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THA with supracondylar femoral osteotomy effective for chronic hip dislocation
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ISTANBUL — Nicolás Restrepo Giraldo, MD, of San Juan de Pasto, Colombia, shared his vision of how to perform THA in patients with chronic dislocated hips during a symposium on primary complex hip arthroplasty at the EFORT Congress. The session was organized by the Latin American Society of Orthopedics and Traumatology (SLAOT), an invited guest federation at this year’s congress.
“A good technique with a good choice of implants probably would be the solution with high dysplastic hips,” Restrepo said.
For the indication of chronic dislocation, THA should be done in patients who are young, in pain or have functional limitations, but it should never be performed solely for cosmetic reasons, he said.
Nicolás Restrepo Giraldo
Restrepo, who is the SLAOT past secretary, explained that surgeons must select the appropriate implants for patients who are chronic dislocators. For him, this involves a 48-mm diameter head, but he urged orthopaedists to use the biggest femoral head possible.
Occasionally, Restrepo opts for a 52- mm diameter ceramic head, but uses that only in ceramic-on-ceramic constructs. On the femoral side, he prefers small, uncemented stems that are designed with either a proximal porous or fully coated surface. However, the acetabular reconstruction steps of the procedure are just as important as the femoral reconstruction during THA for this indication, according to Restrepo.
“It is better to reconstruct it at the original place,” he said, and then described his surgical technique, which involves a mini-Watson approach, following the teres ligament and then finding the transverse ligament to locate the appropriate area of the acetabulum and its walls.
Concerning osteotomies done on the femoral side, Restrepo refuted the subtrochanteric osteotomy as the gold standard for these cases and reminded the audience that “the problem is probably not the scar on the leg, but what is going on inside,” including anteversion issues.
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Instead, supracondylar femoral osteotomy offers surgeons such key advantages as the ability to correct distal anteversion of the femoral neck and it allows the use of different stems and cemented or uncemented prostheses, Restrepo said.
Only about 10% of these cases require a subtrochanteric osteotomy, he said, and those patients usually have type C femurs.
It is important that patients undergoing THA for chronic dislocation provide informed patient consent. The complex nature of the surgery is associated with leg length discrepancies and gait abnormalities postoperatively, an increased risk of neurovascular complications and 10% to 30% rates of neurapraxia, he said.
Reference:
Restrepo Giraldo N. My vision of THA in chronic dislocated hips. Presented at: EFORT Congress. June 5-8, 2013; Istanbul.
Disclosure: Restrepo has no relevant financial disclosures.