Developmental Dysplasia and Dislocation of the Hip in Adults by Kuo-An Lai

Author:Kuo-An Lai
Language: eng
Format: epub, pdf
ISBN: 9789811304149
Publisher: Springer Singapore

Surgical Approach

An ordinary Hardinge lateral approach, anterior-lateral approach, or posterior-lateral approach can be applied to the patients without much anatomical deformity of the femur, according to the surgeon’s preference. The incision wound can be 10–12 cm for a well-experienced surgeon and 15–20 cm in the case of a less-experienced surgeon. The author prefers to approach through the greater trochanteric osteotomy in cases of trochanter overgrowth or obstructed proximal femoral canal. In cases with planned shortening osteotomy, the approach can be an ordinary lateral, posterior lateral, or anterior lateral plus extension to the proximal femur for the subtrochanteric shortening osteotomy. The incision usually needs to be 20–25 cm for an adequate exposure.

The femoral head is removed at the base of the neck for the stem to be prepared at the adequate orientation and avoiding overlengthening of the leg. A less-experienced surgeon may have difficulty finding the true acetabulum. It can be traced through the joint capsule or from the inferior border of the acetabulum. The redundant and hypertrophic joint capsule should be excised as completely as possible for better identification of the hypo-trophic, obstructed true acetabulum and the best bone stock for cup implantation.

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