Hip Preservation Surgery in Children and Adolescents by Kim Young-Jo;Novais Eduardo; & Eduardo N. Novais

Author:Kim, Young-Jo;Novais, Eduardo; & Eduardo N. Novais
Language: eng
Format: epub
Publisher: Wolters Kluwer Health
Published: 2020-09-15T00:00:00+00:00

FIGURE 9.7 Residual symptomatic deformity of the hip secondary to LCPD, leading to intra-articular femoral head–induced pincer impingement treated by a femoral head reduction osteotomy in a 10-year-old girl A, Preoperative AP and frog-leg lateral radiographs showing severe deformity of the left hip after LCPD with a large portion of the femoral head not well covered by the acetabulum. B, Intraoperative picture showing the dysmorphic femoral head exposed through a surgical hip dislocation approach after development of an extended retinacular soft-tissue flap. The black arrow points to a central area of the femoral head with blistering of the chondral surface. C, Intraoperative picture showing the demarcation for the femoral head osteotomy: the osteotomies are performed in the sagittal plane to protect the blood supply to the femoral head. The medial osteotomy is performed first with an oscillating saw, as shown in the picture. D, Intraoperative picture showing the lateral osteotomy (dashed green line) has been performed parallel to the medial osteotomy (dashed blue line) to the level of the base of the femoral neck. An osteotomy at the base of the lateral segment is performed (black dashed line) to allow for mobilization of the lateral segment. E, Intraoperative picture showing the femoral head after the central portion had been removed and the lateral segment mobilized medially and held to the medial segment by a pointed clamp. F, After fixation of the head reduction osteotomy, a spherical template is used to confirm the appropriate sphericity of the femoral head. G, Postoperative AP and lateral radiographs at 18-month follow-up showing a well-contained femoral head with improved sphericity index. The patient is asymptomatic with improvement of hip range of motion. (Courtesy case from Dr. Travis Matheney, MD.)

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