Case for opinion-
This 52yr old gentleman had girdlestone followed by shanz ostetotomy in 1995 for neglected fracture dislocation left hip.
Now he complains pain around same hip and wants THR
Bloods are normal
The senders plan is for uncmented Depuy ceramic on poly with S-ROM stem.
Will he need Subtrochantric shortening Ostetotomy?
This 52yr old gentleman had girdlestone followed by shanz ostetotomy in 1995 for neglected fracture dislocation left hip.
Now he complains pain around same hip and wants THR
Bloods are normal
The senders plan is for uncmented Depuy ceramic on poly with S-ROM stem.
Will he need Subtrochantric shortening Ostetotomy?
My view is
1. I need judet view/CTscan to see the acetabulum the posterior colum and wall in particular
2. intraop specimens for frozen section and culture
3.Looking at the AP a primary acetabular cup is possible.
4. I wouldnt do an SROM as in a similar case the corrective subtroch osteotomy went in for nonunion as SROM is essentially a distal fitting stem and the hold on the distal fragment is not rigid as a distal loading stem like Solution or Echelon
5. You wouldnt need a shortening most likely but would correct the deformity where the central axis of the proximal fragment(Red Line) reaches the medial shaft- an opening variety(ORANGE IS THE LINE OF THE OSTEOTOMY PERPENDICULAR TO THE RED LINE) and ream and hold the distal fragment tight with solution or echelon COCR stems . graft the result defect with the cancellous graft> plrase strip the v lateralis only at the osteotomy keeping the muscle through a vertical split maintaing the the extramedullary blood supply of the distal fragment.