Proximal femoral deformities may not need to be addressed in THA
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ORLANDO — At the Current Concepts in Joint Replacement Winter Meeting, a presenter said proximal femoral deformities may not need to be addressed during total hip arthroplasty as long as surgeons are able to achieve implant fixation.
“My usual modus operandi is to ignore the deformity if I can, as long as I can achieve good fixation into that proximal fragment and that can be accomplished with hip resurfacing, a shorter stem [and] possibly a smaller stem with cemented fixation,” Edwin P. Su, MD, said during his presentation. “If you are going to consider performing an osteotomy, you need to get fixation in both fragments hopefully avoiding the use of cement.”
He added, “THA in the setting of proximal femoral deformities can be challenging. The risks are femoral preformation, inadequate fixation and poor biomechanics.”
Su said it was important to have a plan to see how the proximal femoral deformity will impact a typical femoral fixation. Then surgeons may decide to address or ignore the deformity. Surgeons should also consider comorbidities, biomechanics of the joint and limb length.
He said good treatment options include use of short stems or hip resurfacing. Both procedures have had good results in the last 10 years, Su said.
“Hip resurfacing is a useful tool,” he said. “Sometimes with these deformities you don’t require any fixation is the diaphysis. You can avoid most of these deformities, especially if there is a short proximal segment.”
Su said hip resurfacing is a good solution for male patients with a femoral head size of 48 mm or greater.
If the proximal segment is long enough, he said use of short stems can allow surgeons to get cementless fixation without interference from the proximal femoral deformity.
“It’s familiar to most surgeons, more familiar than [hip] surfacing, and can be used in both men and women,” he said.
He said diaphyseal osteotomies can increase the morbidity and complexity of the THA. Su recommends surgeons bypass the osteotomy site by two cortical diameters and then use some form of supplemental fixation.
“You are going to have to place meticulously and consider fixation both proximally and distally. It is a powerful technique that would allow you the correction of rotational, translational and angular deformities, but it would lead to improved hip joint biomechanics and alignment,” Su said. – by Monica Jaramillo
Reference:
Su EP. Proximal femoral deformity: Paper. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 11-14, 2019; Orlando.
Disclosure: Su reports no relevant financial disclosures.