Severe hip dysplasia (Crowe IV) – subtrochanteric shortening osteotomy and acetabular augmentation


This is a 30 year old male who underwent prior open hip reduction and spica casting as an infant for developmental hip dysplasia. He complained of severe left hip pain, leg shortening, and difficulty walking. The patient was told he was too young for hip replacement and that the surgery was too complicated. He came to Dr. Chen for a second opinion, who agreed to take on this challenging reconstruction.

The patient underwent complex total hip replacement. Due to a severe adduction hip contracture, he first had a percutaneous adductor tenotomy to allow for correction of pelvic obliquity as well as reduction of the hip. The acetabulum was reconstruction with an anatomically placed 42mm micro socket at the native hip center and superior augmentation with a trabecular metal implant. The femur was reconstructed using a subtrochanteric shortening osteotomy and a modular SROM stem. The sciatic nerve was monitored using a handheld nerve stimulator to protect against sciatic nerve palsy.

The patient did well after surgery and can walk unassisted with near normal leg lengths.