{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T01:38:56Z","timestamp":1792201136776,"version":"4.4.0"},"reference-count":25,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>High dislocation due to developmental dysplasia of the hip (DDH), classified as Crowe type III or IV, presents significant challenges in total hip arthroplasty (THA), particularly in preventing nerve complications while restoring leg length.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>This study aimed to evaluate the clinical and radiographic outcomes of primary THA using an S\u2010ROM\u2010A modular stem with oblique subtrochanteric shortening osteotomy in patients with high hip dislocation; to identify the advantages, limitations, and possible countermeasures of this surgical approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>Subjects were 45 hips (37 patients) with high hip dislocation (Crowe III\/IV) treated by primary THA using an S\u2010ROM\u2010A stem, with femoral shortening osteotomy performed at our institution. Outcomes 3\u2009years after surgery were examined in 100% of the subjects. Postoperative complications and functional and radiographic outcomes were investigated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean age at surgery was 65\u2009years and the mean duration of postoperative follow\u2010up was 10.7\u2009\u00b1\u20093.4\u2009years. There were no cases of postoperative infection, symptomatic pulmonary embolism, or neurological complications in the legs. Early postoperative dislocation occurred in two hips (4%, resolved conservatively) and osteotomy site nonunion in one hip (2%). Repeat surgery was required in only this case of nonunion (2%). The hip function score was significantly improved postoperatively. Leg lengthening after surgery was 0\u201356\u2009mm (mean, 28\u2009mm). Examination of radiographs revealed that it took 12\u2009weeks for bone union at the osteotomy site in all hips except for the one hip with nonunion. No stem subsidence was found postoperatively, and \u201cfixation by bone ingrowth\u201d was achieved at the final follow\u2010up examination in all hips (100%), including the one that required repeat surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>THA using an S\u2010ROM\u2010A modular stem with oblique subtrochanteric shortening osteotomy provided favorable mid\u2010term outcomes in patients with Crowe III\/IV DDH. No neurological complications occurred, and functional and radiographic improvements were substantial. Our method, which emphasizes intraoperative sciatic nerve palpation for individualized leg lengthening, may serve as a practical and safe alternative to more complex monitoring systems. Further research incorporating objective intraoperative monitoring may help standardize this approach.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.70154","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T02:55:06Z","timestamp":1755658506000},"page":"2895-2902","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Total Hip Arthroplasty for Crowe III\/IV Hip Dysplasia With Oblique Subtrochanteric Shortening Osteotomy and S\u2010ROM\u2010A Modular Stem: 10\u2010Year Outcomes"],"prefix":"10.1111","volume":"17","author":[{"given":"Tetsuo","family":"Hayama","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motoi","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Kyoto Kuno Hospital  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Otani","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Saitama Seikeikai Hospital  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8985-6312","authenticated-orcid":false,"given":"Hideki","family":"Fujii","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery The Jikei University Daisan Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiko","family":"Kawaguchi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Chofu Tozan Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiomi","family":"Abe","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuru","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"15","article-title":"Total Hip Replacement in Congenital Dislocation and Dysplasia of the Hip","volume":"61","author":"Crowe J. F.","year":"1979","journal-title":"Journal of Bone and Joint Surgery. American Volume"},{"issue":"2","key":"e_1_2_10_3_1","first-page":"205","article-title":"Cementless Total Replacement for Severely Dysplastic or Dislocated Hips","volume":"72","author":"Paavilainen T.","year":"1990","journal-title":"Journal of Bone and Joint Surgery. British Volume"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2017.01.010"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-018-4122-5"},{"key":"e_1_2_10_6_1","first-page":"548","article-title":"Cementless Modular Total Hip Arthroplasty With Subtrochanteric Shortening Osteotomy for Hips With Developmental Dysplasia","volume":"93","author":"Takao M.","year":"2011","journal-title":"Journal of Bone and Joint Surgery. American Volume"},{"key":"e_1_2_10_7_1","first-page":"65","article-title":"Lower Limb Inequality Treatment With Subtrochanteric Femoral Shortening Osteotomy Fixed With Intramedullary Nail","volume":"77","author":"Koczewski P.","year":"2012","journal-title":"Polish Orthopedics and Traumatology"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2010.03.029"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0883-5403(05)80180-9"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0883-5403(05)80181-0"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.3109\/17453679608995605"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1054\/arth.2002.27672"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-198705000-00019"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.4055\/cios.2013.5.3.167"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199407000-00025"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199103000-00025"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2013.04.041"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2022.04.022"},{"key":"e_1_2_10_19_1","first-page":"860","article-title":"Evaluation Chart of Hip Joint Functions","volume":"69","author":"Ogawa R.","year":"1995","journal-title":"Nippon Seikeigeka Gakkai Zasshi"},{"key":"e_1_2_10_20_1","first-page":"45","article-title":"Porous\u2010Coated Hip Replacement. The Factors Governing Bone Ingrowth, Stress Shielding, and Clinical Results","volume":"69","author":"Engh C. A.","year":"1987","journal-title":"Journal of Bone and Joint Surgery. British Volume"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/0300060519853383"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.12576"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.13996"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2023.103684"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/CORR.0000000000002900"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12306-023-00779-w"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.70154","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T03:45:06Z","timestamp":1759722306000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.70154"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,19]]},"references-count":25,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1111\/os.70154"],"URL":"https:\/\/doi.org\/10.1111\/os.70154","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"value":"1757-7853","type":"print"},{"value":"1757-7861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,19]]},"assertion":[{"value":"2025-04-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}