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SHORTENING SUBTROCHANTERIC OSTEOTOMY FOR HIGH HIP DISLOCATIONDaniel J. Berry, MD Mayo Clinic Rochester, MN
SUBTROCH. SHORTENING OSTEOTOMY IntroductionHigh Dislocation: Goals of Surgery: Normalize hip center Gain stable implant fixation Optimize abductor function Protect sciatic nerve
SUBTROCH. SHORTENING OSTEOTOMY IntroductionTraditional Method: Greater trochanteric osteotomy Shorten femur until hip can be reduced Insert cemented stem
SUBTROCH. SHORTENING OSTEOTOMY Traditional MethodDrawbacks to Traditional Method: Problems with greater trochanter– which doesn’t always heal
SUBTROCH. SHORTENING OSTEOTOMY Traditional MethodDrawbacks to Traditional Method: Permanently changes shape of proximal femur - no metaphyseal flare
SUBTROCH. SHORTENING OSTEOTOMY Traditional MethodDrawbacks to Traditional Method: Requires cemented stem - less desirable in younger patients?
SUBTROCH. SHORTENING OSTEOTOMY AdvantagesAdvantages of Shortening Osteotomy: No greater trochanteric problems
SUBTROCH. SHORTENING OSTEOTOMY AdvantagesAdvantages of Shortening Osteotomy: Preserves architecture of proximal femur
SUBTROCH. SHORTENING OSTEOTOMY AdvantagesAdvantages of Shortening Osteotomy: Allows use of uncemented implants
SUBTROCH. SHORTENING OSTEOTOMY AdvantagesAdvantages of Shortening Osteotomy: Protects sciatic nerve
SUBTROCH. SHORTENING OSTEOTOMY AdvantagesAdvantages of Shortening Osteotomy: Allow leg length, femoral anteversion correction
SUBTROCH. SHORTENING OSTEOTOMY ResultsMasonis et al. (London, Ontario): 21 hips (F/U 6 yrs) 10 uncemented, 11 cemented 2 nonunions 1 loose cemented stem
SUBTROCH. SHORTENING OSTEOTOMY ResultsMasonis et al. (London, Ontario): 3 dislocations No sciatic n. injury
SUBTROCH. SHORTENING OSTEOTOMY ResultsMayo Clinic: Uncemented fully coated or modular stem 18 hips
SUBTROCH. SHORTENING OSTEOTOMY Results100% stable implants 0% nonunions Complications: 1 dislocation 0 infection
SUBTROCH. SHORTENING OSTEOTOMY ResultsFunctional Results: Favorable return of abductor function
SUBTROCH. SHORTENING OSTEOTOMY MethodPosterior hip dislocation Osteotomize femoral neck Preliminary femoral preparation
SUBTROCH. SHORTENING OSTEOTOMY MethodLimited exposure of femur at planned osteotomy level Transverse osteotomy
SUBTROCH. SHORTENING OSTEOTOMY MethodRetract femur anteriorly Direct exposure of acetabulum Insert cup
SUBTROCH. SHORTENING OSTEOTOMY MethodReduce hip with trial in proximal fragment only Shorten femur appropriately Trial with osteotomy reduced
SUBTROCH. SHORTENING OSTEOTOMY MethodInsert femoral component Add autogenous strut if desired
SUBTROCH. SHORTENING OSTEOTOMY ConclusionsElegant method Safe and effective Satisfies goals of surgery: normalize hip center protect nerve stable implant fixation
THA TO SALVAGE FAILED ACETABULAR FRACTURES
In the name of GOD THA & DDH By : paisoudeh karim MD Firoozgar hospital Iran university of medicine.
OSTEONECROSIS OF THE FEMORAL HEAD: Modern Results of Total Hip Arthroplasty Daniel J. Berry, MD Prof and Chairman Mayo Clinic Rochester, MN.
FEMORAL COMPONENT Prosthetic design M. E. Cabanela, M.D. Professor of Orthopedic Surgery Mayo Clinic College of Medicine Rochester, MN.
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