DDHTHAChina先天性髋关节脱位的髋关节置换

THA FOR DEVELOPMENTAL HIP DYSPLASIA,Daniel J. Berry, MDMayo ClinicRochester, MN, USA,THA FOR DYSPLASIA Problem to Overcome on Acetabulum,Problem:Lateral acetabular bone deficiency of varying severity,THA FOR DYSPLASIA/LOW DDH,ACETABULAR RECONSTRUCTION,THA FOR DYSPLASIA/LOW DDH Acetabular Reconstruction,General Principles:Uncemented socketOptimize cup stability on host boneDont let bone deficiency dictate cup position,THA FOR DYSPLASIA/LOW DDH Acetabular Reconstruction,Key Point:Use supplemental screwsAvoid pressfit fixation alone without screws in deficient acetabulum,THA FOR DYSPLASIA/LOW DDH Acetabular Reconstruction,Technique of arthroplasty is determined by severity of antero-lateral acetabular bone loss,THA FOR DYSPLASIA/LOW DDH Acetabular Reconstruction,Mild Lateral Deficiency:Routine acetabular reconstruction (uncemented)Slight medialization of cup if necessaryAccept slight lateral uncoverage,THA FOR DYSPLASIA/LOW DDH Acetabular Reconstruction,Moderate Lateral Deficiency:Medialize hip center to medial wallAccept some lateral uncoverage (1.5 cm of cup)Accept slight elevation of hip center,Marked Lateral Deficiency: Options:Medialize through medial wall High hip centerLateral bulk autogenous femoral head graft,THA FOR DYSPLASIA/LOW DDH Acetabular Reconstruction,MANAGEMENT OF THE DYSPLASTIC HIP Acetabular Reconstruction,My preference:Medialize to (but not through) medial wallAccept slight elevation of hip centerLateral fem head graft if neededHigh hip center only in rare cases,10 yrs, bone restored,FEMORAL HEAD AUTOGRAFTSSlight Extra work, Extra RiskThey do bank bone for future,THA IN DEVELOPMENTAL DYSPLASIAAcetabular Reconstruction,High DislocationFalse AcetabulumNot thick or wide enough for cup fixationTrue AcetabulumThicker bonePosterior column: best bone,THA IN DEVELOPMENTAL DYSPLASIA,Acetabulum:Reconstruct at anatomic centerSmall cup, 22 m headNo graft (usually)Technical tips:- open socket with burr- ream in reverse,THA FOR DYSPLASIA/LOW DDH Conclusions,Acetabular reconstruction in hip dysplasia:Uncemented cupSupplemental screwsJudicious medializationStructural graft only when necessary,THA FOR DEVELOPMENTAL HIP DYSPLASIA: THE FEMORAL SIDE,Daniel J. Berry, MDMayo ClinicRochester MN,THA FOR DYSPLASIA Problems to Overcome on Femoral Side,Problems to overcome:Femoral anatomy: Abnormal neck shaft angle and anteversionLeg length: Variable discrepancy,THA FOR DYSPLASIA Problems to Overcome,Femoral Deformity:The amount of femoral deformity does not always correlate with level of acetabular dysplasia,THA FOR DYSPLASIAFemoral Reconstruction,Femoral Reconstruction options:Cemented DDH stemUncemented stem-monoblock prox coated-monoblock ext coated-modular stem,THA FOR DYSPLASIAFemoral Reconstruction,Cemented Femur:DDH stems, cement help manage abnormal proximal anatomyBut.cemented fixation less desirable in mostly young patients,Uncemented PreferredIn Most young patients,Prox coated,Fully coated,Modular,THA FOR DYSPLASIAFemoral Reconstruction,Monoblock Proximally Coated Stem:Good only if mild deformityNot good (poor fit, anteversion problems, fracture) if more deformity,THA FOR DYSPLASIAFemoral Reconstruction,THA FOR DYSPLASIAFemoral Reconstruction,Fully Coated Uncemented Stems:Allow more adjustment for anteversionSpecial stems accommodate valgus neck? Extensively coated less desirable in young patients,THA FOR DYSPLASIAFemoral Reconstruction,THA FOR DYSPLASIAFemoral Reconstruction,Modular Uncemented Stems:Proximally coatedAllow version adjustmentRequire surgeon familiarity,THA FOR DYSPLASIAFemoral Reconstruction,THA FOR HIGH DISLOCATION,Acetabular reconstruction at anatomic center with small cupNeed to shorten femur to reduce hip, minimize sciatic nerve stretch,THA FOR HIGH DISLOCATION,Traditional method: Trochanteric Osteotomy, Proximal Shortening, cemented stemDisadvantages:trochanteric healing problemsproximal femur becomes a straight tube,THA FOR DYSPLASIAHigh Dislocation,Newer method: Subtrochanteric Shortening OsteotomyElegantMaintains proximal femoral anatomyAllows uncemented femurAvoids trochanteric problems,THA FOR DYSPLASIAHigh Dislocation,Subtroch shortening osteotomy:Post approachOsteotomize femur, translate anteriorlyPlace cupShorten femurPlace uncemented stemStem with beads or flutes: fixes osteotomy,THA FOR HIP DYSPLASIASciatic Nerve,Lengthening: how much is safe?No definite guidelines but be