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Re: Hip Case
послал Mangal Parihar 01 Февраль 2004, 17:49
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Certainly, this is an option and a valuable one, to restore limb length and reduce the trendelenburg gait for conditions like old septic arthritis of the hip, dislocated hips.
This operation - the Ilizarov Hip Reconstruction consists of an extreme valgus osteotomy in the proximal femur, to stabilise the unstable hip, a lengthening distally to equalise the limb lengths, and a varusization thru that lengthening zone to bring back the distal limb parallel to the other limb, and normalise the "mechanical axis".
Arthroplasty surgeons and societies where joint replacement is commonplace, would argue that a joint replacement is a better option.
To that I say - Different horses for different courses
Generalisations as a rule are a bad idea but for "developing" countries where financial realities and cultural requirements are different, certainly this procedure has an important place in the armamentarium.
No doubt that there are quite specific indications where this procedure would help, but that is a statement that is true for any surgical procedure.
In my understanding, the set of indications (either singly or in combination) where this procedure could be useful are as below.
Absence of head/neck due to any cause;
Young, active, unilateral dislocated hip;
High riding hip dislocation;
Very active patients with any of the above;
Cultural requirements -- sitting crosslegged, squatting etc.;
Inability to afford hip replacement, or more importantly, inability to afford multiple revisions in the future....
Lack of infrastructure to perform hip replacements (poor orthopedic surgical facilities)
In my understanding, and (limited) experience, it is unlikely to be helpful in neurological conditions including polio, and I would not attempt it in those circumstances.
Non-union of the proximal osteotomy is a very unlikely and uncommon outcome if the osteotomy is done percutaneously and good fixation is achieved.
The bowing of the femur that you mention, is intentionally created thru the lengthening site as noted previously.
Treatment now would need to be by the use of an ilizarov fixator and bone grafting on the concave portion of the proximal femur rather than between the bone ends actually.
Attached are some pics of a case of an 18 year old girl with shortening and trendelenburg lurch, both of which were corrected by the procedure.
The xrays in single stance show that the pelvis continues to remain level, in the single stance, despite the absence of the head.
Mangal Parihar
Mumbai, India
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