric osteotomy (STO) with bone segment resection is a technique that could reduce the risk of sciatic nerve palsy when placing the acetabular cup in an anatomical position during THA for severe DDH.¹³ STO is also a good option for adjusting leg length discrepancy.¹⁴ However, THA with STO has potential complications, such as delayed union or nonunion of the osteotomy site and intraoperative fractures, in addition to the complications of standard THA, such as dislocation and infection.¹⁵

The efficacy and safety of STO are unknown because few studies have compared THA without STO to THA with STO. To address this limitation, we performed a systematic literature review and single-arm meta-analysis to integrate the study results of THA with STO for severe DDH.

2 Materials and methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement¹⁶ was followed. Ethical approval for this systematic review and meta-analysis was deemed unnecessary as the study did not include individual patient data.

2.1

2.1 Search strategy

On the May 26, 2023, we systematically searched PubMed, Web of Science, and the Cochrane Library electronic databases for relevant articles. The following terms were used for our search: “total hip arthroplasty” and “subtrochanteric osteotomy”. We also checked the reference lists in the retrieved articles to include additional studies that met the criteria but had not been identified by the electronic search. All studies identified were individually assessed for inclusion.

2.2

2.2 Eligibility criteria

Articles were selected according to the following eligibility criteria: (1) prospective or retrospective study; (2) reporting THA with STO for severe DDH in more than 50 hips; (3) published after 2000; and (4) including data for surgical and clinical outcomes.

Duplicate publications and articles written in languages other than English were excluded. Reviews, letters, comments, meeting proceedings, editorials, practice guidelines, registry studies, and studies reporting insufficient data were considered unsuitable and also excluded.

2.3

2.3 Data extraction

Two authors independently scanned the titles and abstracts of all potential articles. Additionally, the full texts of articles that met our inclusion criteria were screened and a final decision was made regarding inclusion/exclusion of the article in our review. Disagreements were resolved through discussion and consensus.

The following data were extracted from selected articles: (1) name of the first author, year of publication, country, and study design; (2) demographic characteristics of the participants including sample size, sex, age, follow-up period, and classification of DDH; and (3) outcomes for the meta-analysis including complications and clinical outcomes, and outcomes for the subanalysis including type of STO, type of femoral stem, surgical approach, and amount of femoral bone resection.

2.4

2.4 Outcome measures

The primary outcome was the rate of sciatic nerve palsy, and secondary outcomes were the rate of delayed union or nonunion, dislocation, intraoperative femoral fracture, infection, and clinical score. The clinical score was evaluated using the Harris Hip Score (HHS)¹⁷ or a modified version of the score.

2.5

2.5 Quality assessment

Two authors independently assessed the quality of the included studies, and any disagreement was resolved through discussion. The Newcastle-Ottawa Scale (NOS)¹⁸ was used to evaluate the quality of the study as included studies were single-arm studies. The NOS is a quality assessment tool comprised of three sections (selection, comparability, and exposure or outcome), with rating scores of 0–3, 4–6, and 7–9 indicating poor, fair, and good studies, respectively.

2.6

2.6 Statistical analysis

Data were pooled using RevMan software (version 5.3, Cochrane Collaboration, Oxford, UK). A p value < 0.05 was considered statistically significant. The results are expressed as incidences with 95 % confidence intervals (CIs) for dichotomous data and means with 95 % CI for continuous data. Statistical heterogeneity was assessed based on I² using the standard χ² test. Significant heterogeneity was assumed, and a random-effects model was applied for the meta-analysis when the evaluation showed I² > 50 %. A fixed-effects model was used in the absence of significant heterogeneity. For studies that reported continuous variables with ranges instead of standard deviation (SD), we estimated the SD using the Walter method.¹⁹ Publication bias was estimated using funnel plots. An asymmetry in the funnel plot suggested the existence of a publication bias.

3 Results

3.1

3.1 Search results

A preliminary review of 385 articles sourced from the database searches was conducted. Of those, 132 articles were excluded because of duplication. Among the remaining 253 articles, 190 were excluded after screening the titles and abstracts. Of the remaining 63 articles, 51 were excluded from the meta-analysis following a review of the full text of the article. No articles from the reference review were deemed eligible for inclusion. Following the completion of all screening processes, 12 studies (including a total of 856 THAs)^20–31 were eligible for inclusion in the meta-analysis for the assessment of methodological quality. A flowchart of the inclusion process for the articles is shown in Fig. 1.

