16 year old lady had a long standing dislocation of the hip joint due to childhood septic arthritis of hip joint. She had a lurch and shortening of the limb with tiredness on walking a few steps.
X-ray shows a high riding femoral head with a false acetabulum and a very shallow true acetabulum. Here it is not possible to relocate the hip.
The femoral head is left in situ and a significant valgus subtrochanteric osteotomy is done to give pelvic support. The valgus created is as much as 70 to 90 degrees. This reduces the Trendelenberg sign and does not allow any further adduction at the hip joint. The sigificant valgus would pose problems for the knee and also some length is needed and hence a distal femoral lengthening is performed with a gradual creation of varus to ensure that the mechanical axis passes thru the centre of the knee and that limb lengths are equal.
The lurch in the hip joint is reduced by at least 70 to 80% and this effect is long lasting. The Trendelenberg test is negative . X-ray shows nice subtrochanteric valgus, distal lengthening by 4 cm and a normal mechanical axis of the femur.
This young lady is happily married and has two children as well with no pain in the hip and a 80% reduction of her lurch.