Background

The decision to attempt limb salvage vs to amputate in a significant traumatic limb injury is based on patient´s best predicted outcome. When amputation cannot be avoided the aim is to provide a pain free limb whilst preserving the soft tissue and limb length.

Purpose of the study: Generally, hip prosthesis implantation for congenital hip dysplasia is a routine procedure.

Material and methods: We compared preliminary results between two surgical techniques. On one hand, hip prostheses were implanted via trochanterotomy with femoral shortening osteotomy for cemented insertion and trochanteroplasty. On the other, access was achieved via a triple infratrochanteric osteotomy for shortening, correction of valgum and derotation followed by implantation of a press-fit prosthesis without osteosynthesis.

Results:

Between 1993 and 2001, 61 patients underwent surgery for Crowe III or Eftekhar grade C hips (n=45) and Crowe IV or Eftekhar grade D hips (n=16). Mean patient age was 42 years. Prostheses inserted via the trans-trochanteric approach with femoral shortening osteotomy and cementing developed complications related to the trochanteroplasty: nonunion of the greater trochanter (n=6), functional impairment (n=2), infection after bursitis on suture and secondary necrosis (n=1). Because of these complications we adopted the triple femoral osteotomy technique for shortening, derotation and press-fit femoral implants.

Conclusion: These preliminary results concern non-cemented femoral prosthesis with insufficient follow-up. We nevertheless have found this an attractive technique free of femoral complications.

Introduction: We present only the difficult cases of THR in high dislocated hip: grade III DUNN, type IV CROWE, or stage C and D EFTEKHAR; and also our classification of the femoral displasias: 1. Stage I vice of the femoral head associated with type III Crowe, Dunn III, Eftekhar stage B or C 2. Stage II femoral canal eliptique, supplementary vice of torsion of the diaphysis, metaphysis associated with type III Crowe, degree III Dunn, Eftekhar C or D, witch could bee operated without diaphyseal osteotomy by trochanterotomy 3. Stage III important torsion of the diaphysis large medullar diameter of the metaphysis perpendicular to the large diameter of the diaphysis canal Excellent indication for triple osteotomy femoral 4. Stage IV caricaturized

Materials and Methods: We intend to compare here the preliminary results of two surgical techniques: I) cemented prosthesis implanted by trochanterotomy, with femoral shortening osteotomia and trochanteroplastia versus II) femoral subtrochanteric triple osteotomia of shortening, with correction of a fore-existent valgum and derotation by using a non-cemented femoral component.

Results: I) between 1993 – 2001 we have operated 61 patients, average age 42. Technically, we have implanted cemented prostheses by trochanterotomy and femoral shortening osteotomy, followed by Kerboull-Postel trochanteroplastia. The nonunion of greater trochanter, considered as failed cases, determined us to adopt the technique of triple femoral osteotomy, using a non cemented femoral component functioning as a centromedulary nail. II) Between 2001 – 2003, more other 6 cases have been operated by the technique of triple femoral osteotomy. We have pre- and postoperative clinically evaluated our patients by Merle D’Aubigne-Postel criteria.

Conclusions: These results are preliminary, we have not had enough surveillance time for uncemented femoral prostheses, but this technique seems us attractive though femoral complications have not yet been noticed.

Background: The major objectives in total hip replacement for coxarthrosis secondary to DDH are: – Anatomical restoration of the hip rotation center – The restoration of the acetabular contention function – The reconstruction of the acetabular bone stock

Patients and Method: Between 1999 – 2003 there were operated 83 cases of coxarthrosis secondary to hip dysplasia, by total hip arthroplasty both cemented and uncemented. 27 cases were operated with uncemented cups and acetabular reconstruction 20 cases received a HA coated Stryker Secure Fit 40–42 mm cup 7 cases received Zweimuller screwed cup The mean age of the patients was 39 years (21–57 years) The mean weight was 69.5 kg (58–82 kg) Body mass index 28 (25–31) The dysplasia grade was Crowe II 11 cases, Crowe III 16 cases

Results: The mean dimension of the graft (S2), measured on the AP Rx was 43 % of the cup weight bearing surface The S2/S1 fraction exceeded 1 in one case that necessitated revision at 4,5 years due to the resorbtion of the graft All the grafts healed to the host bone in a 6 month interval

Discussions and Conclusions For defects smaller than 20% of the weight bearing surface of the cup, there was an intrinsic stability of the cup and the acetabuloplasty was optional For defects between 20–50% of the cup weight bearing surface it was necessary to perform acetabuloplasty with auto graft from the femoral head fixed with screws in compression For defects larger than 50 % of the weight bearing surface of the cup the fraction S2/S1 is greater than 1 with risk of the resorbtion and collapse of the graft. In such cases we recommend slight ascending of the cup in a position with better bone stock or a protrusion technique method