Clinical History, Examination and Blood Test Results

  • Step 5 case 2 presents a 53-year-old woman who had developmental dysplasia of the right hip (grade 4) with osteoarthritis.
     
  • She has severe pain and restriction of mobility as a result of the deformity.

Imaging Results

PRE-OP RADIOGRAPH

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PRE-OP LONG LEG RADIOGRAPH

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This shows developmental dysplasia of the right hip with a high hip centre.

This radiograph allows the surgeon to determine the best method to attain a more symmetrical leg length.  In this case the hip centre needs to be brought equal to the other side, and will be achieved by use of a shortening femoral osteotomy.


Diagnosis

  • This patient was diagnosed with developmental dysplasia of the right hip causing a leg length discrepancy.


Treatment

S-ROM - LONG MODULAR STEM

Image 1 (Trial components of S ROM) This is a long modular stem, with the ability to vary the sleeve, stem length, proximal body type and head. This gives 10,398 combinations to suit the individual patient anatomy.

 

Image 2 (Final implant) The distal segment is fluted, providing stability in the distal bone.

 

Image 3 (close-up of fluted distal segment).

 
 

SHORTENING FEMORAL OSTEOTOMY

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Graphic demonstrating shortening femoral osteotomy.  This is required for 2 reasons – to establish equal leg length, and to take the stretch of the sciatic nerve which can only tolerate up to 2 inches of stretch in these operations.

 

Imaging Outcomes

POST-OP RADIOGRAPH

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This shows satisfactory positioning of the implant.  The cables help fix the osteotomy in place so that the bone heals.

 

Clinical Outcomes

  • The patients leg length discrepancy was equalised without stretching the sciatic nerve. She has a good post-operative function.


Learning Points

  • When a decision is made to bring the hip centre back to its anatomical position, the femur often needs shortening in order to equalize leg length and take the stretch of the sciatic nerve.