Surgical Outcomes of Total Hip Arthroplasty With Paavilainen Osteotomy in Patients Who Have High Developmental Hip Dislocation: Mean 4.4-Year Follow-Up

• Published in: The Journal of arthroplasty 2024-10
• Main Authors: Li, Xuezhou, Zheng, Tong, Du, Longzhuo, Wei, Shusheng, Guo, Yongyuan, Jia, Yuhua
• Format: Article
• Language: English
• Subjects: high developmental hip dislocation; hip joint reconstruction; Paavilainen osteotomy; surgical outcomes; total hip arthroplasty
• ISSN: 0883-5403; 1532-8406; 1532-8406
• DOI: 10.1016/j.arth.2024.10.059

Although subtrochanteric osteotomy is a common procedure, the use of Paavilainen osteotomy combined with total hip arthroplasty (THA) for high developmental hip dislocation is less documented. This study assessed the efficacy and complications of this approach, with a particular focus on the risk factors for nonunion postosteotomy. All patients who had high dislocated hip dysplasia who underwent combined THA and Paavilainen osteotomy were retrospectively reviewed with over 1 year of follow-up. A total of 44 patients (51 hips) were included, with an average follow-up period of 4.4 years (range, 1.97 to 6.94). Anatomical data of the hip joints were measured on preoperative and postoperative radiographs. Demographic data, Trendelenburg sign, complications related to this procedure, Harris Hip Score, and EuroQoL-5-Dimension 5-Level health questionnaire were collected from the medical chart. Binary logistic regression analysis was used to identify predictors for bone nonunion. Out of the 51 hips, eight displayed a positive Trendelenburg sign. Patients’ Harris Hip Score saw an improvement from 43.8 ± 11.8 preoperatively to 85.7 ± 11.1 at the latest follow-up (P < 0.001), accompanied by a substantial enhancement in the average EuroQoL-5-Dimension 5-Level score from 0.38 ± 0.15 to 0.87 ± 0.13 (P < 0.001). Non-union, as the most concerning complication, occurred in 12% (seven of 56) of osteotomy cases. The contact length between the osteotomy block and femoral cortex was a key risk factor for nonunion. The receiver operating characteristic analysis identified 2.15 cm as the critical bone contact length for healing. Paavilainen osteotomy combined with THA and subtrochanteric osteotomy proved effective and less complex than other techniques for high-dislocation hip dysplasia. A bone contact length between the greater trochanteric fragment and the femoral cortex of less than 2.15 cm is a risk factor for nonunion.