Hip replacement for adults with unreduced congenital dislocation. A new surgical technique

Seo

Clinical Orthopaedics &Amp; Related Research

2009

To ascertain whether THA in patients with high dislocation after childhood sepsis would relieve pain and improve function, we assessed the rate of postoperative infection, improvement in Harris hip and WOMAC scores, and improvement in range of motion after the THA in 62 patients (62 hips) with high dislocation (Crowe Type 4) after childhood sepsis. The revision rate and the incidence of complications also were assessed. The mean age of the patients was 47.5 years. The minimum followup was 13 years (mean, 15.2 years; range, 13-17 years). One patient had persistent infection. The mean preoperative Harris hip score of 55 points improved to 89 points at the final followup, and the mean preoperative WOMAC score of 65 points improved to 42 points. The mean combined preoperative arc of range of motion of 197°improved to 275°. Four cups (6%) and three stems (5%) were revised. Complications developed in nine hips (15%), but the rate of infection was low. Improved surgical technique and design of components provided favorable results for total hip replacement performed for complications of childhood sepsis in these young and active patients.

Section: Discussionmentioning

confidence: 99%

Outcomes after THA in Patients with High Hip Dislocation after Childhood Sepsis

Seo

Clinical Orthopaedics &Amp; Related Research

2009

International Orthopaedics (SICOT)

“…proximal femoral shortening osteotomy with distal advancement of the greater trochanter, splitting the femoral shaft with proximal shortening, a modified lateral approach combined with chisel detachment of the anterior and posterior halves of the continuous tendon of the gluteus medius and vastus lateralis muscle and a step-cut shortening osteotomy with or without angular correction [1,2,7,8,13,18,20]. We used the step-cut osteotomy to secure the fragments against rotation and to obtain correction of antetorsion and angulation combined with shortening if a Schanz osteotomy had been previously performed.…”

Section: Discussionmentioning

confidence: 99%

“…In surgical reconstruction of congenital hip dislocation, positioning of the acetabular component in the true acetabulum can only be accomplished by shortening of the femur [1][2][3][4]. Resection of several centimetres of the proximal end of the femur and cemented fixation of the stem has been previously reported [1,3,[5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Femoral shortening and cementless arthroplasty in Crowe type 4 congenital dislocation of the hip

Neumann¹,

Thaler²,

Dorn³

2011

Purpose In reconstruction of congenital hip dislocation by total hip arthroplasty (THA), positioning of the acetabular component in the true acetabulum is sometimes accompanied by shortening of the femur. Shortening of the femur is of importance for minimising risk of damaging neurovascular structures due to excessive limb lengthening. Furthermore, reduction of the femoral head into the true acetabulum remains challenging without shortening of the femur. Methods We performed a consecutive case series of cementless THA with femoral shortening and Crowe type 4 congenital dislocation. All acetabular cups were placed in their original anatomical location. In all cases a proximal diaphyseal step-cut shortening osteotomy was performed and stabilised with two to three titanium cerclage bands. Results At an average of 60 months follow-up (range 36-96), 12 patients (13 THA) were scored clinically by the Merle D'Aubigne and Harris hip scores. In ten cases good to excellent outcome scores were observed. During the followup period no cases of aseptic loosening, nerve palsy, nonunions or dislocations were found. Conclusions This technique seems to be an excellent treatment option in the case of Crowe type 4 hips presenting with endstage osteoarthritis.

Strategies in Trauma and Limb Reconstruction

“…The successful placement of the acetabular component demands an anatomic reduction so as to avoid excessive compressive loads across the hip joint. In order to accomplish this flexor and abductor muscles may be released from the iliac bone as suggested by Harley and Wilkinson [1].…”

Section: Discussionmentioning

confidence: 99%

External fixator-assisted acute shortening with internal fixation for leg length discrepancy after total hip replacement

Kasis¹,

Stockley²,

Saleh³

2008

We report a case of a 51-year-old lady, who underwent a femoral shortening using a fixator assisted blade plate after total hip replacement. The patient had a total hip replacement on the other side with previous revisions, which resulted in a leg length discrepancy. We used the above technique to control the shortening and preserve the mechanical and anatomical axis of the femur.Keywords External fixator Á Femoral shortening Á Total hip replacement Case reportA 35-year-old lady with a history of neglected developmental dysplasia (DDH) of the right hip presented with increasing hip pain, back pain and progressive knee deformity. She subsequently underwent conversion of the pseudoarthrosis to a total hip replacement. At the time of surgery, despite adductor tenotomy, it was difficult to relocate the trial prosthesis and a resection of the proximal femur was necessary. A straight stem prosthesis was cemented in the femur (Fig. 1).Ten years later the patient required a revision of the acetabular component as a consequence of aseptic loosening. The acetabular reconstruction was undertaken using a cemented socket and with impacted bone graft. The reconstruction lasted for 9 more years before a further revision was required. There was extensive bone loss in the acetabulum and the reconstruction was performed using a Burch Schneider support ring, mesh and again with impaction bone graft. The bone stock in the proximal femur was so poor that a proximal femoral allograft with an uncemented stem was used to reconstruct the proximal femur. A leg length discrepancy of 5 cm remained.Increasingly symptomatic osteoarthritis in the left hip necessitated a left primary arthroplasty to be performed 3 years later. Six months after the left THR (age 51), she presented with increasing back pain attributed to a 5-cm discrepancy in leg length (Fig. 2). Shortening of the left femur was done by performing an external fixator-assisted shortening through a supracondylar resection and internal stabilisation with a blade plate. Operative techniqueA limb reconstruction system (LRS) external fixator (Orthofix SRL, Italy) with four screws (150/50) was inserted in the sagittal plane under X-ray control perpendicular to the anatomical axis of the femur. Two screws were inserted above and two below the proposed level of femoral resection (Fig. 3). Through a lateral incision and subperiosteal approach a 4-cm segment of the distal femur was removed. The femur was then gradually shortened using the compression-distraction device on the fixator until bone contact at the edges of the osteotomy was achieved. With the fixator still in place, the newly shortened femur