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MIÉRCOLES / WEDNESDAY
136
ment of the greater trochanter with intact
attachment of the gluteus medius muscle. A
subtrochanteric shortening osteotomy fi xed
with prosthetic stem was the other method.
During the “Lord-period” exact rasping of
the proximal femur and diaphysis distal to
osteotomy and locking the proper rotation by
step method was tedious and time consuming.
Functional results, ROM and abduction
strength were some better with the trochanter
transfer method, although the radiographic
result looks more anatomic and nicer after
the subtrochanteric shortening technique.
Lengthening of the leg was also easier with
the fi rst method. To day we use the latter
technique combined with angular and rotation
correction in cases after low seated unilateral
Schanz osteotomy. With the modern modular
stems with fl uted distal part the procedure is
much easier and faster.
Patient material. The methods are applied
for all grades of DDH, arthrogryphosis,
diastrophic dysplasia, congenital coxa vara
and all kinds of dysplastic hips with osteoarthrosis.
Results. Our experiences and results have
been published in many articles (J Bone Joint
Surg Br. 1990; 72:205-11, Clin Orthop Relat
Res. 1993; 297:71-81, Acta Ortop Scand.
1997; 68:77-84, J Bone Joint Surg Am.
2003; 85:441-7, J Bone Joint Surg Am. 2006;
88:80-91). In the last article Antti Eskelinen
et al. reports results of 68 consecutive hip
replacements performed in DDH-patients
with high dislocation. They were operated
on between 1989-94. Follow-up time was
12,3 y. Harris hip score increased from 54 to
84 points. Trendelenburg sign was negative
in 92% of the cases. With revision because
of aseptic loosening as the end point the ten
year survival rate for press-fi t porous coated
acetabular component was 94,9%(95% confi
dence interval, 89,3% -100%), but all the 9
threaded cups loosened and all but one had
been revised already. There were 6 revisions
of the press-fi t cups because of liner wear and
osteolysis, and 7 patients were scheduled for
liner revision because of wear (1-5mm). The
rate of survival for the DDH stem (proximally
porous coated, Biomet Inc.), with revision because
of aseptic loosening as the end point,
was 98,4% (95% confi dence interval , 96,8%
-100%)at ten years. One malpositioned stem
perforated the posteromedial cortex of the
femur. Two early dislocations occurred because
of excessive anteversion of the stem.
There were four transient nerve palsies, two
peroneal, one femoral and one superior gluteal.
In the case of the other peroneal nerve
palsy, a big postoperative haematoma was
evacuated on the fi rst postoperative day, and
lengthening of the leg was reduced from 5 to
4 cm with successful recovery.
Conclusions. Replacement surgery of different
types of hip dysplasia with osteoarthrosis
is feasible with the presented techniques. In
cases of high congenital dislocation we prefer,
based on our experience, the technique
of proximal shortening of the femur with distal
advancement of the greater trochanter. If
lengthening of the leg is desired more than
3 cm, neurological status is controlled today
with perioperative ENMG. The technique of
segmental shortening with angle correction,
we use only in cases after low seated unilateral
Schanz osteotomy. Nowadays hard on
hard articulations are our fi rst choice to avoid
wear and osteolysis.
PREVENTION AND
TREATMENT OF RECURRENT
DISLOCATION IN THA
R. Geesink
University Hospital Maastricht, Netherlands