SHORTENING SUBTROCHANTERIC OSTEOTOMY FOR HIGH HIP DISLOCATION

|
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
 110 views
of 31

Please download to get full document.

View again

Description
SHORTENING SUBTROCHANTERIC OSTEOTOMY FOR HIGH HIP DISLOCATION. Daniel J. Berry, MD Mayo Clinic Rochester, MN. SUBTROCH. SHORTENING OSTEOTOMY Introduction. High Dislocation: Goals of Surgery: Normalize hip center Gain stable implant fixation Optimize abductor function
Share
Transcript
SHORTENING SUBTROCHANTERIC OSTEOTOMY FOR HIGH HIP DISLOCATION Daniel J. Berry, MD Mayo Clinic Rochester, MN SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONIntroduction High Dislocation: Goals of Surgery:
  • Normalize hip center
  • Gain stable implant fixation
  • Optimize abductor function
  • Protect sciatic nerve
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONIntroduction Traditional Method:
  • Greater trochanteric osteotomy
  • Shorten femur until hip can be reduced
  • Insert cemented stem
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONTraditional Method Drawbacks to Traditional Method:
  • Problems with greater trochanter– which doesn’t always heal
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONTraditional Method Drawbacks to Traditional Method:
  • Permanently changes shape of proximal femur
  • - no metaphyseal flare
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONTraditional Method Drawbacks to Traditional Method:
  • Requires cemented stem
  • - less desirable in younger patients?
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONAdvantages Advantages of Shortening Osteotomy:
  • No greater trochanteric problems
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONAdvantages Advantages of Shortening Osteotomy:
  • Preserves architecture of proximal femur
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONAdvantages Advantages of Shortening Osteotomy:
  • Allows use of uncemented implants
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONAdvantages Advantages of Shortening Osteotomy:
  • Protects sciatic nerve
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONAdvantages Advantages of Shortening Osteotomy:
  • Allow leg length, femoral anteversion correction
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONResults Masonis et al. (London, Ontario):
  • 21 hips (F/U 6 yrs)
  • 10 uncemented, 11 cemented
  • 2 nonunions
  • 1 loose cemented stem
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONResults Masonis et al. (London, Ontario):
  • 3 dislocations
  • No sciatic n. injury
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONResults Mayo Clinic:
  • Uncemented fully coated or modular stem
  • 18 hips
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONResults Results:
  • 100% stable implants
  • 0% nonunions
  • Complications:
  • 1 dislocation
  • 0 infection
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONResults Functional Results:
  • Favorable return of abductor function
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONMethod
  • Posterior hip dislocation
  • Osteotomize femoral neck
  • Preliminary femoral preparation
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONMethod
  • Limited exposure of femur at planned osteotomy level
  • Transverse osteotomy
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONMethod
  • Retract femur anteriorly
  • Direct exposure of acetabulum
  • Insert cup
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONMethod
  • Reduce hip with trial in proximal fragment only
  • Shorten femur appropriately
  • Trial with osteotomy reduced
  • SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONMethod
  • Insert femoral component
  • Add autogenous strut if desired
  • CASE EXAMPLES DISLOCATION SUBTROCH. SHORTENING OSTEOTOMY DISLOCATIONConclusions
  • Elegant method
  • Safe and effective
  • Satisfies goals of surgery:
  • normalize hip center
  • protect nerve
  • stable implant fixation
  • Related Search
    We Need Your Support
    Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

    Thanks to everyone for your continued support.

    No, Thanks