Flowchart of literature screening. After applying inclusion and exclusion criteria, 12 studies were included in this review. THA: total hip arthroplasty.

3.2

3.2 Patient characteristics

Among the 12 studies included in this meta-analysis, six studies were performed in Turkey, three in China, and one each in Japan, Norway, and Italy. Further details regarding these studies are summarised in Table 1. In addition, the surgical details for each study are shown in Table 2.

Table 1 Characteristics of the selected studies.

Authors	Year	Country	Study design	Hips/Patients	Sex (F/M)	Age (years)	Follow-up period (years)	Classification of dysplasia (Crowe Ⅲ/Ⅳ)
Fujishiro et al.	2012	Japan	retrospective	70/59	58/1	62.4 (47-78)	NA	0/70
Sofu et al.	2015	Turkey	retrospective	73/68	60/8	47 (31-69)	5.1 (3-7.7)	10/63
Desteli et al.	2015	Turkey	retrospective	60/52	49/11	51.4 ± 13.4	6.5 ± 1.7	37/23
Zeng et al.	2017	China	retrospective	52/45	37/8	40.6 (18-62)	9.8 (8.9-11.8)	0/52
Wang et al.	2017	China	retrospective	76/62	49/13	46.5 (19-73)	10 (6.6-13.2)	0/76
Vreim Holm et al.	2019	Norway	retrospective	65/46	34/12	48 (16-79)	13 (8-18)	NA
Grappiolo et al.	2019	Italy	retrospective	102/74	57/17	53.9 (20-83)	11.3 (5-25)	0/102
Karaismailoglu et al.	2020	Turkey	retrospective	51/40	37/3	44.6 ± 10.4	5.7 (5-7.1)	18/33
Köken et al.	2020	Turkey	retrospective	50/28	26/2	38.6 ± 11.9	7.9 (6.0-9.8)	0/50
Sun et al.	2020	China	retrospective	62/NA	55/7	41.62 ± 13.34	NA	0/62
Sukur et al.	2022	Turkey	retrospective	68/56	56/0	48.2 (36-64)	12.9 (5.2-16.8)	0/68
Ors et al.	2022	Turkey	retrospective	127/91	81/10	43.0 ± 13.8	8.4 (6-10.4)	0/127

Table 2 Details of surgeries.

Authors	Type of STO	Femoral stem	Approach	Amount of femoral bone resection (cm)
Fujishiro et al.	Transverse	S-ROM (Depuy, Warsaw, Indiana)	Posterior	2.9 (1.0 - 5.5)
Sofu et al.	Transverse	Proximally HA porous-coated fit and fill type	Posterior	Crowe Ⅲ: 3.4 ± 0.5Crowe Ⅳ: 4.7 ± 0.3
Desteli et al.	Transverse	Proximally HA porous-coated fit and fill type	Posterior	NA
Zeng et al.	Transverse	S-ROM (Depuy, Warsaw, Indiana)	Posterior	3.5 ± 0.6
Wang et al.	Transverse	S-ROM (Depuy, Warsaw, Indiana)	Posterior	2.68 (2.0 - 4.6)
Vreim Holm et al.	Step-cut/Oblique	Monoblock straight stem	DL/Posterior	NA
Grappiolo et al.	Transverse	Monoblock conical cementless stem	Posterior	3.3 (2.0 - 5.0)
Karaismailoglu et al.	Oblique	Cementless stems	Posterior	NA
Köken et al.	Transverse	Cementless Zweymüller	DL	3 (2 - 4)
Sun et al.	Transverse	S-ROM (Depuy, Warsaw, Indiana)	Posterior	NA
Sukur et al.	Transverse	Straight cylindrical cementless/modular femoral revision stem	Posterior	6.7 ± 0.5
Ors et al.	Transverse	Monoblock conical cementless stem	Posterior	3.2 ± 0.5

3.3

3.3 Quality assessment

The NOS was used to evaluate the eligibility of the 12 included studies. The articles were scored according to the three sections of the NOS (Table 3).

