ASSESSMENT OF PRE-OPERATIVE PREDICTORS FOR FEMORAL SHORTENING IN DEVELOPMENTAL DYSPLASIA OF HIP
DOI:
https://doi.org/10.71000/j00saw59Keywords:
Breech Presentation, Developmental Dysplasia of Hip, Femoral Osteotomy, Femoral Shortening, Orthopedic Surgery, Pediatric Orthopedics, Predictive FactorsAbstract
Background: Femoral shortening is a critical adjunct during open reduction for developmental dysplasia of the hip (DDH), especially in cases presenting late or with severe dislocation. It reduces soft tissue tension and minimizes complications like avascular necrosis and redislocation. Despite its importance, limited data exist regarding preoperative predictors of its necessity, particularly in local clinical settings.
Objective: To determine the preoperative factors associated with the need for femoral shortening during surgical management of DDH.
Methods: A cross-sectional study was conducted at the Department of Orthopaedic Surgery, Khyber Teaching Hospital, Peshawar. A total of 169 children aged 1–10 years, diagnosed with IHDI grade 3 or 4 DDH and scheduled for open reduction, were enrolled through non-probability consecutive sampling. Data on demographics, clinical history, and radiological findings were collected. The primary outcome was whether femoral shortening was performed, assessed intraoperatively. Statistical analysis was performed using SPSS v25, with chi-square tests and binary logistic regression applied to identify significant predictive factors (p≤0.05).
Results: Femoral shortening was performed in 89 patients (52.7%). Significant predictors included age >5 years (76.4%), female gender (66.2%), breech delivery (64.3%), positive family history of DDH (61.8%), and IHDI grade 4 (72.5%). Each of these variables showed a strong association with the likelihood of undergoing femoral shortening during surgery.
Conclusion: Older age, female gender, breech presentation, familial predisposition, and higher DDH grade are strong preoperative indicators for femoral shortening. Early identification of these factors allows for better surgical planning and improved parental counseling.
References
Miyazaki T, Shimizu T, Ohura H, Katayama N, Iwasaki N, Takahashi D. Total hip arthroplasty with femoral shortening osteotomy using polished cemented stem vs. modular cementless stem in patients with Crowe type IV developmental dysplasia of the hip. Arch Orthop Trauma Surg. 2023;143(6):3487-93.
Ibrahim FMF, Gameel S. Total cementless unconstrained hip arthroplasty in Crowe type IV hip dysplasia with subtrochentric derotation osteotomy. Acta Orthop Belg. 2022;88(3):517-24.
Tao K, Wang SC, Ma XY, Shao L, Di ZL, Huang ZY. Three-dimensional femur morphology analysis for the optimal location of subtrochanteric osteotomy with an implanted Wagner cone stem in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip. J Orthop Surg Res. 2023;18(1):410.
Talwar J, Agarwal S, Agarwal S, Krishna LG, Rustagi A. Step-Cut Subtrochanteric Osteotomy Combined with Total Hip Arthroplasty for Neglected Traumatic Hip Dislocations. Clin Orthop Surg. 2022;14(2):205-12.
Davulcu CD, Ozsahin MK, Kayaalp ME, Celayir A, Akbaba D, Unlu MC. Rectangular femoral stems can successfully accommodate the medullary canal in patients with severe hip dysplasia operated on with total hip arthroplasty and a shortening osteotomy: A morphometric study. Acta Orthop Belg. 2024;90(4):581-7.
Köroğlu C, Özdemir E, Çolak M, Şensöz E, Öztuna FV. Open reduction and Salter innominate osteotomy combined with femoral osteotomy in the treatment of developmental dysplasia of the hip: Comparison of results before and after the age of 4 years. Acta Orthop Traumatol Turc. 2021;55(1):28-32.
Sun J, Cui Y, Qu J, Lian F. Mathematical calculation of the difference in shortening length after two types of proximal femoral varus and an investigation of their applicable conditions: an own-pair design. J Orthop Surg Res. 2022;17(1):563.
Sun C, Zhang Y, Li LT, Ding H, Guo T, Zhao JN. Long-Term Outcomes of Total Hip Arthroplasty With Transverse Subtrochanteric Shortening Osteotomy and Modular Stem in Crowe IV Developmental Dysplasia. J Arthroplasty. 2021;36(2):630-5.
Du YQ, Guo LF, Sun JY, Shen JM, Zhang BH, Jin ZG, et al. The Influence of Femoral Proximal Medullary Morphology on Subtrochanteric Osteotomy in Total Hip Arthroplasty for Unilateral High Dislocated Hips. Orthop Surg. 2021;13(6):1787-92.
