<ul><li>Management of severe CDH  </li></ul><ul><li>with THA plus derotating & shortening  </li></ul><ul><li>osteotomy at ...
<ul><li>CDH prevalence is dramatically different in literature reports between  </li></ul>60,0 %  Japan 16%   in our exper...
<ul><li>CDH grade is measured on the Xrays according to Wiberg e Sharp. </li></ul>   = 56° “ Total Hip Replacement in Con...
CDH patients Crowe grade 1 to 3 Crowe grade 4 THA performed 2.308   1267   476   565 21.538 1984 - 2009 osteotomies sequel...
1984 - 2009 Santa Corona Hospital, Pietra Ligure Humanitas Clinical Institute (2010), Milano THA and osteotomy Subtrochant...
Proximal Femoral Deformities  in C.D.H. •  increase in antiversion angle  •  G.T. posterior displacement  •  L.T. anterior...
Acetabular  alterations in CDH (3D) (*) ischiatic prevalence  ischiatic overload bone stock increase @ posterior column (*...
Soft tissue alterations in CDH <ul><li>Ileopsoas </li></ul>•  lengthening (on Crowe IV, with wrapping on iliopettineal rid...
  The Surgeon has to keep in mind the local and peripheral abnormal anatomy of CDH A B C C B A E E’ D and try to  restore ...
1970 Surgical technique evolution Cemented stem Proximal osteotomy and lowering of GT 70 ’s
17/4/1996 12/4/1996 13/9/1995 13/9/1995
Surgical technique evolutions 1970 1980 Distal shortening Osteotomy and femoral derotation 80 ’s
•  cemented stem implant according to CDH anteversion •  distal femur shortening & derotation (according to preoperative p...
18 y f-up i.d. 12575 <ul><li>Arduous surgical technique </li></ul><ul><li>Longer operative time </li></ul><ul><li>Longer p...
<ul><li>• Faster and safer bone healing </li></ul><ul><li>• Accurate control of femoral derotation </li></ul><ul><li>• Ret...
4/11/2000 it is possible to perform THA with a femoral shortening osteotomy at the same time. I.D. 17688 In patients affec...
<ul><li>Uncemented stem for osteotomy fixation </li></ul><ul><li>Additional fixation: </li></ul><ul><li>plate and screws o...
Rebuilding  “ theoric anatomical”  rotational center I.D. 7367
 
 
 
 
I.D. 7823 9/4/1995 22/2/1996
I.D. 7823 14 ys F. up
17230 3 ys F-up
16679
post-op i.d. 14416 Conclusions Crowe 3 / 4 treatment,  specially in association  with torsional deviation, is complex and ...
i.d. 14416 In Crowe IV patients, one time THA & shortening osteotomy is a technycally demanding but reasonable option
300 Consecutive T.H.R. Dec. 1983 - Apr. 1985 1757 f-up 13y ...still high wear for overloading of the cup 0 0.2 0.4 0.6 0.8...
% first implants revisions implants Diagnosis vs implant failure F-up 6 y F-up 7,5 y I.D. 54
9882 4 ys F. up 8 ys F. up 9 ys F. up
F.N.19744  - f. 26 ys
F.N.19744 - f. 26 ys 9 months F-UP
F.N.19744 - f. 26 ys 9 months F-UP
F.N.19744 - f. 26 ys 21 months F-UP
Livio Sciutto   F O N D A Z I O N E www.fondazione.it THANK YOU VERY MUCH FOR YOUR ATTENTION
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Displasia congenita anca - EFORT Madrid 2010

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La presentazione proiettata pochi giorni fa in aula magna al congresso europeo di ortopedia di Madrid.

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Displasia congenita anca - EFORT Madrid 2010