Table 3 Newcastle-Ottawa Scale for the included studies.

	Selection	Comparability	Outcome
Fujishiro et al.	※※	※	※※
Sofu et al.	※※	※	※※
Desteli et al.	※※	※	※※
Zeng et al.	※※	※	※※
Wang et al.	※※	※	※※
Vreim Holm et al.	※※	※	※※
Grappiolo et al.	※※	※	※※
Karaismailoglu et al.	※※	※	※
Köken et al.	※※	※	※※
Sun et al.	※※	※	※
Sukur et al.	※※	※	※※
Ors et al.	※※	※	※※

3.4

3.4 Sciatic nerve palsy

Eight articles (including a total of 542 hips)²⁰^,²¹^,²³^,²⁴^,^26–28^,³⁰ reported the rate of sciatic nerve palsy. No significant heterogeneity was observed (I² = 0 %); therefore, the fixed-effects model was used. The pooled incidence of sciatic nerve palsy was 2.44 % (95 % CI: 0.86–4.01) (Fig. 2A). A subgroup analysis showed a pooled incidence of sciatic nerve palsy of 2.01 % (95 % CI: -0.10–4.12) for femoral resection greater than 3 cm and 2.74 % (95 % CI: 0.09–5.38) for femoral resection less than 3 cm (Fig. 2B). A subgroup analysis regarding the surgical approach showed a pooled incidence of sciatic nerve palsy of 2.52 % (95 % CI: 0.80–4.25) for the posterior approach and 2.00 % (95 % CI: -1.88–5.88) for the direct lateral (DL) approach (Fig. 2C).

Forest plot of sciatic nerve palsy. No significant heterogeneity was observed (I2 = 0 %); therefore, the fixed-effects model was used. 2A. Sciatic nerve palsy. 2B. Sciatic nerve palsy by amount of femoral shortening. 2C. Sciatic nerve palsy by the surgical approach. SE: standard error; IV: inverse variance method; CI: confidence intervals; df: degrees of freedom; DL: direct lateral.

3.5

3.5 Delayed union or nonunion

Eight articles (including a total of 547 hips)^21–27^,³⁰ reported the rate of delayed union or nonunion. No significant heterogeneity was observed (I² = 0 %); therefore, the fixed-effects model was used. The pooled incidence of delayed union or nonunion was 2.74 % (95 % CI: 1.11–4.37) (Fig. 3A). A subgroup analysis regarding the type of STO showed a pooled incidence of delayed union or nonunion of 2.68 % (95 % CI: 0.92–4.45) for transverse STO and 3.08 % (95 % CI: -1.11–7.27) for other osteotomies (Fig. 3B).

Forest plot of delayed/nonunion. No significant heterogeneity was observed (I2 = 0 %); therefore, the fixed-effects model was used. 3A. Delayed union or nonunion. 3B. Delayed union or nonunion by each type of osteotomy. SE: standard error; IV: inverse variance method; CI: confidence intervals; df: degrees of freedom.

3.6

3.6 Dislocation

Nine articles (including a total of 653 hips)^23–31 reported the rate of dislocation. No significant heterogeneity was observed (I² = 0 %); therefore, the fixed-effects model was used. The pooled incidence of dislocation was 2.92 % (95 % CI: 1.63–4.20) (Fig. 4A). A subgroup analysis showed a pooled incidence of dislocation of 3.17 % (95 % CI: 1.70–4.65) for THA performed using the posterior approach (Fig. 4B). A subgroup analysis showed a pooled incidence of dislocation of 3.02 % (95 % CI: 0.94–5.09) for THA using a changeable neck stem (S-ROM or modular femoral revision stem) and 3.93 % (95 % CI: 1.41–6.45) for THA using a conical stem (Wagner cone stem) (Fig. 4C).

Forest plot of dislocations. No significant heterogeneity was observed (I2 = 0 %); therefore, the fixed-effects model was used. 4A. Dislocations. 4B. Dislocations by each surgical approach. 4C. Dislocations by each femoral stem. SE: standard error; IV: inverse variance method; CI: confidence intervals; df; degrees of freedom.

3.7

3.7 Intraoperative femoral fracture

Eight articles (including a total of 586 hips)^22–24^,^26–28^,³⁰^,³¹ reported the rate of intraoperative femoral fracture. No significant heterogeneity was observed (I² = 11 %); therefore, the fixed-effects model was used. The pooled incidence of intraoperative femoral fracture was 2.19 % (95 % CI: 0.95–3.42) (Fig. 5A). A subgroup analysis showed a pooled incidence of intraoperative femoral fracture of 1.46 % (95 % CI: -0.10–3.01) for THA using a conical stem (Wagner cone stem) (Fig. 5B).

Forest plot of intraoperative femoral fractures. No significant heterogeneity was observed (I2 = 11 %); therefore, the fixed-effects model was used. 5A. Intraoperative femoral fractures 5B. Intraoperative femoral fracture by each femoral stem. fx: fracture; SE: standard error; IV: inverse variance method; CI: confidence intervals; df: degrees of freedom.

3.8

3.8 Infection

Six articles (including a total of 409 hips)^22–24^,²⁶^,²⁷^,³⁰ reported the rate of infection. No significant heterogeneity was observed (I² = 0 %); therefore, the fixed-effects model was used. The pooled incidence of infection was 3.11 % (95 % CI: 0.10–6.12) (Fig. 6).

Forest plot of infections. No significant heterogeneity was observed (I2 = 0 %); therefore, the fixed-effects model was used. SE: standard error; IV: inverse variance method; CI: confidence intervals; df: degrees of freedom.

3.9

3.9 HHS

Eight articles (including a total of 609 hips)^21–24^,²⁶^,²⁷^,³⁰^,³¹ reported the HHS. Significant heterogeneity was observed (I² = 98 %); therefore, the random-effects model was used. Pooling of the data showed a mean HHS of 88.33 (95 % CI: 84.95–91.70) (Fig. 7).

Forest plot of Harris Hip Scores. Significant heterogeneity was observed (I2 = 98 %); therefore, the random-effects model was used. HHS: Harris Hip Score; SE: standard error; IV: inverse variance method; CI: confidence intervals; df: degrees of freedom.

3.10

3.10 Publication bias

A funnel plot of dislocations was used to evaluate publication bias. An asymmetry was exhibited in the funnel plot, which reflected publication bias (Fig. 8). However, only nine studies were included in the funnel plot. Therefore, the results should be interpreted with caution.

Funnel plot of dislocations. An asymmetry was exhibited in the funnel plot, which reflected publication bias.

4 Discussion

The pooled incidence of sciatic nerve palsy, delayed union or nonunion, dislocation, intraoperative femoral fracture, and infection were 2.44 % (95 % CI: 0.86–4.01), 2.74 % (95 % CI: 1.11–4.37), 2.92 % (95 % CI: 1.63–4.20), 2.19 % (95 % CI: 0.95–3.42), and 3.11 % (95 % CI: 0.10–6.12), respectively. Pooling of the data showed a mean HHS of 88.33 (95 % CI: 84.95–91.70).

Sciatic nerve palsy is one of the serious complications. Its apparent risk factors are revision operations, female sex, significant lengthening of the extremity,³² and a previous femoral osteotomy.³³ Our meta-analysis showed a pooled incidence of sciatic nerve palsy of 2.44 % (95 % CI: 0.86–4.01) for THA with STO. Even if THA with STO is performed for severe DDH, placing the acetabular component at the true acetabular height may result in hyperextension of the sciatic nerve, resulting in sciatic nerve palsy. A study by Eggli et al. showed that the occurrence of nerve damage was independent of limb length changes, with direct or indirect trauma being the most common cause.³⁴ Consistent with the Eggli et al. study, our subgroup analysis comparing femoral bone resections of more than 3 cm with those of less than 3 cm found a similar incidence of sciatic nerve palsy between the two. We hypothesized that the posterior approach for THA with STO were less likely to cause sciatic nerve palsy because the sciatic nerve was easier to identify for anatomical reasons when using the approach. However, the subgroup analysis regarding the surgical approach showed a greater rate of sciatic nerve palsy in the posterior approach than that in the DL approach. İncesoy et al. reported that anatomical parameters associated with the shortening decision in severe DDH (Crowe type Ⅳ), operative leg length discrepancy, coronal position of neo-acetabulum, and axial position of neo-acetabulum are possible predictive factors of STO. They concluded that owing to these parameters, it may be possible to lower the technically demanding level of THA and avoid unnecessary repeated reduction attempts,³⁵ which may reduce the incidence of sciatic nerve palsy.

