achieving stability and lower-limb length in total hip arthroplasty by keith r. berend, scott m....

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Achieving Stability and Lower-Limb Length in Total Hip Arthroplasty by Keith R. Berend, Scott M. Sporer, Rafael J. Sierra, Andrew H. Glassman, and Michael J. Morris J Bone Joint Surg Am Volume 92(16):2737-2752 November 17, 2010 ©2010 by The Journal of Bone and Joint Surgery, Inc.

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Page 1: Achieving Stability and Lower-Limb Length in Total Hip Arthroplasty by Keith R. Berend, Scott M. Sporer, Rafael J. Sierra, Andrew H. Glassman, and Michael

Achieving Stability and Lower-Limb Length in Total Hip Arthroplasty

by Keith R. Berend, Scott M. Sporer, Rafael J. Sierra, Andrew H. Glassman, and Michael J. Morris

J Bone Joint Surg AmVolume 92(16):2737-2752

November 17, 2010

©2010 by The Journal of Bone and Joint Surgery, Inc.

Page 2: Achieving Stability and Lower-Limb Length in Total Hip Arthroplasty by Keith R. Berend, Scott M. Sporer, Rafael J. Sierra, Andrew H. Glassman, and Michael

Keith R. Berend et al. J Bone Joint Surg Am 2010;92:2737-2752

©2010 by The Journal of Bone and Joint Surgery, Inc.

Page 3: Achieving Stability and Lower-Limb Length in Total Hip Arthroplasty by Keith R. Berend, Scott M. Sporer, Rafael J. Sierra, Andrew H. Glassman, and Michael

Keith R. Berend et al. J Bone Joint Surg Am 2010;92:2737-2752

©2010 by The Journal of Bone and Joint Surgery, Inc.

Page 4: Achieving Stability and Lower-Limb Length in Total Hip Arthroplasty by Keith R. Berend, Scott M. Sporer, Rafael J. Sierra, Andrew H. Glassman, and Michael

Standing evaluation of clinical limb length is performed by measuring the pelvic obliquity and limb length difference.

Keith R. Berend et al. J Bone Joint Surg Am 2010;92:2737-2752

©2010 by The Journal of Bone and Joint Surgery, Inc.

Page 5: Achieving Stability and Lower-Limb Length in Total Hip Arthroplasty by Keith R. Berend, Scott M. Sporer, Rafael J. Sierra, Andrew H. Glassman, and Michael

Supine evaluation of limb length inequality is performed by measuring the distance between the anterior superior iliac spine and the medial malleolus with a tape measure.

Keith R. Berend et al. J Bone Joint Surg Am 2010;92:2737-2752

©2010 by The Journal of Bone and Joint Surgery, Inc.

Page 6: Achieving Stability and Lower-Limb Length in Total Hip Arthroplasty by Keith R. Berend, Scott M. Sporer, Rafael J. Sierra, Andrew H. Glassman, and Michael

Keith R. Berend et al. J Bone Joint Surg Am 2010;92:2737-2752

©2010 by The Journal of Bone and Joint Surgery, Inc.

Page 7: Achieving Stability and Lower-Limb Length in Total Hip Arthroplasty by Keith R. Berend, Scott M. Sporer, Rafael J. Sierra, Andrew H. Glassman, and Michael

Keith R. Berend et al. J Bone Joint Surg Am 2010;92:2737-2752

©2010 by The Journal of Bone and Joint Surgery, Inc.

Page 8: Achieving Stability and Lower-Limb Length in Total Hip Arthroplasty by Keith R. Berend, Scott M. Sporer, Rafael J. Sierra, Andrew H. Glassman, and Michael

Preoperative anteroposterior pelvic radiograph made with the patient supine shows severe erosive arthritis of the right hip.

Keith R. Berend et al. J Bone Joint Surg Am 2010;92:2737-2752

©2010 by The Journal of Bone and Joint Surgery, Inc.

Page 9: Achieving Stability and Lower-Limb Length in Total Hip Arthroplasty by Keith R. Berend, Scott M. Sporer, Rafael J. Sierra, Andrew H. Glassman, and Michael

Preoperative templating can be performed with use of computerized radiology software.

Keith R. Berend et al. J Bone Joint Surg Am 2010;92:2737-2752

©2010 by The Journal of Bone and Joint Surgery, Inc.

Page 10: Achieving Stability and Lower-Limb Length in Total Hip Arthroplasty by Keith R. Berend, Scott M. Sporer, Rafael J. Sierra, Andrew H. Glassman, and Michael

The so-called safe zone for orientation of the acetabular component.

Keith R. Berend et al. J Bone Joint Surg Am 2010;92:2737-2752

©2010 by The Journal of Bone and Joint Surgery, Inc.

Page 11: Achieving Stability and Lower-Limb Length in Total Hip Arthroplasty by Keith R. Berend, Scott M. Sporer, Rafael J. Sierra, Andrew H. Glassman, and Michael

Various methods of restoring offset with use of the femoral stem.

Keith R. Berend et al. J Bone Joint Surg Am 2010;92:2737-2752

©2010 by The Journal of Bone and Joint Surgery, Inc.

Page 12: Achieving Stability and Lower-Limb Length in Total Hip Arthroplasty by Keith R. Berend, Scott M. Sporer, Rafael J. Sierra, Andrew H. Glassman, and Michael

With the patient in a lateral position, the uninvolved lower limb is used to reference limb lengths intraoperatively.

Keith R. Berend et al. J Bone Joint Surg Am 2010;92:2737-2752

©2010 by The Journal of Bone and Joint Surgery, Inc.