DDHTHAChina先天性髋关节脱位的髋关节置换课件

THA FOR DEVELOPMENTAL HIP DYSPLASIADaniel J.Berry,MDMayo ClinicRochester,MN,USATHA FOR DEVELOPMENTAL HIP DYSPTHA FOR DYSPLASIA Problem to Overcome on AcetabulumProblem:Lateral acetabular bone deficiency of varying severityTHA FOR DYSPLASIA Problem to THA FOR DYSPLASIA/LOW DDHACETABULAR RECONSTRUCTIONTHA FOR DYSPLASIA/LOW DDHACETATHA FOR DYSPLASIA/LOW DDH Acetabular ReconstructionGeneral Principles:Uncemented socketOptimize cup stability on host boneDont let bone deficiency dictate cup positionTHA FOR DYSPLASIA/LOW DDH AceTHA FOR DYSPLASIA/LOW DDH Acetabular ReconstructionKey Point:Use supplemental screwsAvoid pressfit fixation alone without screws in deficient acetabulumTHA FOR DYSPLASIA/LOW DDH AceTHA FOR DYSPLASIA/LOW DDH Acetabular ReconstructionTechnique of arthroplasty is determined by severity of antero-lateral acetabular bone lossTHA FOR DYSPLASIA/LOW DDH AceTHA 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 AceDDHTHAChina先天性髋关节脱位的髋关节置换课件THA 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 AcetDDHTHAChina先天性髋关节脱位的髋关节置换课件DDHTHAChina先天性髋关节脱位的髋关节置换课件Marked Lateral Deficiency:Options:Medialize through medial wall High hip centerLateral bulk autogenous femoral head graftTHA FOR DYSPLASIA/LOW DDH Acetabular ReconstructionMarked Lateral Deficiency:OpMANAGEMENT OF THE DYSPLASTIC HIP Acetabular ReconstructionMy preference:1.Medialize to(but not through)medial wall2.Accept slight elevation of hip center3.Lateral fem head graft if needed4.High hip center only in rare casesMANAGEMENT OF THE DYSPLASTIC HDDHTHAChina先天性髋关节脱位的髋关节置换课件DDHTHAChina先天性髋关节脱位的髋关节置换课件DDHTHAChina先天性髋关节脱位的髋关节置换课件10 yrs,bone restoredFEMORAL HEAD AUTOGRAFTSSlight Extra work,Extra RiskThey do bank bone for future10 yrs,bone restoredFEMORAL HTHA IN DEVELOPMENTAL DYSPLASIAAcetabular Reconstruction High DislocationFalse AcetabulumNot thick or wide enough for cup fixationTrue AcetabulumThicker bonePosterior column:best boneTHA IN DEVELOPMENTAL DYSPLASIATHA IN DEVELOPMENTAL DYSPLASIAAcetabulum:Reconstruct at anatomic centerSmall cup,22 m headNo graft(usually)Technical tips:-open socket with burr-ream in reverseTHA IN DEVELOPMENTAL DYSPLASIADDHTHAChina先天性髋关节脱位的髋关节置换课件THA FOR DYSPLASIA/LOW DDH ConclusionsAcetabular reconstruction in hip dysplasia:Uncemented cupSupplemental screwsJudicious medializationStructural graft only when necessaryTHA FOR DYSPLASIA/LOW DDH ConTHA FOR DEVELOPMENTAL HIP DYSPLASIA:THE FEMORAL SIDEDaniel J.Berry,MDMayo ClinicRochester MNTHA FOR DEVELOPMENTAL HIP DYSPTHA FOR DYSPLASIA Problems to Overcome on Femoral SideProblems to overcome:Femoral anatomy:Abnormal neck shaft angle and anteversionLeg length:Variable discrepancyTHA FOR DYSPLASIA Problems toTHA FOR DYSPLASIA Problems to OvercomeFemoral Deformity:The amount of femoral deformity does not always correlate with level of acetabular dysplasiaTHA FOR DYSPLASIA Problems toTHA FOR DYSPLASIAFemoral ReconstructionFemoral Reconstruction options:Cemented DDH stemUncemented stem-monoblock prox coated-monoblock ext coated-modular stemTHA FOR DYSPLASIAFemoral RecoTHA FOR DYSPLASIAFemoral ReconstructionCemented Femur:DDH stems,cement help manage abnormal proximal anatomyBut.cemented fixation less desirable in mostly young patientsTHA FOR DYSPLASIAFemoral RecoUncemented PreferredIn Most young patientsProx coatedFully coatedModularUncemented Prox coatedFully coTHA FOR DYSPLASIAFemoral ReconstructionMonoblock Proximally Coated Stem:Good only if mild deformityNot good(poor fit,anteversion problems,fracture)if more deformityTHA FOR DYSPLASIAFemoral RecoTHA FOR DYSPLASIAFemoral ReconstructionTHA FOR DYSPLASIAFemoral RecoTHA FOR DYSPLASIAFemoral ReconstructionFully Coated Uncemented Stems:Allow more adjustment for anteversionSpecial stems accommodate valgus neck?Extensively coated less desirable in young patientsTHA FOR DYSPLASIAFemoral RecoTHA FOR DYSPLASIAFemoral ReconstructionTHA FOR DYSPLASIAFemoral RecoTHA FOR DYSPLASIAFemoral ReconstructionModular Uncemented Stems:Proximally coatedAllow version adjustmentRequire surgeon familiarityTHA FOR DYSPLASIAFemoral RecoTHA FOR DYSPLASIAFemoral ReconstructionTHA FOR DYSPLASIAFemoral RecoDDHTHAChina先天性髋关节脱位的髋关节置换课件DDHTHAChina先天性髋关节脱位的髋关节置换课件THA FOR HIGH DISLOCATIONAcetabular reconstruction at anatomic center with small cupNeed to shorten femur to reduce hip,minimize sciatic nerve stretchTHA FOR HIGH DISLOCATIONTHA FOR HIGH DISLOCATIONTraditional method:Trochanteric Osteotomy,Proximal Shortening,cemented stemDisadvantages:trochanteric healing problemsproximal femur becomes a straight tubeTHA FOR HIGH DISLOCATIONTradiTHA FOR DYSPLASIAHigh DislocationNewer method:Subtrochanteric Shortening OsteotomyElegantMaintains proximal femoral anatomyAllows uncemented femurAvoids trochanteric problemsTHA FOR DYSPLASIAHigh DislocaTHA FOR DYSPLASIAHigh DislocationSubtroch shortening osteotomy:Post approachOsteotomize femur,translate anteriorlyPlace cupShorten femurPlace uncemented stemStem with beads or flutes:fixes osteotomyTHA FOR DYSPLASIAHigh DislocaDDHTHAChina先天性髋关节脱位的髋关节置换课件DDHTHAChina先天性髋关节脱位的髋关节置换课件THA FOR HIP DYSPLASIASciatic NerveLengthening:how much is safe?No definite guidelines but beware when over 2 cmFlex knee post op to relax nerveTHA FOR HIP DYSPLASIASciatic 提问与解答环节Questions And Answers提问与解答环节43谢谢聆听 学习就是为了达到一定目的而努力去干,是为一个目标去战胜各种困难的过程,这个过程会充满压力、痛苦和挫折Learning Is To Achieve A Certain Goal And Work Hard,Is A Process To Overcome Various Difficulties For A Goal谢谢聆听Learning Is To Achieve A C44