Archives of Orthopaedic and Trauma Surgery (2018) 138:427–434
Cementless total hip arthroplasty for severely dislocated hips
previously treated with Schanz osteotomy of the proximal femur
Yunus Emre Akman
· Umut Yavuz
· Engin Çetinkaya
· Volkan Gür
· Murat Gül
· Bilal Demir
Received: 21 June 2017 / Published online: 2 February 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Introduction We report the short-term outcomes of total hip arthroplasty(THA) in patients previously treated with Schanz
Materials and methods Eighteen patients [2 male, 16 female; mean age, 55.4 (range, 50–66) years] who had undergone
THA after SO were retrospectively evaluated. Clinical evaluation was performed based on the Harris hip score. Radiological
evaluation was performed using full-length radiographs of the lower extremities, pelvis, and hip.
Results The mean follow-up period was 30.8 (range, 18–56) months. Mean femoral shortening was 3.7 (range, 2–5) cm.
Perioperative complications occurred in 4 (22.2%) patients. Nonunion was not found at the osteotomy sites. No dislocation
was observed. The Trendelenburg sign was positive for ﬁve (27.7%) patients, postoperatively. The mean Harris hip score
improved from 42.7 to 78.7 (p < 0.05).
Conclusion THA for hips previously treated with SO is technically demanding. If careful preoperative planning is performed,
successful treatment can be achieved.
Keywords Schanz osteotomy · Proximal femur · Total hip replacement · Harris hip score
Schanz osteotomy (SO) is a palliative procedure for patients
with neglected congenital dislocation of the hip. This sur-
gery aims to reduce pain and limping and to improve hip
function by providing anatomical support . It is a low
subtrochanteric valgization osteotomy. The apex of the oste-
otomy is kept at the level of the ischial tuberosity. Because
the length of the ﬂexor and abductor group muscles is not
changed, the hip motion strength is maintained in these
Total hip arthroplasty (THA) following SO of the proxi-
mal femur is challenging due to altered bony anatomy
including medullary canal narrowing and ossification,
changes in femoral alignment, and soft tissue contractures.
In some cases, hardware needs to be removed at the time
of THA and prior surgeries do increase the risk of deep
implant infections [2–4]. However, few studies have reported
the clinical and radiological outcomes of THA performed in
patients previously treated with SO; these patients were eval-
uated only as small subgroups of a whole series [2, 5–12].
In the literature, only two studies have concentrated on THA
after SO [3, 4]. Diﬀerent osteotomy techniques, including
trochantheric advancement, are suggested for deformity cor-
rection in the proximal femur. Complications related to the
osteotomy site, neurological deﬁcits, and dislocations are
frequent [3, 4].
In this study, we evaluated the short-term radiological
and clinical outcomes of THA after SO. Here, we report the
perioperative complications of THA procedures performed
for hips previously treated with SO.
Materials and methods
This study was approved by our institutional review board.
All participants provided written informed consent. We
retrospectively evaluated cementless THA procedures
* Engin Çetinkaya
Yunus Emre Akman
Baltalimani Bone and Joint Diseases Education and Research
Hospital, Rumelihisari Cad. No: 62, Baltalimani, Sariyer,