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SHORTENING SUBTROCHANTERIC OSTEOTOMY FOR HIGH HIP DISLOCATION Daniel J. Berry, MD Mayo Clinic Rochester, MN.

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Presentation on theme: "SHORTENING SUBTROCHANTERIC OSTEOTOMY FOR HIGH HIP DISLOCATION Daniel J. Berry, MD Mayo Clinic Rochester, MN."— Presentation transcript:

1 SHORTENING SUBTROCHANTERIC OSTEOTOMY FOR HIGH HIP DISLOCATION Daniel J. Berry, MD Mayo Clinic Rochester, MN

2 SUBTROCH. SHORTENING OSTEOTOMY Introduction High Dislocation: Goals of Surgery: Normalize hip center Gain stable implant fixation Optimize abductor function Protect sciatic nerve

3 SUBTROCH. SHORTENING OSTEOTOMY Introduction Traditional Method: Greater trochanteric osteotomy Shorten femur until hip can be reduced Insert cemented stem

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5 SUBTROCH. SHORTENING OSTEOTOMY Traditional Method Drawbacks to Traditional Method: Problems with greater trochanter– which doesn’t always heal

6 SUBTROCH. SHORTENING OSTEOTOMY Traditional Method Drawbacks to Traditional Method: Permanently changes shape of proximal femur - no metaphyseal flare

7 SUBTROCH. SHORTENING OSTEOTOMY Traditional Method Drawbacks to Traditional Method: Requires cemented stem - less desirable in younger patients?

8 SUBTROCH. SHORTENING OSTEOTOMY Advantages Advantages of Shortening Osteotomy: No greater trochanteric problems

9 SUBTROCH. SHORTENING OSTEOTOMY Advantages Advantages of Shortening Osteotomy: Preserves architecture of proximal femur

10 SUBTROCH. SHORTENING OSTEOTOMY Advantages Advantages of Shortening Osteotomy: Allows use of uncemented implants

11 SUBTROCH. SHORTENING OSTEOTOMY Advantages Advantages of Shortening Osteotomy: Protects sciatic nerve

12 SUBTROCH. SHORTENING OSTEOTOMY Advantages Advantages of Shortening Osteotomy: Allow leg length, femoral anteversion correction

13 SUBTROCH. SHORTENING OSTEOTOMY Results Masonis et al. (London, Ontario): 21 hips (F/U 6 yrs) 10 uncemented, 11 cemented 2 nonunions 1 loose cemented stem

14 SUBTROCH. SHORTENING OSTEOTOMY Results Masonis et al. (London, Ontario): 3 dislocations No sciatic n. injury

15 SUBTROCH. SHORTENING OSTEOTOMY Results Mayo Clinic: Uncemented fully coated or modular stem 18 hips

16 SUBTROCH. SHORTENING OSTEOTOMY Results Results: 100% stable implants 0% nonunions Complications: 1 dislocation 0 infection

17 SUBTROCH. SHORTENING OSTEOTOMY Results Functional Results: Favorable return of abductor function

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20 SUBTROCH. SHORTENING OSTEOTOMY Method Posterior hip dislocation Osteotomize femoral neck Preliminary femoral preparation

21 SUBTROCH. SHORTENING OSTEOTOMY Method Limited exposure of femur at planned osteotomy level Transverse osteotomy

22 SUBTROCH. SHORTENING OSTEOTOMY Method Retract femur anteriorly Direct exposure of acetabulum Insert cup

23 SUBTROCH. SHORTENING OSTEOTOMY Method Reduce hip with trial in proximal fragment only Shorten femur appropriately Trial with osteotomy reduced

24 SUBTROCH. SHORTENING OSTEOTOMY Method Insert femoral component Add autogenous strut if desired

25 CASE EXAMPLES

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31 SUBTROCH. SHORTENING OSTEOTOMY Conclusions Elegant method Safe and effective Satisfies goals of surgery: -normalize hip center -protect nerve -stable implant fixation


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