ddhthachina先天性髋关节脱位的髋关节置换.pptxVIP

THA FOR DEVELOPMENTAL HIP DYSPLASIATHA FOR DYSPLASIA Problem to Overcome on AcetabulumProblem:Lateral acetabular bone deficiency of varying severityTHA FOR DYSPLASIA/LOW DDHACETABULAR RECONSTRUCTIONTHA FOR DYSPLASIA/LOW DDH Acetabular ReconstructionGeneral Principles:Uncemented socketOptimize cup stability on host boneDon’t let bone deficiency dictate cup positionTHA FOR DYSPLASIA/LOW DDH Acetabular ReconstructionKey Point:Use supplemental screwsAvoid pressfit fixation alone without screws in deficient acetabulumTHA FOR DYSPLASIA/LOW DDH Acetabular ReconstructionTechnique of arthroplasty is determined by severity of antero-lateral acetabular bone lossTHA FOR DYSPLASIA/LOW DDH Acetabular ReconstructionMild Lateral Deficiency:Routine acetabular reconstruction (uncemented)Slight medialization of cup if necessaryAccept slight lateral uncoverageTHA FOR DYSPLASIA/LOW DDH Acetabular ReconstructionModerate Lateral Deficiency:Medialize hip center to medial wallAccept some lateral uncoverage (~1.5 cm of cup)Accept slight elevation of hip centerTHA FOR DYSPLASIA/LOW DDH Acetabular ReconstructionMarked Lateral Deficiency: Options:Medialize through medial wall High hip centerLateral bulk autogenous femoral head graftMANAGEMENT OF THE DYSPLASTIC HIP Acetabular ReconstructionMy preference:Medialize to (but not through) medial wallAccept slight elevation of hip centerLateral fem head graft if neededHigh hip center only in rare casesFEMORAL HEAD AUTOGRAFTSSlight Extra work, Extra RiskThey do bank bone for future10 yrs, bone restoredTHA IN DEVELOPMENTAL DYSPLASIAAcetabular Reconstruction High DislocationFalse AcetabulumNot thick or wide enough for cup fixationTrue AcetabulumThicker bonePosterior column: best boneTHA IN DEVELOPMENTAL DYSPLASIAAcetabulum:Reconstruct at anatomic centerSmall cup, 22 m headNo graft (usually)Technical tips:- open socket with burr- ream in reverseTHA FOR DYSPLASIA/LOW DDH ConclusionsAcetabular reconstruction in hip dysplasia:Uncemented cupSupplemental scre