Delayed union or nonunion is usually painful and leads to a poor prognosis.³⁶ In the present study, the pooled incidence of delayed union or nonunion after THA with STO was 2.74 % (95 % CI: 1.11–4.37). Regarding the type of osteotomy, transverse STO was used in most of the studies included in this meta-analysis. The subanalysis showed a rate of delayed union or nonunion after THA with STO of 2.68 % (95 % CI: 0.92–4.45) for transverse STO and 3.08 % (95 % CI: –1.11–7.27) for other STO approaches. The advantages of transverse STO are the ease of the femoral rotation adjustment and overall simplicity of the technique.³⁷ Conversely, the small contact area of the osteotomy site is considered a disadvantage for bone fusion. Notably, our meta-analysis revealed that transverse STO was not disadvantageous for bone fusion.

Dislocation is a serious complication of THA and may require revision surgery.³⁸ The present meta-analysis showed a pooled incidence of dislocation after THA with STO of 2.92 % (95 % CI: 1.63–4.20). The causes of dislocation are multifactorial, and the surgical approach is one of the predictive factors.³⁹^,⁴⁰ According to the subanalysis regarding the surgical approach, the dislocation rate after THA with STO was 3.17 % (95 % CI: 1.70–4.65) for the posterior approach. Although the posterior approach is generally considered to have higher dislocation rates, the approach was used in most of the studies in our meta-analysis. This may be due to the wider field of view provided by the approach, allowing easier manipulation of the femur. Several recent reports showed the results of THA with STO using the direct anterior approach (DAA).⁴¹ The DAA may reduce the risk of dislocation by preserving the posterior soft tissues of the hip joint, such as the posterior capsule and short external rotators.⁴² More outcome data of THA with STO using the DAA approach are expected as the procedure becomes more common. This will result in more published studies, thus allowing for future meta-analyses.

The orientation of the femoral component is another predictive factor of dislocation.⁴³ The changeable neck system has been found to decrease the rate of dislocations after THA; this system allows for intraoperative control of the version of the femoral component. However, according to our subanalysis, the dislocation rate after THA with STO using a changeable neck system (S-ROM type and modular femoral revision stems) was relatively high.

One possible reason for the high frequency of intraoperative femoral fractures in THA for DDH is the characteristic narrow femoral canal.¹⁵ To reduce the risk of intraoperative fractures, the use of dedicated or custom stems is recommended. Another way to reduce the risk of intraoperative femoral fractures is to use a conical stem (Wagner cone stem). The present subanalysis showed a relatively low pooled incidence of intraoperative femoral fractures (1.46 %; 95 % CI: -0.10–3.01) in studies that reported using the conical stem (Wagner cone stem).

Surgical site infection, particularly periprosthetic joint infection (PJI), is a serious complication and significant burden due to increased morbidity, mortality, and disability. Patients with PJI often require multiple surgeries; therefore, infection prevention is very important.⁴⁴ This meta-analysis showed a relatively high pooled incidence of infection (3.11 %; 95 % CI: 0.10–6.12). This infection rate may be related to the large surgical field and the long operative time due to the complexity of the procedure. Surgeons who perform this surgery must be attentive in preventing PJI.

Tahta et al. performed THA without STO in 77 patients with severe DDH (Crowe type III/IV) and reported a mean postoperative HHS of 82.7 (76–95), dislocation in three patients (3.8 %), and no sciatic nerve palsy in any patients.⁴⁵ In comparison to their study, THA with STO had a lower dislocation rate (2.92 %) and a higher HHS score (88.33), although a higher rate of sciatic nerve palsy (2.44 %) than THA without STO. Therefore, surgeons must recognize that sciatic nerve palsy can occur with THA for DDH even when adding STO, and operations should be performed with careful attention to the sciatic nerve.

