8Treatment Options Alter bone to fit prosthesis (osteotomy) 2. Select prosthesis to fit femur3. Short implants or surface replacement to avoid more distal deformity
9THA In Femoral Deformity Greater Trochanteric SolutionsTrochanteric Osteotomy (exposure)Trochanteric Advancement
10THA In Femoral Deformity Femoral NeckVarusValgusAbnormal Version
11THA In Femoral Deformity Abnormal VersionCement small femoral implant in proper anteversion independent of anatomyModular cementless implantsDerotational osteotomy (subtrochanteric)
12Implantation Modular Advantages Goal: Avoid hard bearing impingement while maximizing range of motion.The ability to adjust femoral anteversion after cup placement has become increasingly important when using hard bearing implants where only neutral acetabular liners are available.
27Adequate Exposure in Complex THA Aids in Component Removal and Re-InsertionAccuracy of Instrument and Component positioningReduces incidence of fractures and perforationsBone grafting procedures easier, faster, more accurate
28Extensile LateralLimitations: Post-column, retained trochanter, limp, H.O., lengtheningretained trochanter, limp, H.O., lengtheningImproved femoral exposureReduces need for femoral fluoroscopyPerforations further weaken compromised femoral canalIndicationsMost complex THA’sLess instabilitySepsisPostop irradiation
29Posterior Excellent exposure, minimal muscle damage, fast rehab Easy to make extensile(soft tissue releases; femoral or trochanteric osteotomies)Retained trochanter limits distal canal access (>180 to 200 mm)Increased risk posterior dislocationIndicationsMost acetabular/femoral revisionsPosterior column platingComplex THA