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Question

Describe XR

What other XR can you do to determine amount of extrusion?

What classification do you know?

What is extrusion index?

What are the treatment options in a patient aged 30?

What osteotomy techniques are there?

What arthroplasty techniques are there?

What common problems can be anticipated at THR?

Answer

Describe XR

    • Dysplastic hip (Crowe type II) ,extrusion,2 OA, coxa valga

What other XR can you do to determine amount of extrusion?

    • 60 deg standing oblique

What classification do you know?

    • Crowe (JBJS 1979)
      • I < 50%
      • II 50 to 75
      • III 75-100%
      • IV >100 (high dislocation) False acetabulum

What is extrusion index?

    • A/A+B x 100 (OA if >31% ie one third extruded)

What are the treatment options in a patient aged 30?

    • Conservative
    • Surgical
        • Osteotomy,arthrodesis,arthroplasty

What osteotomy techniques are there?

    • Periacetabular osteotomy (Ganz 1983, Muller 1995)

What arthroplasty techniques are there?

    • Total hip arthroplasty + autograft bone block(Harris 1977)
    • Impaction BG + mesh

What common problems can be anticipated at THR?

    • Acetabulum deficiency and small, femoral XS anteversion (80 deg) therefore need modular component or CDH stem(eg SROM dial in anteversion), narrow femoral canal may require extra small components
    • Limb shortened : can only lenghten 2.5 cm before osteotomy required to protect sciatic nerve in high dislocations
    • Poor abductors
    • If offset not increased trochanteric impingement

Answer