The present investigation is characterized by limitations which should be acknowledged. First, significant heterogeneity was observed between the included studies regarding the HHS (I² = 98 %). This heterogeneity may be attributable to differences in various factors, such as the different demographic characteristics of patients. Second, unpublished trials and articles written in languages other than English were not included in this analysis, potentially leading to publication bias. Third, only 12 studies with relatively small sample sizes were included. Fourth, this study was a single-arm meta-analysis due to the lack of randomized controlled trial studies comparing THA with and without STO for severe DDH. These limitations may have reduced the quality of the evidence included in this meta-analysis, and more studies with larger sample sizes are needed to verify the stability and reliability of this study's results.

5 Conclusion

Twelve studies were included in this meta-analysis. The meta-analysis revealed that THA with STO for severe DDH resulted in low complication rates and good clinical scores.

CRediT authorship contribution statement

Tomonori Shigemura: Conceptualization, Methodology, Software, Data curation, Writing – original draft, Software, Validation. Yohei Yamamoto: Visualization, Investigation, Writing – review & editing. Yasuaki Murata: Supervision.

Patient confidentiality and consent to publish

Not applicable.

Data availability

Data from this study is available from the corresponding author upon reasonable request.

Ethical statement

Ethics approval was not required due to the nature of the study.

Funding

None

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Show Sections

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[19] Walter S.D., Yao X., . Effect sizes can be calculated for studies reporting ranges for outcome variables in systematic reviews. J Clin Epidemiol. 2007;60:849-852.
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[20] Fujishiro T., Nishiyama T., Hayashi S., Kurosaka M., Kanno T., Masuda T., . Leg length change in total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe type IV developmental hip dysplasia. J Arthroplast. 2012;27:1019-1022.
[Google Scholar]

[21] Sofu H., Kockara N., Gursu S., Issin A., Oner A., Sahin V., . Transverse subtrochanteric shortening osteotomy during cementless total hip arthroplasty in Crowe type-III or IV developmental dysplasia. J Arthroplast. 2015;30:1019-1023.
[Google Scholar]

[22] Desteli E.E., Imren Y., Tan E., Erdoğan M., Özcan H., . Clinical results of cementless total hip arthroplasty with shortening osteotomy for high dislocation with developmental dysplasia. Acta Orthop Belg. 2015;81:30-35.
[Google Scholar]

[23] Zeng W.N., Liu J.L., Wang F.Y., et al . Total hip arthroplasty for patients with Crowe type IV developmental dysplasia of the hip: ten years results. Int J Surg. 2017;42:17-21.
[Google Scholar]

[24] Wang D., Li L.L., Wang H.Y., Pei F.X., Zhou Z.K., . Long-term results of cementless total hip arthroplasty with subtrochanteric shortening osteotomy in Crowe type IV developmental dysplasia. J Arthroplast. 2017;32:1211-1219.
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[25] Vreim Holm A.G., Terjesen T., Reikerås O., . Subtrochanteric shortening and uncemented arthroplasty in hips with high dislocation - a cohort study with 13-30 years follow-up. J Orthop. 2018;16:80-85.
[Google Scholar]

[26] Grappiolo G., La Camera F., Della Rocca A., Mazziotta G., Santoro G., Loppini M., . Total hip arthroplasty with a monoblock conical stem and subtrochanteric transverse shortening osteotomy in Crowe type IV dysplastic hips. Int Orthop. 2019;43:77-83.
[Google Scholar]

[27] Karaismailoglu B., Karaismailoglu T.N., . Comparison of trochanteric slide and subtrochanteric shortening osteotomy in the treatment of severe hip dysplasia: mid-term clinical outcomes of cementless total hip arthroplasty. J Arthroplast. 2020;35:2529-2536.
[Google Scholar]

[28] Köken M., Güçlü B., Çetİn İ., . Long-term results of total hip arthroplasty with transverse subtrochanteric shortening osteotomy in developmental high dislocation of the hip. Acta Orthop Belg. 2020;86:77-82.
[Google Scholar]

[29] Sun J., Zhang G., Shen J., et al . Dislocation height performs well in predicting the use of subtrochanteric osteotomy in Crowe type IV hips. Therapeut Clin Risk Manag. 2020;16:989-997.
[Google Scholar]

