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Casestudies  >  Reconstruction of Hip  >  Chronic Dislocation treated by Ilizarov Hip Reconstruction

 
Reconstruction of Hip
 
 

  16 year old suffering from after effects of septic arthritis of the hip joint in childhood with a lurch in the hip and pain and shortneing         x-ray shows high riding dislocation with a shallow true acetabulum and a high false acetabulum.

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 ilizarov apparatus is applied in a double level mode in the femur with good comfort and ability to walk  and sleep in bed.                                           The proximal osteotomy is done at the subtrochanteric level with sigificant valgus of more than 70 degrees. this provides a good pelvic support and reduction of the trendelenberg sign.

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.

                          post-operatively she has very less of the lurch and limb lengths are almost equal.. She has married since then and has two children and very less of a  lurch in the hip.                                            post-operative xray showing a very nice subtrochanteric valgus with excellent pelvic support. in the distal part, the femur has been lengthened and a gradual varus was created. Now the mechanical axis can be seen passing through the centre of the knee.                

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.