Clinical History, Examination and Blood Test Results

  • Case 1 is a 53-year-old female with right sided Crowe grade 4 developmental dysplasia of the hip (DDH). This lady presented with difficulty walking due to severe pain in her right hip. She was otherwise fit and healthy, and had received no previous treatment for her DDH.

  • Examination revealed a 4cm shoe raise on the right side with restricted painful movement in the right hip. She had an intact pulse and sensation in her right foot.


Imaging Results

PRE-OP RADIOGRAPH

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Pre-operative anteroposterior radiograph showing severe Crowe grade 4 developmental dysplasia of the right hip causing a leg length discrepancy of 4cm.

 

Diagnosis

  • Crowe grade 4 developmental dysplasia of the right hip with osteoarthritis causing severe pain.


Treatment

  • Primary total hip replacement on the right side, restoring the centre of rotation compared with the other side.

  • A shortening femoral osteotomy was required in this case to prevent stretching of the soft tissues.

  • An S-ROM was used with a ceramic head articulating with a polyethylene liner in a Pinnacle Gription socket.


Imaging Outcomes

POST-OP RADIOGRAPH

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This post-operative anteroposterior radiograph shows the S-ROM femoral implant in position correcting the centre of rotation in the right hip. A shortening femoral osteotomy was used to prevent overstretching of the soft tissues.

 

Clinical Outcomes

  • This lady was very happy after her procedure. She had pain free mobility without the aid of analgesics.


Learning Points

  • In cases of severe leg length discrepancy that require correction of the centre of rotation of the hip, over-stretching of the soft tissues is prevented by using a shortening femoral osteotomy.