MANAGEMENT OF ANGULAR AND TORSIONAL DEVIATION IN CDH 20 YEARS EXPERIENCE OF PROSTHETIC SURGERY

Abstract

Introduction: The anatomic abnormalities associated with the dysplastic hip increase the complexity of hip arthroplasty, in addition previous femural osteotomy can deformate proximal femur.

Despite the fact that uncemented cup and stems are specifically designed for dysplasia to recover the true acetabular region in Crowe IV and sometimes Crowe III additional surgical procedure are required.

Purpose of the study is to analize surgical procedure and then reconstruction options on severe hip dysplasia.

Materials and methods: From 1984 till today 2308 cases of arthroplasty were performed in dysplastic hip, 565 cases have a previous femoral osteotomy; out of these 2308 cases 128 cases need treatment for corrections of femural side deformity.

64 cases were subjected to a greater trochanteric osteotomy. In 12 cases proximal femural shortening was associated. In 9 cases rotational abnormality and shortening were controlled with a distal femur osteotomy.

55 cases were treated by a shortening subtrochanteric osteotomy that allows corrections of any deformity. Only uncemented stems were used and in the majority of cases a specific device for displastic hip (Wagner Conus produced by Zimmer).

Discussion: Long-term results in these patients are steadily inferior to that in the general population (70% survival at 15 yrs). On femural side early failures are the reflection of learning curve and are due to insufficient fixation of the osteotomy.

Despite this, the more promising outcomes are concerning shortening subtrochanteric osteotomy with uncemented stem but only early and mid-term data are available.