I am an arthroplasty surgeon with a lot of revision reconstruction and complex hip surgery under my belt and I have done a few of DDH in my career achieving lengthening of 4-5cm. After my first complication following a Crowe IV hip in a patient of short stature (sciatic nerve palsy), I am questioning if the given "safe" length is just a number or if this has to follow a 'relative to the height of the patient' equation. As mentioned the present patient is of short stature and all my previous experiences were on taller patients. Anybody with any knowledge to this specific problem?
Dear Dr. Zafiropoulos, you mean a hip arthroplasty in adults with high congenital dislocation (following DDH ), don't you ?
You may reach even a bigger lengthening if you use one of the following both procedures: osteotomy of the femur as an adjuvant step or two-staged surgery (resection of head and skeletal traction for 2 weeks as a first stage and implanting of the endoprosthesis into the primary acetabulum as a second stage). In my experience these procedures yield a smaller rate of neuro-vascular complications.
Dear Panayot
Thank you very much for your answer. As you correctly understood I am meaning DDH in adult hip. I am routinely doing an osteotomy of the femur and in this case I removed 3.5cm. Then I rap the osteotomised bone around the femoral shaft at the level of the osteotomy. Up to now I had not any complications but my patients were tall enough. I have not tried the traction. My question though is if it known to any the existence of a calculation that links the height of the patient with the amount of limb lengthening permitted. Are you familiar to any as I can not find any literature on it. I once more thank you for the answer and the helpful comments.
Dear George,
If the patient is of short stature you should have to calculate the lengthening proportionally. It is logic to do so.
Thank you Panayot for your answer and help
Are you aware of the equation used to calculate such proportional difference?
The reason that I am asking is that this is the first time that I am experiencing the sciatic nerve palsy despite that I have lengthened about 4-5 cm other patients who were though slightly taller. This is the only difference between them and the present case which triggered the question. I would be most grateful if you could let me know the way of calculating this.
Equations are not common in orthopedic surgery. However, I would proceed as follows:
180 cm height - 4 cm lengthening
150 cm height - x
x = (150 x 4) : 180 = 3.33 cm
This seems very simplified, but there is also logics in it, not only mathematics.
Dear colleagues.
I think each case is strongly individual, it depends on level of hip flexion cintracture, scarring of the tissues after previous surgeries.
If it is spoken about DDH reconstruction THR, the first aim is a stable and painless hip. Second aim is equal length of limbs. Even with equal length somtimes severe limping is permanent because of abductor weakness, so inequality of 1-2 cm, looks like minor problem. In order to be safe, better to avoid more than 2-3 cm of lengthening.
- Badges
- Science topic
- Similar topics
- Correction