DDH-THA-China--先天性髋关节脱位的髋关节置换.pptVIP

THA FOR DEVELOPMENTAL HIP DYSPLASIA Daniel J. Berry, MD Mayo ClinicRochester, MN, USA THA FOR DYSPLASIA Problem to Overcome on Acetabulum Problem: Lateral acetabular bone deficiency of varying severity THA FOR DYSPLASIA/LOW DDH ACETABULAR RECONSTRUCTION THA FOR DYSPLASIA/LOW DDH Acetabular Reconstruction General Principles: Uncemented socket Optimize cup stability on host bone Don’t let bone deficiency dictate cup position THA FOR DYSPLASIA/LOW DDH Acetabular Reconstruction Key Point: Use supplemental screws Avoid pressfit fixation alone without screws in deficient acetabulum THA FOR DYSPLASIA/LOW DDH Acetabular Reconstruction Technique of arthroplasty is determined by severity of antero-lateral acetabular bone loss THA FOR DYSPLASIA/LOW DDH Acetabular Reconstruction Mild Lateral Deficiency: Routine acetabular reconstruction (uncemented) Slight medialization of cup if necessary Accept slight lateral uncoverage THA FOR DYSPLASIA/LOW DDH Acetabular Reconstruction Moderate Lateral Deficiency: Medialize hip center to medial wall Accept some lateral uncoverage (~1.5 cm of cup) Accept slight elevation of hip center THA FOR DYSPLASIA/LOW DDH Acetabular Reconstruction Marked Lateral Deficiency: Options: Medialize through medial wall High hip center Lateral bulk autogenous femoral head graft MANAGEMENT OF THE DYSPLASTIC HIP Acetabular Reconstruction My preference: Medialize to (but not through) medial wall Accept slight elevation of hip center Lateral fem head graft if needed High hip center only in rare cases THA IN DEVELOPMENTAL DYSPLASIAAcetabular Reconstruction High Dislocation False Acetabulum Not thick or wide enough for cup fixation True Acetabulum Thicker bone Posterior column: best bone THA IN DEVELOPMENTAL DYSPLASIA Acetabulum: Reconstruct at anatomic center Small cup, 22 m head No graft (usually) Technical tips: - open socket with burr - ream in reverse THA FOR DYSPLASIA/LOW DDH Conclusions Acetabular reconstruction in hip dysplasia: Uncemented cup