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MIÉRCOLES / WEDNESDAY
134
TOTAL HIP REPLACEMENT
FOR THE CONGENITAL
DISLOCATED HIP
K. Soballe
Department of Orthopaeadics, Aarhus
University Hospital. Denmark
We have performed 18 total hip replacements
due to congenitally dislocated hips using the
Paavoleinen technique with shortening of the
proximal femur and placement o the acetabulat
component in the original acetabulum..
The patients were 9 women and 6 men with
a mean age of 38(16-73). All operations were
performed by the same surgeon (KS).
The patients were all classifi ed as C or D
after the Eftekahrs classifi cation. The follow
up period was from 1 to 9 years.
We had no incident of aseptic loosening and
no infections after primary operation was
encountered.
Three patients underwent reoperation due to
wear of the polyethylene liner There were two
reoperations, one due to early displacement
of the cup and one was open reducted due to
dislocation Two patients experienced dislocation
and were reduced close .Only one patient
experienced temporary peroneal nerve palsy
with complete recurrence after 1 week .
Trendelenburg sign was positive in all patients
preoperatively and only in one postoperatively.
Harris Hip Score regarding pain
on an accumulated basis improved from 81
preoperatively to 28 postoperatively. Likewise
the score for walking ability improved from
63 to 29. .
These intermediate results indicate that the
Paavoleinen operation for the congenital
dislocated hip provides the patient with a
stable and functional hip with a limited rate of
complications. The number of disloations is
high but comparable with similar publications
on CDH and can be explained by the altered
biomechanicanical situation and the use of
small 22 mm heads. The problem with wear
of the polyethylene liner in younger patients
is still an unsolved issue but hard bearings
might be a solution if available in small sizes
(40-44 mm cup).
ARTHROPLASTIES IN
DYSPLASTIC HIPS
T. Paavilainen
Hospital ORTON, Helsinki, Finland
Introduction. Cementless method created
new possibilities for replacement surgery of
dysplastic hips. Osteotomies of the femur
and the protrusion socket technique became
feasible. In our hospital the operative methods
were developed in 1980’s, already, when
the Lord´s madreporic components were
adopted. Since then the threaded cups were
replaced with the press fi t ones, and more
appropriate stems have been designed and
manufactured by Biomet Inc.
Operative methods. The acetabular component
is seated at anatomic level or even
lower, if the a-p-diameter at that level is too
small for the cup. The protrusion socket
technique is used in cases with thin pelvic
wall to achieve reliable fi xation of the cup to
the host bone.
The level of resection of the femur is estimated
according to the need of lengthening, and
the type and size of the stem is chosen according
to the shape of the femur at the level
of resection. In cases with high dislocation
we have used two techniques. Most favoured
became the method of proximal shortening
of the femur combined with distal advance-