JOA - 2026-07-04 - Journal Article
Patient Satisfaction and Outcomes at a Mean 11-Year Follow-Up Following Total Hip Arthroplasty with Subtrochanteric Osteotomy for Dislocated Hips After Schanz Osteotomy.
Fujii M, Kawano S, Ueno M, Oba Y, Sonohata M, Morimoto T
Topics
Key Takeaway
THA with subtrochanteric osteotomy for Crowe IV hips after Schanz osteotomy achieved 88.9% implant survivorship at 10 and 20 years and 90% patient satisfaction, with preoperative mobility aid use carrying a 13x odds of dissatisfaction.
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Summary
This study evaluated clinical outcomes, implant survivorship, and satisfaction predictors in 93 hips with Crowe IV dislocation after prior Schanz osteotomy treated with THA plus subtrochanteric osteotomy. Median JOA score improved from 49 to 86 (P<0.001), and Kaplan-Meier survivorship was 88.9% at both 10 and 20 years with no revisions after 8.4 years. Preoperative mobility aid use independently predicted both poor functional outcome (OR 12.21) and dissatisfaction (OR 13.08) on multivariate analysis.
Key Limitation
The extremely wide confidence intervals on the key predictors (OR 12.21, 95% CI 1.35–1,615.31) reflect insufficient statistical power, rendering the magnitude of the mobility aid association unreliable for clinical decision thresholds.
Original Abstract
BACKGROUND
Total hip arthroplasty (THA) for chronically dislocated hips after Schanz osteotomy is technically demanding, with limited data on outcomes and patient satisfaction. This study aimed to determine clinical outcomes, implant survivorship, and factors associated with poor functional outcome and dissatisfaction after THA with subtrochanteric osteotomy.
METHODS
We retrospectively reviewed 73 patients (93 hips) who had Crowe IV dislocation treated with Schanz osteotomy and who underwent THA with subtrochanteric osteotomy. Implant survival (revision for any reason as the endpoint) and predictors of poor functional outcome (Japanese Orthopaedic Association [JOA] hip score less than 70) were analyzed. Factors associated with dissatisfaction (visual analog scale less than 50) were analyzed in patients who completed patient-reported outcome measure (PROM) questionnaires (55 patients, 71 hips; 75% response rate). Multivariate analyses used bias-reduced logistic regression models for limited events.
RESULTS
The median JOA score improved from 49 (interquartile range [IQR], 41 to 62) to 86 (IQR, 76 to 93) at a mean follow-up of 11 years (range, 2.0 to 21) (P < 0.001). Kaplan-Meier implant survivorship was 88.9% (95% confidence interval [CI], 82.0 to 95.9) at both 10 and 20 years, with no revisions beyond 8.4 years postoperatively. Multivariate analyses showed that preoperative mobility aid use was associated with poor functional outcome (odds ratio [OR], 12.21; 95% CI, 1.35 to 1,615.31; P = 0.013). In the PROM cohort, 64 of 71 hips (90%) were satisfied, and preoperative mobility aid use was associated with dissatisfaction (OR, 13.08; 95% CI, 1.28 to 1,774.59; P = 0.016).
CONCLUSIONS
A THA for Crowe IV dislocation after Schanz osteotomy improved function and patient satisfaction, with acceptable implant survivorship; however, complication and revision rates remained substantial. Preoperative mobility aid use was associated with poor outcomes, although estimates showed limited precision. The retrospective design and incomplete PROM follow-up warrant prospective multicenter validation.