Role of Ortho Biologics in Subtrochanteric Osteotomy Non-union in a Case of Developmental Hip Dysplasia Managed with Total Hip Replacement - A Case Report.

Abstract

Introduction: Hip dislocations are very common at a younger age because of predisposing factors, such as laxity of the hip. If not reduced promptly, osteonecrosis of the femoral head can occur, requiring osteotomies or hip replacement later in life. In case of severe deformities, along with hip replacement, subtrochanteric osteotomy is often needed so as to address deformity and limb length discrepancy. Non-unions at the osteotomy site are not rare and can be treated with orthobiologics. Orthobiologics have been found to increase union rates, decrease healing times, and enhance union in long bone fractures. Plateletrich plasma (PRP) and bone marrow aspirate concentrate (BMAC) are rich sources of several growth factors that promote angiogenesis and osteogenesis through multiple mechanisms.

Case report: Here, we discuss the case of a 27-year-old male who had congenital hip dislocation, which was managed conservatively. At 18 years of age, he underwent a pelvic osteotomy and limb lengthening procedure. The symptoms subsided, but there was a recurrence of pain for the past 2 years, which was aggravated with movements. He was diagnosed with Crowe type IV dysplastic hip, and a right total hip with long stem was carried out along with subtrochanteric osteotomy. However, at 3 months of follow-up, the union was not sufficiently appreciated on radiograph, and the patient still complained of pain.

Conclusion: Hence, a single dose of BMAC injection was given, followed by three doses of PRP injections. The final follow-up was done 1 year after the surgery, and the patient had satisfactory outcomes.