Speaker: Identify, understand proximal femoral deformities
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When a patient presents with a proximal femoral deformity, it is important to understand the deformity, identify where it is located and determine why the patient has the deformity, according to a presenter here.
“There are many potential causes for deformity that we see when it comes to total hip arthroplasty and the specifics of that deformity may dictate your exposure, may dictate your approach, certainly it will dictate your implant choice, it may also involve hardware removal, etc,” James A. Browne, MD, said during his presentation at the Current Concepts in Joint Replacement Winter Meeting.
He also noted that preoperative planning is critical, and templating is a must in these patients. Surgeons should not solely focus on the femur, but remember the acetabular side, according to Browne.
“It’s important to have a plan A, B and C,” Browne said. “Femoral version can be difficult to understand before you’re in the operating room. You don’t want to be caught with your pants down and have a patient who had an unanticipated versional deformity.”
Browne noted intraoperative imaging is crucial in deformity cases, and surgeons should be prepared to use osteotomies when necessary.
“I think one key decision when you’re making your osteotomy is where are you going to obtain fixation?” Browne said. “Is it going to be proximal to your osteotomy or distal to your osteotomy?”
Finally, Browne noted surgeons should only “mess with deformities” if necessary.
“Many of these subtrochanteric-diaphyseal deformities can be avoided using a short neck preserving implant or, in rare cases, hip resurfacing,” Browne said.
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Browne JA. THA in proximal femoral deformity: Strategy, technique, pitfalls. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 8-11, 2021; Orlando (hybrid meeting).
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