G. BOU. F. 75 y. 1 m60 61 Kg R.H : ankylosed in adduction L.H : dislocated with a femoral Schanz osteotomy Lumbar spine arthritic partially fixed Right.

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Presentation transcript:

G. BOU. F. 75 y. 1 m60 61 Kg R.H : ankylosed in adduction L.H : dislocated with a femoral Schanz osteotomy Lumbar spine arthritic partially fixed Right knee in varus, painfull Left knee in valgus, painless Major leg length discrepancy mechanically 8.5 cm anatomically 6 cm She just complains about lumbar spine and right knee What would you do? 1985

G. BOU After THA on the left side with femoral alignment osteotomy, the standing position is improved. The valgus deformation of the left knee is completely reduced and leg length discrepancy decreased The pelvic tilt as well as the varus of the right knee persist. Leg length inequality is still 4.5 cm After THA on the right hip with shortening osteotomy of 3 cm, the standing position is perfect with a good alignment of the lower limbs but it persists a 10° pelvic tilt which could not be corrected. The lumbar spine pain has been greatly reduced as well as pain in the right knee for 12 years.

G. BOU y PO The residual pelvic tilt has almost completely disappeared

F. FAV. F. 41 y. 1 m65 60 Kg 1976 Right hip dislocated with Schanz osteotomy Left hip displastic with anteversion 60° after previous adduction osteotomy Pelvic tilt. Lumbar spine almost normal but painful What would you do?

F. FAV 1977 THA on the right hip with alignment osteotomy of the femur No modification of the pelvic tilt

F. FAV 1978 Because the left hip remained painful we decided to correct the hip anteversion by a rotation osteotomy. The hip has been greatly improved for 12 years. Left hip hyperanteversion 60° AP view of the left hip in internal rotation 40° After rotation osteotomy

F. FAV Deterioration of the left hip After THR on the left side, the pelvic tilt significantly decreased but she complained of the valgus arthritic knee. It was aligned by a femoral low osteotomy in

F. FAV R.H : 27 y PO L.H : 13 y PO R.K : 10 y PO 2004 A 10° of pelvic tilt persists because the right femur is 1.5 cm shorter than the left. Despite this, the standing position is very good. Lumbar spine, hips and right knee are painless.