THR IN DDH

 The gluteal incision on for hardinge approach is angled inferior than superiorly.  Neck osteotomy and circumferential capsular release and iliopsoas tenotomy is performed. After reaching the psuedo acetabulum the floor of the psuedoacetabulum is cleared and the Holman I a walked on the floor in an inferior direction till the tear drop is reached thereby identifying the true floor. The anterior wall is generally thin. A medial cotyloid fossa is broken or reamed with a 36 reamer to break the medial wall. The further enlargement of the acetabulum is done gradually with a small posterior vector to avoid removing what's remaining  of the matter wall. The uncemented cup which best fits anterior and posterior dimensions and not superioroinferior  dimensions is chosen and fixed with 2 screws. Usually 44 to 46  size cup is used.

PREOP PLANS

POSTOP

THE  SUBTROC SHORTENING OSTEOTOMY  REDUCED A  7 CM SHORTENING TO 3 CM AND THE EXCISED SHAFT WAS SPLIT LONGITIDINALLY TO LIE AS VASCULARISED GRAFT AT THE OSTEOTOMY SITE.

 A SIMMILAR BILATERAL EXAMPLE

 
Another example were the uncovered cup was covered with dowel shaped cancellous grafts impacted into the defect on the left and a flying buttress graft fixed with screws on the right.. the screws on the graft could have been more oblique

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