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true and false acetabulum2- In Femoral part : small diameter femoral shaft / excessive ante version / posteriorplacement of greater trochanter3- anatomic changes in soft tissue & neurovascular around the hip including : adductormuscle contracture / shortening of abductor muscles / risk of sciatic nerve injury followinglengthening of the limb after reduction in true acetabulum / vascular injuryThe purpose of this lecture is how to manage above problems with using reinforcement ring(ARR) for reconstruction of true acetabulum and step cut L fashion proximal femoral neckshortening osteotomy in a single stage operationMethod:23 surgeries in 19 patients, including 18 female and one male were performed by me from Jan.1997 till Dec. 2009. Six patients had bilateral hip dislocation, but till now only four of them hadbilateral stepped operation. Left hip was involved in 15 cases (65.2%). The average age was 40years old. All hips were high riding DDH according to both hartofillokides and croweclassification. Reconstruction of true acetabulum was performed with aid of reinforcement ringand bone graft from femoral head in all cases. Trochantric osteotomy was done in all, followedby fixation with wire in 22 cases which needed two revisions due to symptomatic non union(9%). Hooked plate was use in one case for trochantric fixation. Due to high riding femur, itwas necessary to performed femoral shortening in neck area as a step cut L fashion.In two patient , one with bilateral involvement, after excessive limb lengthening following trialreduction , it was necessary to performed concomitant supracondylar femoral shortening .(3cases = 13% )22 mm cup & miniature muller DDH stem were used in 18 cases (78.26%). In 5 cases, onebilaterally, non cemented stem and 28 mm cemented cup in ring were used.Primary adductor tenotomy was performed in 9 cases. Secondary adductor tenotomy needed in 2cases (totally = 47.82%). Repair of iatrogenic femoral artery tear after traction injury withretractor, occurred in 2 cases (8.69%).All patients evaluate retrospectively. Average follow up month is 68.7.Results:One case of left acetabular component revision due to painful bony absorption in infero medialpart of ring with poor inclination wad done , after 2 years of primary operation . Know after 13years she has had early signs of stem loosening in the same side.Another acetabular component revision following traumatic dislodgment of cup and cementfrom ring was performed after 13 months from primary operation. Again she had poor implantinclination.So revision rate is 8.69%. (One case will need revision in near future, so the revision rate willincrease to 13%)Radiological wires breakage which were used for greater trochanteric fixation , could be seenin 11 cases (47.82%) , but only two of them with functional impairment needed to re-fixationwith Menen plate(18.18% of trochanteric non union).Average limb lengthening after operation is 4.3 Cm (2-7 Cm). Only one case of transientSciatic nerve paresis had happened for 2 months followed by complete recovery.Two case of secondary adductor tenotomy wre done, one after traumatic dislocation ofprosthesis with pubic fracture, and the other one after restriction of hip abduction.file:///E|/ISTA2010-Abstracts.htm[12/7/2011 3:15:47 PM]