N. LEM. F. 47 y. 1 m50 49 Kg Bilateral high dislocated hip 1986 Right leg shortening 7.5 cm Left leg shortening 7 cm No leg length discrepancy No deformation of the lumber spine What would you do? 1986 Femoral shortening osteotomy? Or not?

LEM THA with cemented components Leg length lengthening Right 6.5 cm Left 6 cm Without femoral osteotomy 16 y. PO

GRE. A. F. 51 y. 1 m53 55 kg Bilateral Crowe 4 DDH painful painful Left valgus knee – arthritic - painful Lumbar spine – arthritic – not completely fixed painful Pelvic tilt Shortening R.Hip 8,5 cm, left 9 cm Bilateral abduction osteotomy at 5 y. but no residual angular femoral deformation What would you do? Which approach? Which type of prosthesis? Femoral shortening osteotomy? Or not?

First operation on the left side. Acetabular component cemented in the true acetabulum augmented with autograft secured with 2 screws. Femoral component inserted at the lesser trochanter level. It was impossible to reduce the hip. Rather than do a shortening femoral osteotomy, I prefered inserting the femoral component 2 cm below the lesser trochanter. No problem to fix the greater trochanter. Lengthening 6.5 cm.

An acetabular reinforcement device was added on the right side because the acetabular bone was soft and fragile. Same problem as on the left side with the femur. Bone section 2 cm below the lesser trochanter. No problem to fix the greater trochanter. Left hip : 18 months PO Right hip : 1 year PO

R. Hip 15 y. PO L. Hip 16 y. PO Equality of the lower limbs No residual pelvic tilt