treatment of late neglected adult congenital dislocation of the hip with hybrid ilizarov/monolateral...
TRANSCRIPT
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8/6/2019 Treatment of late neglected adult congenital dislocation of the hip with hybrid Ilizarov/monolateral distractor and total hip replacement A new methodology
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Treatment of late neglected adultTreatment of late neglected adult
congenital dislocation of the hip withcongenital dislocation of the hip withhybrid Ilizarov/monolateralhybrid Ilizarov/monolateral distractordistractor
and total hip replacementand total hip replacement
A new methodologyA new methodology
oo Nuno Craveiro LopesNuno Craveiro Lopes
oo Joo JacintoJoo Jacintooo Carolina EscadaCarolina Escadaoo MMrio Tapadinhasrio Tapadinhasoo CarloCarlo VillacresesVillacreses
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Treatment of neglected congenitally dislocated hip in adults is
a challenging problem with a very demanding and problematic
surgical technique
Treatment of neglected congenitally dislocated hip in adults isTreatment of neglected congenitally dislocated hip in adults is
a challenging problem with a very demandinga challenging problem with a very demanding and problematicand problematic
surgical techniquesurgical technique
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o Age of patiento Limb length discrepancy
o Cup on true acetabulumo Distortion of proximal femur
o Small & adapted implant
oo Age of patientAge of patient
oo Limb length discrepancyLimb length discrepancy
oo Cup on true acetabulumCup on true acetabulumoo Distortion of proximal femurDistortion of proximal femur
oo SmallSmall && adaptedadapted implantimplant
ProblemsProblemsProblems
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Classic TechniqueClassicClassic TechniqueTechnique
Paavilainen et al (1990)Paavilainen et al (1990)
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Classic TechniquePaavilainen et al (1990)ClassicClassic TechniqueTechniquePaavilainen et al (1990)
103 patients with FW of 10 yearsParalisis 10%
Fractures 10%
Dislocation 2%
Discrepancy 0-7cm (1.9cm)
Revision acetabular 48%
Revision Femoral 10%
103 patients with FW of 10 yearsParalisis 10%
Fractures 10%
Dislocation 2%
Discrepancy 0-7cm (1.9cm)
Revision acetabular 48%Revision Femoral 10%
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o Resection of femoral neck and head
o Hybrid external distractor
o Distal femoral transport 2 months
o Distractor removal
o Skin traction 2 weeks
o Small THR covered with HA (Corail@,S-Rom@ )
o Cer-Cer, Met-Met or Cer-Met joint
oo Resection of femoral neck and headResection of femoral neck and head
oo Hybrid externalHybrid external distractordistractor
oo Distal femoral transportDistal femoral transport 2 months2 months
oo DistractorDistractor removalremoval
oo Skin tractionSkin traction 2 weeks2 weeks
oo SmallSmall THRTHR covered with HA (covered with HA (CorailCorail@@,S,S--RomRom@@ ))
oo CerCer--CerCer, Met, Met--Met orMet or CerCer--Met jointMet joint
MethodologyMethodologyMethodology
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o More robust and stable
o 4 supra acetabular pins
o 4 femoral pins
o Immediate ambulation
o Weight bearing
oo More robustMore robust andand stablestable
oo 4 supra acetabular pins4 supra acetabular pins
oo 4 femoral pins4 femoral pins
oo Immediate ambulationImmediate ambulation
oo WWeight bearingeight bearing
Advantage of hybrid distractorAdvantageAdvantage ofof hybridhybrid distractordistractor
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o 7 female patients
o Mean age 36 yo (22 to 51)
o Mean overriding 5.3cm (4 to 6.8)
o Mean follow-up 5.5 years (3 to 8)
o 5 CDH sequel
o 1 Septic sequel
o 1 AVN sequel
oo 77 femalefemale patientspatients
oo MeanMean age 36age 36 yoyo (22 to 51)(22 to 51)
oo MeanMean overridingoverriding 5.3cm (4 to 6.8)5.3cm (4 to 6.8)