Rego P, Mascarenhas V, Mafra I, Oliveira F, Pinto P, Ganz R. Femoral neck osteotomy in skeletally mature patients: surgical technique and midterm results. Int Orthop. 2021;45(1):83-94.
Li Y, Zhang Z, Ren N, Cheng H, Luo D, Zhang H. [Effects of femoral offset and mechanical axis of the lower extremity on hip after osteotomy for adult developmental dysplasia of the hip]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021;35(12):1549-54.
Cao J, Gao C, Sun JH, Zheng HJ, Zhu HY, Zhong ZP, et al. Effect of 3D Printing Technology in Proximal Femoral Osteotomy in Children with Developmental Dysplasia of the Hip. Dis Markers. 2022;2022:1291996.
Bourantas CA, Behrman EC, Shepherd MC, Lohse KR, Clohisy JC, Harris MD. Dynamic femoral head coverage following periacetabular osteotomy for developmental dysplasia of the hip. Clin Biomech (Bristol). 2025;124:106471.
Karaismailoglu B, Karaismailoglu TN. Comparison of Trochanteric Slide and Subtrochanteric Shortening Osteotomy in the Treatment of Severe Hip Dysplasia: Mid-Term Clinical Outcomes of Cementless Total Hip Arthroplasty. J Arthroplasty. 2020;35(9):2529-36.
Bulut M, Azboy I, Ozkul E, Karakurt L. Comparison of Iliac and Femoral Autograft Practices in Pemberton Pelvic Osteotomy. J Pediatr Orthop. 2021;41(1):46-50.
Mo TT, Zhu YS, Zhang JN, Zhang WK, Jiang C. The clinical effect of trochanteric slide osteotomy combined with a cementless femoral conical stem in total hip replacement for the treatment of Crowe type IV developmental dysplasia of the hip. Technol Health Care. 2023;31(2):553-63.
Kayaalp ME, Can A, Erdogan F, Ozsahin MK, Aydingoz O, Kaynak G. Clinical and Radiological Results of Crowe Type 3 or 4 Dysplasia Patients Operated on With Total Hip Arthroplasty Using a Cementless Rectangular Femoral Component Without Fixating or Grafting the Transverse Osteotomy Site. J Arthroplasty. 2020;35(9):2537-42.
Zha GC, Wang Y, Zhang K, Guo ZT, Luo JW, Guo KJ, et al. The Clinical and Radiological Outcomes of Subtrochanteric Osteotomy in Crowe Type IV Hip Dysplasia: A Comparison of Three Different Stem Designs. J Am Acad Orthop Surg. 2022;30(12):e867-e77.
Lyu X, Fu G, Feng C, Yang J, Wang Y, Zhu Z. Clinical and radiological outcomes of combined acetabuloplasty with acetabular redirectional osteotomy and femoral shortening for children older than 9 years of age with developmental dysplasia of the hip: a retrospective case series. J Pediatr Orthop B. 2020;29(5):417-23.
Li F, Wu Y, Song Z, Tadum Arthur Vithran D, Li X, Fang K, et al. Characteristics of surface electromyogram signals after Pemberton pelvic osteotomy combined with femoral osteotomy in children with unilateral developmental dysplasia of the hip. Medicine (Baltimore). 2022;101(28):e29794.
Tikhilov RM, Dzhavadov AA, Ziganshin DR, Zakhmatov NS, Alekberov RR, Shubnyakov, II. Cementless Total Hip Arthroplasty With Paavilainen Femoral Shortening Osteotomy Can Provide Good Results at 10 Years in Patients Who Have Crowe IV Developmental Dysplasia of the Hip. J Arthroplasty. 2024;39(9):2316-22.
Barbaret A, Laisne P, Flecher X, Jacquet C, Argenson JN. Can customised total hip arthroplasty without femoral shortening osteotomy improve functional outcome and long-term stem survivorship in developmental dysplasia of the hip? Hip Int. 2025;35(3):308-14.
Hu Y, Zhang J, Sun Z, Yu D, Li H, Zhu Z, et al. Application of a novel osteotomy instrumentation as a substitute tool in total hip arthroplasty. BMC Musculoskelet Disord. 2022;23(1):437.
Uemura K, Hiraiwa T, Okamoto M, Tokunaga K, Anderson AE. The anterior center edge angle has limited ability to predict three-dimensional coverage of the femoral head in patients with developmental dysplasia of the hip undergoing curved periacetabular osteotomy. Arch Orthop Trauma Surg. 2023;143(3):1323-30.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Zeeshan Khan, Abbas Ali, Imtiaz ur Rehman, Wajid Ullah, Muhammad Zeb, Waqar Ali (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
