Article

Historically, a Schanz osteotomy of the femur has been
used to reduce limp in patients with severely dysplastic hips.
In such hips,
total hip arthroplasty is a technically demanding operation. We report the
long-term results of cementless total hip arthroplasty in a group of patients who
had all undergone a Schanz osteotomy earlier. PATIENTS AND METHODS: From 1988
through 1995, 68 total hip replacements were performed in 59 consecutive patients
previously treated with a Schanz osteotomy. With the cup placed at the level of
the true acetabulum, a shortening osteotomy of the proximal part of the femur and
distal advancement of the greater trochanter were performed in 56 hips. At a mean
of 13 (9-18) years postoperatively, we evaluated these patients clinically and
radiographically. RESULTS: The mean Harris hip score had increased from 51 points
preoperatively to 93 points. Trendelenburg sign was negative and there was good
or slightly reduced abduction strength in 23 of 25 hips that had not been
revised. There were 12 perioperative complications. Only 1 cementless press-fit
porous-coated cup was revised for aseptic loosening. However, the 12-year
survival rate of these cups was only 64%, as 18 cups underwent revision for
excessive wear of the polyethylene liner and/or osteolysis. 6 CDH femoral
components had to be revised due to technical errors. INTERPRETATION: Our results
suggest that cementless total hip arthroplasty combined with a shortening
osteotomy of the femur and distal advancement of the greater trochanter can be
recommended for most patients with a previous Schanz osteotomy of the femur.
Because of the high incidence of liner wear and osteolysis of modular cementless
cups in this series, nowadays we use hard-on-hard articulations in these patients.

Langue : ANGLAIS