A New Technique of Subtrochanteric Shortening in Total Hip Replacement for Crowe Type 3 to 4 Dysplasia of the Hip

A new technique of femoral fixation that uses a transverse osteotomy for subtrochanteric shortening and derotation in total hip arthroplasty for Crowe type 3 to 4 dysplasia of the hip is described. This series included 21 cases in 12 women and 2 men, with a mean age of 42.3 years. Follow-up averaged 41.2 months. Bone pegs prepared from the resected femoral segment were seated in the medullary canal around the stem for femoral fixation. Merle d'Aubigne scores for pain, motion, and walking improved from 2.9, 4.4, and 3.7 to 5.2, 5.4, and 5.5, respectively. Radiographic union was detected within 12 +/- 3.4 (range, 6-24) weeks in all cases. Complications were early dislocation in 2 cases. This technique allows correction of anteversion, provides excellent rotational stability, and eliminates the need for additional osteosynthesis regardless of the stem design.