Surgical strategy in total hip arthroplasty for reconstruction of proximal femur with severe deformity

Objective To investigate the optimal surgical strategy in total hip arthroplasty(THA) for reconstruction of proximal femur with severe deformity.Methods The clinical data of 39 patients with severe proximal femur deformity undergoing THA were retrospectively analysed.Imaging examinations were performed to assess the proximal femoral configuration before operation,short-term and mid-term complications were followed up after operation,leg length discrepancy and restoration of hip rotator center were evaluated,and fracture union and fixation stability were analysed in the site of osteotomy.Results Imaging examinations demonstrated complicated configuration change in the proximal femur,and mal-position or abnormal configuration of greater trochanter was found in 28 patients.Harris score significantly increased from(45.80±7.84) points before operation to(82.00±2.57) points after operation(P0.01).The rotator center was restored in the level of true acetabulum in all the 39 patients according to Linde-Jensen classification.Complications included peri-prosthetic fracture,hip dislocation and impingement.In spite of remaining 0.5-1.5 cm leg length discrepancy in 2 patients,bony healing was achieved in all osteotomy sites.Conclusion Location and configuration of the greater trochanter are considered as the most critical pathological parameters for establishing personalized THA strategy for severe deformity in proximal femur.Among the procedures,soft tissue release,osteotomy and prosthesis selection are the key techniques.