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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. Anuj Malhotra &
Dr. Akshat Sharma

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







In Search of a Normal Gait

A Complex Case of Hip Surgery for
Fractured Acetabulum

Hip Replacement has today become a well-established surgery. Some cases, however, remain a challenge such as those of old neglected fracture dislocation, developmental dysplasia of the hip and proximal femoral deficiencies. Total Hip Replacement needs high level of understanding of biomechanics, soft tissue (abductor & sciatic nerve) handling and various highly skilled Osteotomies to correct severe deformities and reconstruct the hip.

THE CASE

An international patient was brought to BLK Centre for Orthopaedics, Joint Reconstruction & Spine Surgery with an old neglected fractured acetabulum and hip dislocation. The incident happened four years back and he was treated locally with traction but could not manage the reduction of hip joint and developed fracture in the femoral shaft that got malunited. On examination, there was a high riding dislocation in the hip with a shortening of about 8 cm. There was angular deformity at upper femoral shaft and the acetabulum was disrupted and malunited. There was no neurovascular complication.

THE PROCEDURE

The hip was exposed through the Lateral Liverpool Approach. The femoral head was identified. It had formed a pseudo acetabulum and was partly destroyed. A femoral neck Osteotomy was done. The malunited fracture of the shaft was exposed and the bone at that level was Osteotomised. The proximal femur was mobilised distally and was shortened by 4 cm so that it could come to the level of the index acetabulum.

The index acetabulum, identified with imaging, was malunited and distorted. The reconstruction of the acetabulum was done under imaging with impaction bone grafting in the crevies where necessary. After adequate preparation, continuum cup (trabecular metal liner) from Zimmer was implanted in correct version and inclination.

The femoral side with its shortening Osteotomy was fixed with a long wagner stem (225 cm). The fixation was stable. A de-rotation DCP plate was used to stabilise the Osteotomy site, which was also bone grafted.

THE RESULT

The recovery process was quite uneventful. The patient was made to stand with the help of a walker the very next day of surgery. Limb length was equalised. Thanks to advancements in surgical techniques coupled with diligent care and strict physiotherapy, the patient made phenomenal progress and started walking around with equal limbs, stable hips and normal gait after four years.