Hip socket fractures are common injuries in the young active population. They result from four/ two wheeler accidents. The timely treatment is fracture fixation. Often this treatment fails when a hip replacement becomes necessary. This presentation outlines the role for an alternative to hip replacement for this condition
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Hip replacement for hip socket fractures- role for short stem hip replacement in India
1. Abstract number 226 E Poster –AP03 Dr. A.K.Venkatachalam
Dr.A.K.Venkatachala
m
MS Orth, DNB Orth, FRCS, M.Ch Orth
Consultant Orthopedic
surgeon
Associate professor
Chennai
2. • Acetabular fractures occur in young patients
• THR requires acetabular reconstruction, bone grafting
and reconstruction
• Limb length discrepancy needs to be addressed-due to
proximal femoral migration, protrusio, proximal femoral
bone loss
• Possible to correct LLD on acetabular side with protrusio
alone by auto graft, allograft, synthetic bone substitutes,
metal
• Hence opportunity to preserve bone on femoral side
• Hence role for short stem femoral prostheses instead of
THR.
Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam
3. • Case1-25 year male, longstanding mal-united acetabular fracture
with protrusio grade 3. Femoral side normal.
• Acetabular reconstruction with peripheral cup capture, bone grafting
with morsellized femoral head autograft. Cup lateralized to
anatomical center
• Short stem femoral prosthesis with ceramic on metal bearings
• Residual LLD- 1.5cm.
Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam
4. • Case 2- 42 year old male, transverse fracture
acetabulum with ORIF.
• Acetabular reconstruction w/o bone grafting, short stem
femoral and uncemented cup. Ceramic on metal
bearings.
• No post op LLD.
• LLD
Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam
5. • Case 3-47 year old female, transverse fracture acetabulum with
absorption of femoral head, proximal & central migration with
protrusio acetabuli
• THR –Acetabular reconstruction with peripheral cup placement, bone
grafting.
• Femoral reconstruction with THR as head was partially resorbed.
Metal on poly bearings
• No LLD post op
Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam
6. • Case 4- 30 year old male, posterior wall & roof fracture, proximal
femoral head migration. Pre op LLD of three inches
• THR with posterior wall & roof acetabular reconstruction with femoral
head cortico-cancellous slice, Recon plate on acetabular side,
conventional uncemented femur. Ceramic on ceramic bearings.
• No post op LLD.
• Post op sciatic N. palsy
Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam
7. • Myositis ossificans post op.
• Sciatic nerve palsy. Keep knee flexed during surgery.
• Limb length discrepancy.
• ? Retention / removal of previous metal ware.
• Hindrance during acetabular preparation from previous metal
ware. May need screw cutting rather than removal.
• Bone graft required- femoral autograft, cryo allograft,
• Synthetic bone substitutes- Hydroxy apatite, Calcium sulphate
• Metal restrictors- trabecular metal, Augments, cages. Cement
not preferred as most patients are young.
• Acetabular reconstruction with Jumbo cups, cages, augments,
restrictors, recon plate, bone graft.
Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam
8. • THR has been standard procedure. Uncemented THR
preferred as most patients are young.
• When gross LLD is present, due to combination of
acetabular and femoral fractures, total hip replacement is
procedure of choice
• If LLD is mainly due to acetabular protrusio and femoral
anatomy is preserved, possible to do a short stem hip
replacement.
• Hard on hard bearings preferred as most patients are
young.
• Hard on cross linked poly in middle aged.
Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam
9. • Previous metal work- can be left alone if Myositis present,
Other wise can be removed
• Pre op swabs for possible wound infection from previous metal
ware
• Acetabular defects analysed by Paproski classification.
Peripheral cup placement in protrusio. Cup should be
lateralized. Jumbo cup used. Central bone grafting
• Peripheral bone grafting in posterior wall and roof fractures.
Roof and wall reinforcement with metal & bone prior to hip
replacement.
• Possible to use TM augments, but since most patients are
young, bone graft preferred.
• Cup requires screw fixation rather than Mono block cups.
Standard or multi hole shells depending on bone loss.Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam
10. • LLD may be present from long standing proximal and
central migration of proximal femur
• Proximal femoral bone loss from AVN, Femoral head &
neck bone deficiency due to fracture.
• Neck anatomy may be altered precluding short stem
prostheses.
Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam
11. • Short stem prosthesis are possible when proximal
femoral anatomy is preserved, minimal LLD( <2”)
• Advantage is femoral bone preservation in carefully
selected cases.
• Limb length < 1inch can be addressed with variable neck
lengths in non modular and modular femoral prosthesis.
• Versatility of bearing combinations like ceramics, metal,
poly.
• Femoral side conversion to primary THR in future
eliminating or reducing need for a revision femoral
implant.
• Increased cost of short stem prosthesis is a factor.
Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam