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

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
100% stable implants
0% nonunions
Complications:
1 dislocation
0 infection

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

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

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