shortening subtrochanteric osteotomy for high hip dislocation daniel j. berry, md mayo clinic...
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SHORTENING SUBTROCHANTERIC OSTEOTOMY FOR HIGH HIP DISLOCATION
Daniel J. Berry, MD
Mayo Clinic
Rochester, MN
SUBTROCH. SHORTENING OSTEOTOMYIntroduction
High Dislocation: Goals of Surgery:• Normalize hip center• Gain stable implant fixation• Optimize abductor function• Protect sciatic nerve
SUBTROCH. SHORTENING OSTEOTOMYIntroduction
Traditional Method:• Greater trochanteric
osteotomy• Shorten femur until hip
can be reduced• Insert cemented stem
SUBTROCH. SHORTENING OSTEOTOMYTraditional Method
Drawbacks to Traditional Method:
• Problems with greater trochanter– which doesn’t always heal
SUBTROCH. SHORTENING OSTEOTOMYTraditional Method
Drawbacks to Traditional Method:
• Permanently changes shape of proximal femur
- no metaphyseal flare
SUBTROCH. SHORTENING OSTEOTOMYTraditional Method
Drawbacks to Traditional Method:
• Requires cemented stem
- less desirable in younger patients?
SUBTROCH. SHORTENING OSTEOTOMYAdvantages
Advantages of Shortening Osteotomy:
• No greater trochanteric problems
SUBTROCH. SHORTENING OSTEOTOMYAdvantages
Advantages of Shortening Osteotomy:
• Preserves architecture of proximal femur
SUBTROCH. SHORTENING OSTEOTOMYAdvantages
Advantages of Shortening Osteotomy:
• Allows use of uncemented implants
SUBTROCH. SHORTENING OSTEOTOMYAdvantages
Advantages of Shortening Osteotomy:
• Protects sciatic nerve
SUBTROCH. SHORTENING OSTEOTOMYAdvantages
Advantages of Shortening Osteotomy:
• Allow leg length, femoral anteversion correction
SUBTROCH. SHORTENING OSTEOTOMYResults
Masonis et al. (London, Ontario):• 21 hips (F/U 6 yrs)• 10 uncemented, 11 cemented• 2 nonunions• 1 loose cemented stem
SUBTROCH. SHORTENING OSTEOTOMYResults
Masonis et al. (London, Ontario):• 3 dislocations• No sciatic n. injury
SUBTROCH. SHORTENING OSTEOTOMYResults
Mayo Clinic:• Uncemented
fully coated or modular stem
• 18 hips
SUBTROCH. SHORTENING OSTEOTOMYResults
Results:• 100% stable implants• 0% nonunions• Complications:
1 dislocation0 infection
SUBTROCH. SHORTENING OSTEOTOMYResults
Functional Results:• Favorable return of abductor
function
SUBTROCH. SHORTENING OSTEOTOMYMethod
• Posterior hip dislocation• Osteotomize femoral neck• Preliminary femoral
preparation
SUBTROCH. SHORTENING OSTEOTOMYMethod
• Limited exposure of femur at planned osteotomy level
• Transverse osteotomy
SUBTROCH. SHORTENING OSTEOTOMYMethod
• Retract femur anteriorly• Direct exposure of acetabulum• Insert cup
SUBTROCH. SHORTENING OSTEOTOMYMethod
• Reduce hip with trial in proximal fragment only
• Shorten femur appropriately• Trial with osteotomy
reduced
SUBTROCH. SHORTENING OSTEOTOMYMethod
• Insert femoral component• Add autogenous strut if desired
CASE EXAMPLES
SUBTROCH. SHORTENING OSTEOTOMYConclusions
• Elegant method• Safe and effective• Satisfies goals of surgery:
- normalize hip center
- protect nerve
- stable implant fixation