Purposes Femoral shortening osteotomy is a promising surgical intervention for patients with the sequelae of high hip dysplasia who need a THA. It offers potential benefits such as preserving limb length, reducing joint stiffness, and preventing neurovascular damage. However, it is considered a complex procedure with a high risk of complications. Various techniques are employed, and their relative safety remains unclear. What is the prevalence of complications (e.g. non-union and dislocations) and rates of revision associated with different techniques of femoral shortening osteotomy? Methods A systematic review was conducted according to the PRISMA guidelines. Multiple databases were searched for studies reporting complications of various femoral shortening osteotomies. Two independent reviewers selected studies, extracted data, and assessed bias. Proportional meta-analysis was employed to estimate non-union rates, while other complications and revisions were described using alluvial diagrams. The study has been registered in the PROSPERO database (CRD42023488761). Results In total, 53 studies (comprising 1,925 hips undergoing osteotomy) were included. The transverse subtrochanteric shortening osteotomy emerged as the most frequently utilized technique. There was an overlapping prevalence of non-union rates among the different osteotomy techniques, ranging from 0% (step-cut osteotomies) to 2% (transverse osteotomies). A higher non-union prevalence was observed with cemented stems in transverse osteotomies (4%, 95% CI: 0–9%). Dislocation rates were similar among techniques. The rate of stem aseptic loosening ranged from 7.14% (Z osteotomy) to 0% (step-cut and V-shaped osteotomies). Oblique osteotomy exhibited the highest infection rate (2.63%). Conclusion Overall, comparable rates of non-union were observed across osteotomy techniques. Heterogeneous results for other complications showed a low risk for all osteotomies. Level of evidence Level IV, therapeutic study.
Casciaro et al. (Sun,) studied this question.