ABSTRACT
To describe a new procedure of total hip replacement in patient with severe developmental dysplasia of the left hip, using technique of acetabular reconstruction with autogenous bone grafts and subtrochanteric shortening femoral osteotomy. Total hip replacement done in January of 2003. The Eftekhar's classification was used and included type D, neglected dislocations. Bone graft incorporated in acetabular shelf and femoral osteotomy. Our contribution is the use of an Allis plate to better fix acetabular grafts, avoiding loosening, and cerclage around bone graft in femoral osteotomy site, which diminish pseudoarthrosis risk. This technique shows efficiency, allowing immediately resolution for this case with pain and range of motion of hip improvement. It also allows the acetabular dysplasia reconstruction, equalization of the limb length (without elevated risk of neurovascular lesion) and repairs the normal hip biomechanics due to the correction of the hip's center of rotation.
Descrever contribuições à técnica da cirurgia de artroplastia total em displasias do desenvolvimento do quadril grave, por meio da reconstrução acetabular com o uso de enxerto autólogo e encurtamento femoral feito com osteotomia subtrocantérica em V invertido. Paciente submetido a artroplastia total do quadril esquerdo em janeiro de 2003. Foi usada a classificação de Eftekhar e o paciente era do tipo D, luxação inveterada. Incorporação do enxerto no teto acetabular e osteotomia femoral. Acrescentamos a fixação do enxerto da cabeça femoral no acetábulo com placa do tipo Allis, que contribui para maior resistência do sistema, e a cerclagem com fio de aço no enxerto ósseo junto à osteotomia subtrocantérica, que diminui o risco de pseudoartrose. Essa técnica demonstrou eficácia e permitiu a resolução imediata do caso com melhoria da dor e da amplitude de movimento do quadril. Permitiu também a reconstrução do déficit ósseo acetabular, a recomposição do comprimento do membro (sem risco aumentado de lesão neurovascular) e a recuperação da biomecânica do quadril com a reparação do centro de rotação normal.
ABSTRACT
OBJECTIVES: To evaluate valgus subtrochanteric osteotomy for the treatment of trochanteric non-union. METHODS: A retrospective study of cases series. From 1998 September to 2009 January, seventeen (17) cases with a diagnosis of non-union of trochanteric fracture were re-operated by the hip group of the Ortophaedic And Traumatology service of the Hospital Geral de Goiania (HGG). The patients presented pain at the fracture site, a femoral varus angle of less than 120°, and non-union of the fracture in the 3(rd) months after the initial surgery. RESULTS: Patients with ages ranging from 30 to 73 years, with a maximum follow-up of 09 years and minimum of 09 years. The mean time from first surgery to osteotomy was six months. Bone union was observed in 16 patients, with a mean union time of 12 weeks after surgery. The mean hip varus angle was 105(0) (120(0) to 90(0)). After surgery, the mean hip valgus angle was 144(0) (155(0) to 135(0)). We had one unsuccessful case; a 78-year old patient who had osteogtomy, fixed with DHS of 150(0), with valgization to 154(0). After six months of follow-up without union of the fracture, it was decided to perform total cemented hip artroplasthy, without complications. CONCLUSION: Valgus subtrochanteric osteotomies can be indicated for the treatment of trochanteric treatment of pseudoarthroses, with good final results for bone union, avoiding the need for total hip artroplasthy and maintaining biological fixation, as well as reestablishing the mechanical and anatomical axis of the affected limb.