  1. 1. <ul><li>Management of severe CDH </li></ul><ul><li>with THA plus derotating & shortening </li></ul><ul><li>osteotomy at the same time: our 20 years experience </li></ul><ul><li>G. Grappiolo, G. Cusmà Guatteri </li></ul>Hip & Knee Surgery Center @ Rozzano - Milano - Italy
  2. 2. <ul><li>CDH prevalence is dramatically different in literature reports between </li></ul>60,0 % Japan 16% in our experience the prevalence is about 5,7 % U.S.A.
  3. 3. <ul><li>CDH grade is measured on the Xrays according to Wiberg e Sharp. </li></ul> = 56° “ Total Hip Replacement in Congenital Dislocation of the Hip” J.F. Crowe, J. Mani and C.S. Ranawat J. Bone and Joint Surgery 61-A, n° 1 January 1979 CDH classification Subluxation luxation Grade I Grade II Grade III Grade IV
  4. 4. CDH patients Crowe grade 1 to 3 Crowe grade 4 THA performed 2.308 1267 476 565 21.538 1984 - 2009 osteotomies sequelae Santa Corona Hospital, Pietra Ligure Humanitas Clinical Institute, Milano
  5. 5. 1984 - 2009 Santa Corona Hospital, Pietra Ligure Humanitas Clinical Institute (2010), Milano THA and osteotomy Subtrochanteric osteotomies ( 21 last 2 y. ) GT osteotomies THAs on CDH 148 67 52 12 2.308 Combined procedures 9 Distal femur ostheotomies
  6. 6. Proximal Femoral Deformities in C.D.H. • increase in antiversion angle • G.T. posterior displacement • L.T. anterior displacement • diafiseal diameter reduction • ipoplasia of metaphisys
  7. 7. Acetabular alterations in CDH (3D) (*) ischiatic prevalence ischiatic overload bone stock increase @ posterior column (*) anterior column defect Pubic branch ipoplasia secondary to loss of charge
  8. 8. Soft tissue alterations in CDH <ul><li>Ileopsoas </li></ul>• lengthening (on Crowe IV, with wrapping on iliopettineal ridge) • Reduction of flexability • Increasing of extrarotation function • shortening Externalrotator Gluteus Maximus • Distal insertion medialization (linea aspera) • Muscle fibres reorientation • Maintenance of extrarotary function • Reduction of flexability (Pelvis stabilizer) • Shortening • Reduction of abduction lever arm Gluteus Medius Gluteus Minimus • Articular capsule adhesion
  9. 9. The Surgeon has to keep in mind the local and peripheral abnormal anatomy of CDH A B C C B A E E’ D and try to restore the normal hip biomechanics A = gluteus maior B = gluteus medius C = gluteus minor D = ileopsoas E = short adductor E’= long adductor A B C C B A D
  10. 10. 1970 Surgical technique evolution Cemented stem Proximal osteotomy and lowering of GT 70 ’s
  11. 11. 17/4/1996 12/4/1996 13/9/1995 13/9/1995
  12. 12. Surgical technique evolutions 1970 1980 Distal shortening Osteotomy and femoral derotation 80 ’s
  13. 13. • cemented stem implant according to CDH anteversion • distal femur shortening & derotation (according to preoperative planning) Surgical technique: shortening osteotomy and distal derotation
  14. 14. 18 y f-up i.d. 12575 <ul><li>Arduous surgical technique </li></ul><ul><li>Longer operative time </li></ul><ul><li>Longer post-operative care </li></ul><ul><li>(pelvis-malleolus cast sometimes is necessary) </li></ul><ul><li>Other complications </li></ul><ul><li>(pseudo-arthrosis, plate breakage) </li></ul>Disadvantages
  15. 15. <ul><li>• Faster and safer bone healing </li></ul><ul><li>• Accurate control of femoral derotation </li></ul><ul><li>• Retentioning of “Deltoid muscles” thigh </li></ul><ul><li>• Release of Sartorius, adductor Longus </li></ul>our surgical technique: metaphyseal shortening osteotomy
  16. 16. 4/11/2000 it is possible to perform THA with a femoral shortening osteotomy at the same time. I.D. 17688 In patients affected by Crowe IV CDH
  17. 17. <ul><li>Uncemented stem for osteotomy fixation </li></ul><ul><li>Additional fixation: </li></ul><ul><li>plate and screws or wires cerclage </li></ul>I.D. 5697 Surgical technique
  18. 18. Rebuilding “ theoric anatomical” rotational center I.D. 7367
  19. 23. I.D. 7823 9/4/1995 22/2/1996
  20. 24. I.D. 7823 14 ys F. up
  21. 25. 17230 3 ys F-up
  22. 26. 16679
  23. 27. post-op i.d. 14416 Conclusions Crowe 3 / 4 treatment, specially in association with torsional deviation, is complex and technically demanding, with considerable influence on implant survival
  24. 28. i.d. 14416 In Crowe IV patients, one time THA & shortening osteotomy is a technycally demanding but reasonable option
  25. 29. 300 Consecutive T.H.R. Dec. 1983 - Apr. 1985 1757 f-up 13y ...still high wear for overloading of the cup 0 0.2 0.4 0.6 0.8 1.0 Cum. Survival 0 2 4 6 8 10 12 14 16 CUP 70,0% 89,4% 1st series CLS stem 18 STEM 94,0% 20 Yrs
  26. 30. % first implants revisions implants Diagnosis vs implant failure F-up 6 y F-up 7,5 y I.D. 54
  27. 31. 9882 4 ys F. up 8 ys F. up 9 ys F. up
  28. 32. F.N.19744 - f. 26 ys
  29. 33. F.N.19744 - f. 26 ys 9 months F-UP
  30. 34. F.N.19744 - f. 26 ys 9 months F-UP
  31. 35. F.N.19744 - f. 26 ys 21 months F-UP
  32. 36. Livio Sciutto F O N D A Z I O N E www.fondazione.it THANK YOU VERY MUCH FOR YOUR ATTENTION

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