oo Mean followMean follow--up 5.5 years (3 to 8)up 5.5 years (3 to 8)
oo 5 CDH5 CDH sequelsequel
oo 11 SepticSeptic sequelsequel
oo 1 AVN1 AVN sequelsequel
Clinical DataClinicalClinical DataData
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M.M. 51 yo female
Untreated CDH
6.3 cm overriding
M.M. 51M.M. 51 yoyo femalefemale UntreatedUntreated CDHCDH
6.3 cm overriding6.3 cm overriding
8 years of follow-up8 years of follow8 years of follow--upup
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03-20020303--2002200203-20020303--20022002 03-20100303--20102010
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8 years follow-up88 yearsyears followfollow--upup
01-20020101--20022002
03-20100303--20102010
HHS 59.3HHSHHS 59.359.3 HHS 89 (+29,7)HHSHHS 89 (+29,7)89 (+29,7)
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J.F., 24 years old female
Neonate septic arthritis
5.3 cm overriding
J.F., 24J.F., 24 yearsyears oldold femalefemale
NeonateNeonate septicseptic arthritisarthritis
5.3 cm5.3 cm overridingoverriding
7,5 years of follow-up7,5 years of follow7,5 years of follow--upup
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07-20020707--20022002 01-20100101--20102010
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7,5 years follow-up7,57,5 yearsyears followfollow--upup
01-20100101--20102010
11-20011111--20012001
HHS 64.4HHSHHS 64.464.4 HHS 93 (+29,6)HHSHHS 93 (+29,6)93 (+29,6)
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F.M. 47 years old female
Untreated CDH
6.8 cm overriding
F.M. 47F.M. 47 yearsyears oldold femalefemale
UntreatedUntreated CDHCDH
6.8 cm6.8 cm overridingoverriding
6,5 year of follow-up6,56,5 yearyear of followof follow--upup
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FM01.10
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6,5 year of follow-up6,56,5 yearyear of followof follow--upup
HS - 60HSHS -- 6060 HHS 93.6 (+33,6)HHSHHS 93.6 (+33,6)93.6 (+33,6)
10-20031010--20032003
01-20100101--20102010
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T.N. 35 years old female
Untreated bilateral CDH
4 cm overriding
T.N. 35T.N. 35 yearsyears oldold femalefemale
UntreatedUntreated bilateral CDHbilateral CDH
4 cm4 cm overridingoverriding
3 years follow-up3 years follow3 years follow--upup
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TN01.10
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3 years of follow-up3 years of follow3 years of follow--upup
TN01.10
HHS 62.7HHSHHS 62.762.7 HHS 93 (30,3)HHSHHS 93 (30,3)93 (30,3)
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ProblemsFemoral fissure during THR 2Transient paresis after THR 1
Peri-Articular Calcifications 1
Pin fracture 1Pin infection 1
ProblemsProblemsFemoralFemoral fissurefissure duringduring THRTHR 22TransientTransient paresisparesis afterafter THRTHR 11
PeriPeri--ArticularArticular CalcificationsCalcifications 11
PinPin fracturefracture 11PinPin infectioninfection 11
ObstaclesTHR dislocation 1ObstaclesObstacles
THR dislocationTHR dislocation 11
ComplicationsTHR Infection 0
THR loosening 0
ComplicationsComplications
THRTHR InfectionInfection 00
THRTHR looseningloosening 00
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70,4
93,6
57,4
89
62,3
92,5
50
60
70
80
90
100
Before After
Harris Hip ScoreHarrisHarris HipHip ScoreScore
62.3 92.562.3 92.562.3 92.5
Very significant difference (p
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ConclusionConclusionConclusiono Comprehensive approach
o Stable fixation
o Well tolerated
o No complications
o Excelent end results
oo ComprehensiveComprehensive approachapproach
oo StableStable fixationfixation
oo WellWell toleratedtolerated
oo NoNo complicationscomplications
oo ExcelentExcelent endend resultsresults
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GARCIA DE ORTA HOSPITAL, EPEGARCIA DE ORTA HOSPITAL, EPEOrthopedic & TraumaOrthopedic & TraumaDptDpt
Director:Director:CraveiroCraveiroLopes, M.D.Lopes, M.D.