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Hip Osteotomy Surgery pdf | Shri Ramchandra Joint Relacement Centre in Guntur | Vijayawada | Prakasam | AP | India

Shri Ramchandra Joint Relacement Centre a.k.a Happy-Hosputals is the best joint replacement center in Guntur,<br>also providing their services in major hoapitals in Vijayawada, Prakasam,in Andhrapradesh India with strong focus on knee joint replacement, <br>hip joint replacement, shoulder joint replacement, elbow joint replacement imbibing quality, compassion and tender-loving-care.<br><br><br>

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Hip Osteotomy Surgery pdf | Shri Ramchandra Joint Relacement Centre in Guntur | Vijayawada | Prakasam | AP | India

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  1. AdolescentHipDysplasia Thehipisa"ball-and-socket"joint.Inanormalhip,theballattheupperendofthe femur(thighbone)fitsfirmlyintothesocket,whichisacurvedportionofthepelvis calledtheacetabulum.Inayoungpersonwithhipdysplasia,thehipjointhasnot developednormally—theacetabulumistooshallowtoadequatelysupportandcover theheadofthefemur.Thisabnormalitycancauseapainfulhipandtheearly developmentofosteoarthritis,aconditioninwhichthearticularcartilageinthejoint wearsawayandbonerubsagainstbone. Adolescenthipdysplasiaisusuallytheendresultofdevelopmentaldysplasiaofthehip (DDH),aconditionthatoccursatbirthorinearlychildhood.Althoughinfantsare routinelyscreenedforDDH,somecasesremainundetectedoraremildenoughthat theyareleftuntreated.Thesepatientsmaynotshowsymptomsofhipdysplasiauntil reachingadolescence. Treatmentforadolescenthipdysplasiafocusesonrelievingpainwhilepreservingthe patient'snaturalhipjointforaslongaspossible.Inmanycases,thisisachievedthrough surgerytorestorethenormalanatomyofthejointanddelayorpreventtheonsetof painfulosteoarthritis. Anatomy Inahealthyhip,theheadofthefemurstaysfirmlywithintheacetabulum Thehipisoneofthebody'slargestjoints.Itisa"ball-and-socket"joint.Thesocketis formedbytheacetabulum,whichisapartofthelargepelvisbone.Theballisthe femoralhead,whichistheupperendofthefemur(thighbone)

  2. Thebonesurfacesoftheballandsocketarecoveredwitharticularcartilage,asmooth,Thebonesurfacesoftheballandsocketarecoveredwitharticularcartilage,asmooth, slipperysubstancethatprotectsandcushionsthebonesandenablesthemtomove easily. Theacetabulumisringedbystrongfibrocartilagecalledthelabrum.Thelabrumformsa gasketaroundthesocket,creatingatightsealandhelpingtoholdthefemoralheadin place. Description Inpatientswithhipdysplasia,theacetabulumisshallow,meaningthattheball,or femoralhead,cannotfirmlyfitintothesocket. Asaresultofthisabnormality,thewaythatforceisnormallytransmittedbetweenthe bonesurfacesisaltered.Thelabrumcanendupbearingtheforcesthatshouldnormally bedistributedevenlythroughoutthehipjoint.Inaddition,moreforceisplacedona smallersurfaceofthehipcartilageandlabrum.Overtime,thesmootharticularcartilage becomesfrayedandwearsawayandthelabrumbecomestornordamaged.These degenerativechangescanprogresstoearlyosteoarthritis. Themagnitudeandseverityofhipdysplasiacanvaryfrompatienttopatient.Inmild cases,theheadofthefemurmaysimplybelooseinthesocket.Inmoreseverecases, theremaybecompleteinstabilityinthejointand/orthefemoralheadmaybe completelydislocatedoutofthesocket. Cause Adolescenthipdysplasiausuallyresultsfromdevelopmentaldysplasiaofthehip(DDH) thatisundiscoveredoruntreatedduringinfancyorearlychildhood. DDHtendstoruninfamilies.Itcanbepresentineitherhipandinanyindividual.It usuallyaffectsthelefthipandoccursmoreoftenin: •Girls •First-bornchildren •Babiesborninthebreechposition Symptoms Hipdysplasia,itself,isnotapainfulcondition.However,painresultswhenthealtered forcesinthehipcausedegenerativechangestooccurinthearticularcartilageandthe labrum.Inmostcases,thispainis:

