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SHORTENING SUBTROCHANTERIC OSTEOTOMY FOR HIGH HIP DISLOCATION

SHORTENING SUBTROCHANTERIC OSTEOTOMY FOR HIGH HIP DISLOCATION. Daniel J. Berry, MD Mayo Clinic Rochester, MN. SUBTROCH. SHORTENING OSTEOTOMY Introduction. High Dislocation: Goals of Surgery: Normalize hip center Gain stable implant fixation Optimize abductor function

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SHORTENING SUBTROCHANTERIC OSTEOTOMY FOR HIGH HIP DISLOCATION

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  1. SHORTENING SUBTROCHANTERIC OSTEOTOMY FOR HIGH HIP DISLOCATION Daniel J. Berry, MD Mayo Clinic Rochester, MN

  2. SUBTROCH. SHORTENING OSTEOTOMYIntroduction High Dislocation: Goals of Surgery: • Normalize hip center • Gain stable implant fixation • Optimize abductor function • Protect sciatic nerve

  3. SUBTROCH. SHORTENING OSTEOTOMYIntroduction Traditional Method: • Greater trochanteric osteotomy • Shorten femur until hip can be reduced • Insert cemented stem

  4. SUBTROCH. SHORTENING OSTEOTOMYTraditional Method Drawbacks to Traditional Method: • Problems with greater trochanter– which doesn’t always heal

  5. SUBTROCH. SHORTENING OSTEOTOMYTraditional Method Drawbacks to Traditional Method: • Permanently changes shape of proximal femur • - no metaphyseal flare

  6. SUBTROCH. SHORTENING OSTEOTOMYTraditional Method Drawbacks to Traditional Method: • Requires cemented stem • - less desirable in younger patients?

  7. SUBTROCH. SHORTENING OSTEOTOMYAdvantages Advantages of Shortening Osteotomy: • No greater trochanteric problems

  8. SUBTROCH. SHORTENING OSTEOTOMYAdvantages Advantages of Shortening Osteotomy: • Preserves architecture of proximal femur

  9. SUBTROCH. SHORTENING OSTEOTOMYAdvantages Advantages of Shortening Osteotomy: • Allows use of uncemented implants

  10. SUBTROCH. SHORTENING OSTEOTOMYAdvantages Advantages of Shortening Osteotomy: • Protects sciatic nerve

  11. SUBTROCH. SHORTENING OSTEOTOMYAdvantages Advantages of Shortening Osteotomy: • Allow leg length, femoral anteversion correction

  12. SUBTROCH. SHORTENING OSTEOTOMYResults Masonis et al. (London, Ontario): • 21 hips (F/U 6 yrs) • 10 uncemented, 11 cemented • 2 nonunions • 1 loose cemented stem

  13. SUBTROCH. SHORTENING OSTEOTOMYResults Masonis et al. (London, Ontario): • 3 dislocations • No sciatic n. injury

  14. SUBTROCH. SHORTENING OSTEOTOMYResults Mayo Clinic: • Uncemented fully coated or modular stem • 18 hips

  15. SUBTROCH. SHORTENING OSTEOTOMYResults Results: • 100% stable implants • 0% nonunions • Complications: • 1 dislocation • 0 infection

  16. SUBTROCH. SHORTENING OSTEOTOMYResults Functional Results: • Favorable return of abductor function

  17. SUBTROCH. SHORTENING OSTEOTOMYMethod • Posterior hip dislocation • Osteotomize femoral neck • Preliminary femoral preparation

  18. SUBTROCH. SHORTENING OSTEOTOMYMethod • Limited exposure of femur at planned osteotomy level • Transverse osteotomy

  19. SUBTROCH. SHORTENING OSTEOTOMYMethod • Retract femur anteriorly • Direct exposure of acetabulum • Insert cup

  20. SUBTROCH. SHORTENING OSTEOTOMYMethod • Reduce hip with trial in proximal fragment only • Shorten femur appropriately • Trial with osteotomy reduced

  21. SUBTROCH. SHORTENING OSTEOTOMYMethod • Insert femoral component • Add autogenous strut if desired

  22. CASE EXAMPLES

  23. SUBTROCH. SHORTENING OSTEOTOMYConclusions • Elegant method • Safe and effective • Satisfies goals of surgery: • normalize hip center • protect nerve • stable implant fixation

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