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Dr. Pradeep Sharma

Dr. Pradeep Sharma

Director & Head
BLK Centre for Orthopaedics,
Joint Reconstruction & Spine
Surgery
BLK Super Speciality
Hospital, New Delhi

Dr. Akshat Sharma
Dr. Rajesh Verma


Consultants
BLK Centre for Orthopaedics
Joint Reconstruction & Spine
Surgery
BLK Super Speciality
Hospital, New Delhi


Fit for the Hips

Femoral Shortening Osteotomy in High
Riding Hips

Total Hip Arthroplasty in dysplastic hips poses unique technical challenges. Dysplasia is usually the result of developmental anomalies, childhood infections of the hip, neglected trauma etc. The acetabulum shows varying degrees of abnormalities in orientation and depth, while the femoral head is misshaped and lies proximal to the acetabulum. The aim of the reconstruction is to place the acetabular component in its anatomic position. This often results in a prosthetic hip that is difficult to reduce and in extreme malrotation creates abnormally high pressure on the prosthesis.

Dysplastic hips are classified using the Hartofilakidis classification. Type A (dysplasia) includes a hip with femoral head within the acetabulum with deficient superior wall. A low dislocation or Type B hip is characterised by a false acetabulum created by the femoral head superiorly with complete absence of a superior wall. Type C, also called high dislocation, includes a femoral head completely uncovered and located posteriorly and superiorly with a completely deficient acetabulum. A proximal femoral subtrochanteric osteotomy is used as an adjunct in performing Total Hip Arthroplasty in such cases.

Only after a pre-operative evaluation, a Total Hip Arthroplasty is planned. The lateral approach (Liverpool) to the hip is applied in such procedures. After resection of the neck, a transverse osteotomy is performed which facilitates exposure to acetabulum. The acetabular cavity is cleaned and prepared. In all cases, reconstruction is performed using graft, fixed with screws to ensure proper coverage. The femur is provisionally prepared. The depth of reaming of the distal canal is done taking into consideration the length of segment to be removed. A trial reduction with femoral stem in the proximal fragment is performed and overlap between the proximal and distal fragments is noted and commensurate shortening is performed. Distal fragments are prepared, a press fit stem is inserted and the fragments are overlapped over the stem. The stem is rotationally stabilised within both fragments. No fixation of the Osteotomy is required except in cases where locking plate is used for additional stability. No additional grafting is required. Through this procedure, the hip will be reduced and will remain stable.

This technique allows correction of excessive femoral anteversion, maintains limb length, preserves proximal femoral metaphyseal architecture and orientation of greater trochanter and abductors. The hip biomechanics can therefore be restored to prevent limp and instability. A standard femoral stem can also be used easily.

Potential complications include fracture and non-union of the osteotomy. This technique is highly recommended in complex Hip Arthroplasties.