  3. •Locatedinthegroinarea,althoughitmaysometimesbemoretowardthe•Locatedinthegroinarea,althoughitmaysometimesbemoretowardthe outsideofthehip •Occasionalandmildinitially,butmayincreaseinfrequencyandintensityover time •Worsewithactivityorneartheendoftheday Somepatientsmayalsoexperiencethefeelingoflocking,catching,orpoppingwithin thegroin. Treatment Treatmentforadolescenthipdysplasiafocusesondelayingorpreventingtheonsetof osteoarthritiswhilepreservingthenaturalhipjointforaslongaspossible. NonsurgicalTreatment Yourdoctormayrecommendnonsurgicaltreatmentifyourchildhasmildhipdysplasia andnodamagetothelabrumorarticularcartilage.Nonsurgicaltreatmentmayalsobe triedinitiallyforpatientswhohavesuchextensivejointdamagethattheonlysurgical optionwouldbeatotalhipreplacement. Commonnonsurgicaltreatmentsforadolescenthipdysplasiainclude: Observation.Ifyourchildhasminimalsymptomsandmilddysplasia,yourdoctormay recommendsimplymonitoringtheconditiontomakesureitdoesnotgetworse.Your childwillhavefollow-upvisitsevery6to12monthssothatthedoctorcancheckforany progressionthatmaywarranttreatment. Lifestylemodification.Yourdoctormayalsorecommendthatyourchildavoidthe activitiesthatcausethepainanddiscomfort.Forachildwhoisoverweight,losing weightwillalsohelptoreducepressureonthehipjoint. Physicaltherapy.Specificexercisescanimprovetherangeofmotioninthehipand strengthenthemusclesthatsupportthejoint.Thiscanrelievesomestressonthe injuredlabrumorcartilage. Medications.Nonsteroidalanti-inflammatorydrugs(NSAIDs),suchasibuprofenand naproxen,canhelprelievepainandreduceswellinginanarthriticjoint.Inaddition, cortisoneisananti-inflammatoryagentthatcanbeinjecteddirectlyintoajoint. Althoughaninjectionofcortisonecanprovidepainreliefandreduceinflammation,the effectsaretemporary. SurgicalTreatment Yourdoctormayrecommendsurgeryifyourchildisexperiencingpainandhaslimited damagetohisorherarticularcartilage.Thesurgicalproceduremostcommonlyusedto

  4. treathipdysplasiaisanosteotomy."Osteotomy"literallymeans"cuttingofthebone."treathipdysplasiaisanosteotomy."Osteotomy"literallymeans"cuttingofthebone." Inanosteotomy,thedoctorreshapesandreorientstheacetabulumand/orfemurso thatthetwojointsurfacesareinamorenormalanatomicposition. Therearedifferenttypesofosteotomiesthatcanbeperformedtotreathipdysplasia. Thespecificprocedureyourdoctorrecommendswilldependonanumberoffactors, including: •Yourchild'sage •Theseverityofthedysplasia •Theextentofdamagetothelabrum •Whetherosteoarthritisispresent •Thenumberofremaininggrowingyears Periacetabularosteotomy(PAO).Currently,theosteotomyproceduremostcommonly usedtotreatadolescenthipdysplasiaisaperiacetabularosteotomy(PAO). "Periacetabular"means"aroundtheacetabulum." (A)Inaperiacetabularosteotomy,fourcutsaremadeinthepelvicbone.(B)Thedoctor usesaspecializedtooltomanipulatethebonefragmenttogainaccesstothe acetabulum. Inmostcases,PAOtakesfrom2-3hourstoperform.Duringthesurgery,thedoctor makesfourcutsinthepelvicbonearoundthehipjointtoloosentheacetabulum.Heor shethenrotatestheacetabulum,repositioningitintoamorenormalanatomicposition overthefemoralhead.Thedoctorwillusex-raystodirectthebonycutsandtoensure thattheacetabulumisrepositionedcorrectly.Oncetheboneisrepositioned,thedoctor insertsseveralsmallscrewstoholditinplaceuntilitheals.

  5. Inthisx-rayimage,theacetabulumhasbeenrepositionedduringsurgeryandheldinInthisx-rayimage,theacetabulumhasbeenrepositionedduringsurgeryandheldin placewithscrews. Arthroscopy.InconjunctionwithPAO,yourdoctormayusehiparthroscopytorepaira tornlabrum.Duringarthroscopy,thedoctorinsertsasmallcamera,calledan arthroscope,intothejoint.Thecameradisplayspicturesonatelevisionscreen,andyour doctorusestheseimagestoguideminiaturesurgicalinstruments.Arthroscopic proceduresmayinclude: •Labralrefixation.Inthisprocedure,thedoctortrimsthetornandfrayed tissuearoundtheacetabularrimandreattachesthetornlabrumtothebone oftherim. •Debridement.Insomecases,simplyremovingthetornorweakenedlabral tissuecanprovidepainrelief. Complications Aswithanysurgicalprocedure,therearerisksinvolvedwithPAO.Yourdoctorwill discusseachoftheriskswithyouandwilltakespecificmeasurestohelpavoidpotential complications. Althoughtherisksarelow,themostcommoncomplicationsinclude: •Infection •Bloodclots •Injuriestobloodvesselsandnerves •Persistenthippain •Failureoftheosteotomytoheal Recovery Yourchildwillremaininthehospitalfor2to4daysaftersurgery.Duringthistime,heor shewillbemonitoredandgivenpainmedication.

  6. Inmostcases,fullweight-bearingwillnotbeallowedontheoperatedlegfor6weekstoInmostcases,fullweight-bearingwillnotbeallowedontheoperatedlegfor6weeksto 3monthswhiletheboneshealintheirnewposition.Duringthistime,yourchildwill needtousecrutches. About6weeksaftersurgery,yourchildwillhaveafollow-upvisitwiththedoctor.X-rays willbetakensothatthedoctorcanseehowwellthePAOhashealed.Duringyourvisit, thedoctorwilldeterminewhenitissafetoputweightonthelegandwhenphysical therapycanbegin.Thephysicaltherapistwillshowyourchildspecificexercisestohelp maintainrangeofmotionandrestorestrengthandflexibilityinthehipjoint. Outcomes Periacetabularosteotomyisusuallysuccessfulindelayingtheneedforanartificialhip jointandrelievingpain.Whetherornotatotalhipreplacementwillbeneededinthe futuredependsonanumberoffactors,includingthedegreeofosteoarthritisthatwas presentinthejointwhenthePAOwasperformed.

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