[30] Sukur E., Senel A., Ozdemir U., Akman Y.E., Azboy İ., Ozturkmen Y., . Cementless modular total hip arthroplasty with subtrochanteric transverse shortening osteotomy for high hip dislocations. J Orthop Surg Res. 2022;17:139.
[Google Scholar]

[31] Ors C., Caylak R., Togrul E., . Total hip arthroplasty with the Wagner cone femoral stem in patients with Crowe IV developmental dysplasia of the hip: a retrospective study. J Arthroplast. 2022;37:103-109.
[Google Scholar]

[32] Edwards B.N., Tullos H.S., Noble P.C., . Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res. 1987;218:136-141.
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[33] Gallazzi E., Morelli I., Peretti G., Zagra L., . What is the impact of a previous femoral osteotomy on THA? A systematic review. Clin Orthop Relat Res. 2019;477:1176-1187.
[Google Scholar]

[34] Eggli S., Hankemayer S., Müller M.E., . Nerve palsy after leg lengthening in total replacement arthroplasty for developmental dysplasia of the hip. J Bone Joint Surg Br. 1999;81:843-845.
[Google Scholar]

[35] İncesoy M.A., Seluk S., Turk O.I., Ezici A., Mert M., Misir A., . Anatomical parameters associated with the shortening decision in Crowe type 4 dysplastic hip osteoarthritis: a case-control study. Indian J Orthop. 2022;56:1958-1968.
[Google Scholar]

[36] Kawai T., Goto K., Kuroda Y., Matsuda S., . Total hip arthroplasty combined with subtrochanteric transverse shortening osteotomy: factors associated with delayed union at the osteotomy site. J Am Acad Orthop Surg Glob Res Rev. 2020;4
[Google Scholar]

[37] Li C., Zhang C., Zhang M., Ding Y., . Comparison of transverse and modified subtrochanteric femoral shortening osteotomy in total hip arthroplasty for developmental dysplasia of hip: a meta-analysis. BMC Muscoskelet Disord. 2014;15:331.
[Google Scholar]

[38] Martinot P., Blairon A., Putman S., Pasquier G., Girard J., Migaud H., . Course of dislocated posterior hip arthroplasty: a continuous 232-patient series at a mean 10 years' follow up (range, 1-22 years) Orthop Traumatol Surg Res. 2018;104:325-331.
[Google Scholar]

[39] Woo R.Y., Morrey B.F., . Dislocations after total hip arthroplasty. J Bone Joint Surg Am.. 1982;64:1295-1306.
[Google Scholar]

[40] Masonis J.L., Bourne R.B., . Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res. 2002;405:46-53.
[Google Scholar]

[41] Oinuma K., Tamaki T., Miura Y., Kaneyama R., Shiratsuchi H., . Total hip arthroplasty with subtrochanteric shortening osteotomy for Crowe grade 4 dysplasia using the direct anterior approach. J Arthroplast. 2014;29:626-629.
[Google Scholar]

[42] Haynes J.A., Hopper R.H., Ho H., McDonald J.F., Parks N.L., Hamilton W.G., . Direct anterior approach for primary total hip arthroplasty lowers the risk of dislocation compared to the posterior approach: a single institution experience. J Arthroplast. 2022;37:495-500.
[Google Scholar]

[43] van Erp J.H.J., Snijders T.E., Weinans H., Castelein R.M., Schlösser T.P.C., de Gast A., . The role of the femoral component orientation on dislocations in THA: a systematic review. Arch Orthop Trauma Surg. 2022;142:1253-1264.
[Google Scholar]

[44] Peng Z., Lin X., Kuang X., Teng Z., Lu S., . The application of topical vancomycin powder for the prevention of surgical site infections in primary total hip and knee arthroplasty: a meta-analysis. Orthop Traumatol Surg Res. 2021;107
[Google Scholar]

[45] Tahta M., Isik C., Uluyardimci E., Cepni S., Oltulu I., . Total hip arthroplasty without subtrochanteric femoral osteotomy is possible in patients with Crowe III/IV developmental dysplasia: total hip arthroplasty without femoral osteotomy. Arch Orthop Trauma Surg. 2020;140:409-413.
[Google Scholar]

Total hip arthroplasty with subtrochanteric osteotomy for severe developmental dysplasia of the hip: A systematic review and meta-analysis

Abstract