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[Insertion of Judet's prosthesis in high-region dislocation of the hip (author's transl)]
Insights
This study presents a two-session surgical technique for total hip replacement in cases of high hip dislocation. This method addresses anatomical challenges, improving prosthesis anchoring and repositioning for better outcomes in hip osteoarthrosis treatment.
Area of Science:
- Orthopaedic Surgery
- Biomedical Engineering
Background:
- High-region hip dislocation often leads to osteoarthrosis (coxarthrosis), posing significant surgical challenges.
- Existing total hip replacement (hip endoprosthesis) techniques face difficulties due to underdeveloped acetabular and femoral anatomy.
Observation:
- A novel two-session surgical approach was developed to overcome anatomical limitations in hip replacement.
- The first session involves extended arthrolysis and distraction osteogenesis using Wagner's apparatus for 3-4 weeks.
- This distraction phase allows the femoral head to reach the level of the primary acetabulum.
Findings:
- The two-session method enables secure prosthesis anchoring at the primary acetabulum.
- Repositioning of the hip joint is achieved with reduced technical difficulty.
- Demonstration of a successful total hip endoprosthesis case using this two-session technique.
Implications:
- This innovative surgical strategy offers a viable solution for complex hip osteoarthrosis cases.
- Improved anatomical preparation facilitates more stable and effective hip endoprosthesis implantation.
- The technique holds potential for enhancing surgical outcomes in challenging hip reconstruction scenarios.
Abstract:
Osteoarthrosis of the hip (also known as coxarthrosis) as a result of a high-region dislocation of the hip, presents a difficult task for the orthopaedic surgeon, the solution of which is still under frequent and intense discussion. Total hip replacemnt (hip endoprosthesis) involves technical difficulties which result on the one hand, from the underdeveloped anatomic conditions (underdeveloped primary acetabulum with soft spongiosa on valgus position of the highly sclerosed secondary acetabulum associated with underdeveloped shaft of the femur); on the other hand, a repositioning is difficult if anchoring of the prosthesis is effected at the level of the primary acetabulum. For this reason, we developed an original operation method requiring two sessions: in a first operation, an extended arthrolysis is performed via an anterior access, whereas at the same time an extension is carried out by means of the distraction apparatus according to Wagner. After this first session, distraction is performed during 3 to 4 weeks until the head of the femur has attained the level of the primary acetabulum. The prosthesis is inserted in a second session, where anchoring at the level of the primary acetabulum becomes possible and repositioning can be affected without undue difficulties. An example of such total hip replacement by endoprosthesis, requiring 2 sessions, is demonstrated.