先天性髋关节脱位的髋关节置换课件.ppt

1、THA FOR DEVELOPMENTAL HIP DYSPLASIADaniel J.Berry,MDMayo ClinicRochester,MN,USATHA FOR DYSPLASIA Problem to Overcome on AcetabulumProblem:Lateral acetabular bone deficiency of varying severityTHA FOR DYSPLASIA/LOW DDHACETABULAR RECONSTRUCTIONTHA FOR DYSPLASIA/LOW DDH Acetabular ReconstructionGeneral

2、 Principles:Uncemented socketOptimize cup stability on host boneDont let bone deficiency dictate cup positionTHA FOR DYSPLASIA/LOW DDH Acetabular ReconstructionKey Point:Use supplemental screwsAvoid pressfit fixation alone without screws in deficient acetabulumTHA FOR DYSPLASIA/LOW DDH Acetabular Re

3、constructionTechnique of arthroplasty is determined by severity of antero-lateral acetabular bone lossTHA FOR DYSPLASIA/LOW DDH Acetabular ReconstructionMild Lateral Deficiency:Routine acetabular reconstruction(uncemented)Slight medialization of cup if necessaryAccept slight lateral uncoverageTHA FO

4、R DYSPLASIA/LOW DDH Acetabular ReconstructionModerate Lateral Deficiency:Medialize hip center to medial wallAccept some lateral uncoverage(1.5 cm of cup)Accept slight elevation of hip centerMarked Lateral Deficiency:Options:Medialize through medial wall High hip centerLateral bulk autogenous femoral

5、 head graftTHA FOR DYSPLASIA/LOW DDH Acetabular ReconstructionMANAGEMENT OF THE DYSPLASTIC HIP Acetabular ReconstructionMy preference:Medialize to(but not through)medial wallAccept slight elevation of hip centerLateral fem head graft if needed1.High hip center only in rare cases10 yrs,bone restoredF

6、EMORAL HEAD AUTOGRAFTSFEMORAL HEAD AUTOGRAFTSSlight Extra work,Extra RiskThey do bank bone for futureTHA IN DEVELOPMENTAL DYSPLASIAAcetabular Reconstruction High DislocationHigh DislocationFalse AcetabulumNot thick or wide enough for cup fixationTrue AcetabulumThicker bonePosterior column:best boneT

7、HA IN DEVELOPMENTAL DYSPLASIAAcetabulum:Reconstruct at anatomic centerSmall cup,22 m headNo graft(usually)Technical tips:-open socket with burr-ream in reverseTHA FOR DYSPLASIA/LOW DDH ConclusionsAcetabular reconstruction in hip dysplasia:Uncemented cupSupplemental screwsJudicious medializationStruc

8、tural graft only when necessaryTHA FOR DEVELOPMENTAL HIP DYSPLASIA:THE FEMORAL SIDEDaniel J.Berry,MDMayo ClinicRochester MN2022-10-28.23THANK YOUSUCCESSTHA FOR DYSPLASIA Problems to Overcome on Femoral SideProblems to overcome:Femoral anatomy:Abnormal neck shaft angle and anteversionLeg length:Varia

9、ble discrepancyTHA FOR DYSPLASIA Problems to OvercomeFemoral Deformity:The amount of femoral deformity does not always correlate with level of acetabular dysplasiaTHA FOR DYSPLASIAFemoral ReconstructionFemoral Reconstruction options:Cemented DDH stemUncemented stem-monoblock prox coated-monoblock ex

10、t coated-modular stemTHA FOR DYSPLASIAFemoral ReconstructionCemented Femur:DDH stems,cement help manage abnormal proximal anatomyBut.cemented fixation less desirable in mostly young patientsUncemented PreferredIn Most young patientsProx coatedFully coatedModularTHA FOR DYSPLASIAFemoral Reconstructio

11、nMonoblock Proximally Coated Stem:Good only if mild deformityNot good(poor fit,anteversion problems,fracture)if more deformityTHA FOR DYSPLASIAFemoral ReconstructionTHA FOR DYSPLASIAFemoral ReconstructionFully Coated Uncemented Stems:Allow more adjustment for anteversionSpecial stems accommodate val

12、gus neck?Extensively coated less desirable in young patientsTHA FOR DYSPLASIAFemoral ReconstructionTHA FOR DYSPLASIAFemoral ReconstructionModular Uncemented Stems:Proximally coatedAllow version adjustmentRequire surgeon familiarityTHA FOR DYSPLASIAFemoral ReconstructionTHA FOR HIGH DISLOCATIONAcetab

13、ular reconstruction at anatomic center with small cupNeed to shorten femur to reduce hip,minimize sciatic nerve stretchTHA FOR HIGH DISLOCATIONTraditional method:Trochanteric Osteotomy,Proximal Shortening,cemented stemDisadvantages:trochanteric healing problemsproximal femur becomes a straight tubeT

14、HA FOR DYSPLASIAHigh DislocationNewer method:Subtrochanteric Shortening OsteotomyElegantMaintains proximal femoral anatomyAllows uncemented femurAvoids trochanteric problemsTHA FOR DYSPLASIAHigh DislocationSubtroch shortening osteotomy:Post approachOsteotomize femur,translate anteriorlyPlace cupShor

15、ten femurPlace uncemented stemStem with beads or flutes:fixes osteotomyTHA FOR HIP DYSPLASIASciatic NerveLengthening:how much is safe?No definite guidelines but beware when over 2 cmFlex knee post op to relax nerveTHA FOR DYSPLASIAConclusionsGreat operation:dramatic restoration of pain and improved function for most patientsNew methods and implants:better function and better durability 2022-10-28.45THANK YOUSUCCESS