An oblique osteotomy is better for subtrochanteric shortening in total hip arthroplasty for high hip dislocation: a mechanical comparison of four techniques

Atlihan D., Yildirim C., Muratoglu O. G., Muslu D. C., Tokgozoglu M., Bayir D., ...More

HIP INTERNATIONAL, vol.32, no.3, pp.345-352, 2022 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 32 Issue: 3
  • Publication Date: 2022
  • Doi Number: 10.1177/1120700020957990
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, Aerospace Database, CINAHL, Communication Abstracts, EMBASE, MEDLINE, Metadex, Civil Engineering Abstracts
  • Page Numbers: pp.345-352
  • Keywords: Arthroplasty, biomechanics, high hip dislocation, osteotomy, STEP-CUT, TRANSVERSE, REPLACEMENT, DYSPLASIA
  • Hacettepe University Affiliated: Yes


Background: Subtrochanteric femoral shortening is used during total hip arthroplasty for high hip dislocation in developmental dysplasia of hip patients. Methods: We mechanically tested the stability of various commonly used subtrochanteric osteotomy techniques. As the equivalent of a femoral stem placed in a shortened femur without any stable fixation at the osteotomy line, 2 polyvinylchloride pipes were loosely intertwined. 4 different osteotomies (Z-subtrochanteric osteotomy, oblique-45 degrees osteotomy, double Chevron-90 degrees and 120 degrees subtrochanteric osteotomy) were simulated. Torsional and axial loads were applied, and torsional stiffness was calculated for each test model. Results: Z, double Chevron-90 degrees and 120 degrees subtrochanteric osteotomy models demonstrated lower mean torsional stiffness than oblique-45 degrees osteotomy. With the highest torsional stiffness oblique-45 degrees provides the best stability for treatment of high dislocation hips when a subtrochanteric osteotomy is added. Conclusions: This matches our previous clinical experience. Oblique osteotomy may also provide higher contact surfaces in the osteotomy lines to promote bone healing.