To The Editor:
In the article, “Cementless total hip arthroplasty in
patients with high congenital hip dislocation”(1)
The authors are to be complimented for their classification of the different deformities and proposed
management strategy for each. However,we are concerned
about some of their surgical techniques.
Since 1999, we have used a proximally hydroxyapatite coated cementless stem; (Osteonics,
Securfit Plus®) for these patients. Our surgical technique on the femoral side
includes a short oblique subtrochanteric osteotomy and excision of a
segment of femur sufficient to allow for a safe reduction. Safe reduction usually requires extensive
soft tissue releases of the pelvifemoral muscles. The gluteus maximus, tensor
fascia latae and adductors are routinely released, but we limit the extent of these releases as much as possible because preserving the
attachment of the abductors and iliopsoas are important to optimize the
functional outcome. We never resect or osteotomize the trochanters and, if a
release is unavoidable, it is performed proximally. Thus, it is possible
to preserve a complete segment of the proximal femur with a soft tissue
envelope. This segment allows for better bone stock, prompt healing,
reliable proximal fixation through the intact medial calcar, and avoids the
complications of trochanteric osteotomy. With this technique we have not performed a femoral revision for any reason in 85 high dislocated hips
since 1999.
In the current article(1), the authors prefer to resect the medial calcar with
the lesser trochanter and they perform a greater trochanteric osteotomy. This approach
destroys the proximal femur; thus distal fixation with a calcar replacement femoral
stem remains the only option. Resecting the iliopsoas insertion and
reattachment of the abductors may cause gait abnormalities and fixation
failures. The reported femoral revision rate of 7% can be attributed to
this technique.
We would ask the authors to comment on whether their technique results in deficiency of proximal
bone support and motor power, as these may lead to limping, difficulty in
stair climbing, early fixation failures and difficulty in performing subsequent revisions.
The author(s) of this letter to the editor did not receive payment or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the author(s) are affiliated or associated.
Reference:
1. Eskelinen A, Helenius I, Remes V, Ylinen P, Tallroth K, Paavilainen T. Cementless total hip arthroplasty in patients with high congenital hip dislocation. J Bone Joint Surg Am 2006;88:80-91.
Letters to the Editor: ![[Read Letter to the Editor]](/icons/misc/sectionDOWN.gif){kind=icon}
