Surgeons often face significant challenges when performing Total Hip Arthroplasty (THA) for patients with Crowe type IV Developmental Dysplasia of the Hip (DDH). Specifically, the complete subluxation of the femoral head and a hypoplastic acetabulum complicate the procedure. To achieve safe reduction, surgeons frequently utilize femoral osteotomy techniques during Crowe IV DDH surgery. A recent retrospective study compares two prominent methods: low femoral neck osteotomy (LRNO) and subtrochanteric osteotomy (SO). Consequently, understanding these outcomes helps clinicians optimize perioperative care.

Comparing Surgical Techniques

Researchers evaluated 73 patients undergoing cementless THA. While both techniques effectively manage the proximal femoral deformity, LRNO demonstrated several perioperative advantages. For instance, the LRNO group experienced significantly shorter operative times and smaller incision lengths. Moreover, patients in the LRNO group had lower blood loss and reduced transfusion requirements for both blood and plasma. These findings suggest that LRNO improves perioperative efficiency.

Functional Outcomes in Crowe IV DDH Surgery

In addition to efficiency, clinical scores indicated a faster early recovery for LRNO patients. Specifically, the LRNO group achieved higher Harris Hip Scores (HHS) and Oxford Hip Scores (OHS) at one and three months postoperatively. However, this functional advantage leveled off by the six-month and 12-month marks. Ultimately, both groups showed comparable functional results at the one-year follow-up. Thus, while LRNO accelerates early recovery, the long-term functional benefits remain similar to subtrochanteric osteotomy.

Furthermore, radiographic analysis showed that LRNO resulted in a smaller postoperative leg length discrepancy (LLD). Clinically, this reduction in LLD contributes to improved patient satisfaction and gait. Regarding safety, the complication rates between the two groups did not differ significantly. This indicates that LRNO is as safe as the traditional subtrochanteric approach. Therefore, orthopedic surgeons may consider LRNO as a viable alternative to enhance early post-surgical outcomes.

FAQs about Crowe IV DDH Surgery

Which osteotomy method offers faster recovery?

Patients undergoing low femoral neck osteotomy (LRNO) typically experience faster functional recovery in the first three months compared to those having subtrochanteric osteotomy.

Does LRNO reduce surgical risks?

LRNO significantly reduces operative time, blood loss, and transfusion needs. However, the overall complication rate remains comparable to the subtrochanteric method.

Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice or a professional relationship. Always seek the advice of a qualified healthcare provider for any questions regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

1. Song L et al. Outcomes at 1 Year After Total Hip Arthroplasty Combined With Low Femoral Neck Osteotomy vs Subtrochanteric Osteotomy in 73 Patients With Crowe Type IV Developmental Dysplasia of the Hip: A Retrospective Study. Med Sci Monit. 2026 Mar 29. doi: 10.12659/MSM.951866. PMID: 41904620.


2. Comparison of Cementless Total Hip Arthroplasty With or Without Subtrochanteric Shortening Osteotomy in Crowe Type IV Developmental Dysplasia of the Hip. FirstWord Pharma. August 2025.


3. Early Functional and Radiographic Outcomes of Stable Fixation with a Derotational Plate in Subtrochanteric Osteotomy for Crowe IV Developmental Dysplasia of the Hip. Orthopedic Reviews. December 2025.