SHORTENING SUBTROCHANTERIC OSTEOTOMY FOR HIGH HIP DISLOCATION Daniel J. Berry, MD Mayo Clinic Rochester, MN

SUBTROCH. SHORTENING OSTEOTOMY Introduction High Dislocation: Goals of Surgery: Normalize hip center Gain stable implant fixation Optimize abductor function Protect sciatic nerve

SUBTROCH. SHORTENING OSTEOTOMY Introduction Traditional Method: Greater trochanteric osteotomy Shorten femur until hip can be reduced Insert cemented stem

SUBTROCH. SHORTENING OSTEOTOMY Traditional Method Drawbacks to Traditional Method: Problems with greater trochanter– which doesn’t always heal

SUBTROCH. SHORTENING OSTEOTOMY Traditional Method Drawbacks to Traditional Method: Permanently changes shape of proximal femur - no metaphyseal flare

SUBTROCH. SHORTENING OSTEOTOMY Traditional Method Drawbacks to Traditional Method: Requires cemented stem - less desirable in younger patients?

SUBTROCH. SHORTENING OSTEOTOMY Advantages Advantages of Shortening Osteotomy: No greater trochanteric problems

SUBTROCH. SHORTENING OSTEOTOMY Advantages Advantages of Shortening Osteotomy: Preserves architecture of proximal femur

SUBTROCH. SHORTENING OSTEOTOMY Advantages Advantages of Shortening Osteotomy: Allows use of uncemented implants

SUBTROCH. SHORTENING OSTEOTOMY Advantages Advantages of Shortening Osteotomy: Protects sciatic nerve

SUBTROCH. SHORTENING OSTEOTOMY Advantages Advantages of Shortening Osteotomy: Allow leg length, femoral anteversion correction

SUBTROCH. SHORTENING OSTEOTOMY Results Masonis et al. (London, Ontario): 21 hips (F/U 6 yrs) 10 uncemented, 11 cemented 2 nonunions 1 loose cemented stem

SUBTROCH. SHORTENING OSTEOTOMY Results Masonis et al. (London, Ontario): 3 dislocations No sciatic n. injury

SUBTROCH. SHORTENING OSTEOTOMY Results Mayo Clinic: Uncemented fully coated or modular stem 18 hips

SUBTROCH. SHORTENING OSTEOTOMY Results 100% stable implants 0% nonunions Complications: 1 dislocation 0 infection

SUBTROCH. SHORTENING OSTEOTOMY Results Functional Results: Favorable return of abductor function

SUBTROCH. SHORTENING OSTEOTOMY Method Posterior hip dislocation Osteotomize femoral neck Preliminary femoral preparation

SUBTROCH. SHORTENING OSTEOTOMY Method Limited exposure of femur at planned osteotomy level Transverse osteotomy

SUBTROCH. SHORTENING OSTEOTOMY Method Retract femur anteriorly Direct exposure of acetabulum Insert cup

SUBTROCH. SHORTENING OSTEOTOMY Method Reduce hip with trial in proximal fragment only Shorten femur appropriately Trial with osteotomy reduced

SUBTROCH. SHORTENING OSTEOTOMY Method Insert femoral component Add autogenous strut if desired

CASE EXAMPLES

SUBTROCH. SHORTENING OSTEOTOMY Conclusions Elegant method Safe and effective Satisfies goals of surgery: normalize hip center protect nerve stable implant fixation