osteotomy hip

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William

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hi my name is Will, 18 years.
all started with a Slipped Capital Femoral Epiphysis at 15
i am to have an osteotomy to my right hip due to AVN in 7 weeks.
is this the way to go ? or THR ?
i have had consultation's with experts in both osteotomy surgery and hip replacement. helped ? well yes, i am informed of pros and cons for both, however decision is mine !!
any help or experiences would be welcomed.
Will
 
HI there, Will. Thanks for dropping by. I think at your age, osteotomy is definitely the way to go. !8 is far too young to be contemplating a replacement and an osteotomy will buy you a few more years. It's a great shame you are faced with this. I think there are two or three members who have had it but they were quite a bit older than you.

The thing is with young bones, the healing is so much more vigorous than in older years so it is a better option.

Keep us posted on what you decide and how you get on, won't you?
 
I had a PAO at age 18 on my right hip. It reduced my pain and helped prolong the need for hip replacement. I am 35 now and starting to have trouble again. Since I had the PAO I have many options yet and may even get surgery that will continue to prolong getting the THR. Best adivce on the osteotomy is to make sure you have a good doctor who has peformed this procedure many times.
 
Couldn't agree more, stvang!! As I have already said many times before! Give me the experience of the surgeon over what prosthesis any time.
 
Hi Josephine
Iam interested to here about anyone who has had a rotational osteotomy to the femur as the avn has destroyed a fairly large part of the femur head.Am i right in thinking that having an osteotomy for displaysia is very different than for avn. How long is the operation, and what sort of pain am i to expect i have read that it is a technically difficult operation with a long recovery time.Iam worried about having different leg lengths also that my leg may turn outward,i would welcome any information on this.
 
William, the two ops are quite different. The derotational osteotomy is to correct the improper development of the angles of the upper and lower end of the femur. This also has the added benefit of presenting a different part of the femoral head for weight bearing. Contrary to popular belief, the round ball of the femoral heard does not all bear the weight as the part of the acetabulum that bears the weight is actually saddle shaped. Thus when that part of the head that meets the weight bearing part of the acetabulum becomes worn, it is possible to change the pitch or angle of the head so a different part is in contact. This doesn't cure the arthritis but it does reduce the amount of pain experienced.

As far as the leg length is concerned, there should be no interference with that. And the length of the op should be around an hour or so, all being well. That is the time the surgeon takes to do it, not including the anaesthetic and recovery.

The pain should be adequately controlled by the anesthetist. Most such ops, in my experience, get a morphine pump which the patient operates with a button but it is only a temporary measure. By the next day, you should be up and sitting ina chair at least, with the aid of crutches, able to get to the loo. you should do well. Let us know how you get on, ok?
 
Hi Josephine,
Thank you for your reply.I have an appointment with a surgeon for hip replacements and
one for osteotomys next wednesday, they are going to help me make up my mind as to which will be best for me, unfortunately i don't know of anyone my age that has had either.
Unfortunately i already have a difference in leg length, i had core decompression then an external fixator fitted in june the external fixator was in place for three months in the hope that there would be some new bone growth (i understand that this is sometimes done for Perthes) unfortunately it was a long shot as i seem to have been a bit to old for this and it did'nt work but it has left me with one leg shorter, do you think an osteotomy op could correct this?I dont want to be left with a permenent limp.Also can you tell me about avn, if an osteotomy is chosen is that the end of the avn or does the bone continue to die.Thank you again Will
 
Hi Josephine,
Thank you for your reply.I have an appointment with a surgeon for hip replacements and one for osteotomys next wednesday, they are going to help me make up my mind as to which will be best for me, unfortunately i don't know of anyone my age that has had either.

Well, it has to be said that they are uncommon. But I have known patients of 19 have a hip replacement specifically for Perthes. And before you get in too much of a worry about the longevity of hip replacements, read my sticky about the 40 yr old hip replacement in this section! It's awesome!

Unfortunately i already have a difference in leg length, i had core decompression then an external fixator fitted in june the external fixator was in place for three months in the hope that there would be some new bone growth (i understand that this is sometimes done for Perthes) unfortunately it was a long shot as i seem to have been a bit to old for this and it did'nt work

Sad but true. These procedures are a long shot. At 18 the bone should nominally still be in growth but it's by no means certain.

but it has left me with one leg shorter, do you think an osteotomy op could correct this?I dont want to be left with a permenent limp.Also can you tell me about avn, if an osteotomy is chosen is that the end of the avn or does the bone continue to die.Thank you again Will

Yes, that is one of the objectives of the op, to correct such anomalies. I would expect the surgeon to address any disparity in leg length. I would mention it to him the next time you see him, anyway. Just to be sure.

The other objective is to get the bone to regenerate, same as the core decompression. The idea is, when the bone is damaged the natural healing process causes new microscopic blood vessels to be created within and around the injured bone. The purpose of these is to bring a fresh blood supply to the area which in turn stimulates the growth of new, immature bone cells. If enough of this new growth can be caused, then the AVN can be halted. But it's not an exact science. In fact, the whole thing is based upon an hypothesis rather than scientific fact because, as you discovered, it is not reliable. However, just because it didn't happen before doesn't mean it won't happen this time.
 
Hi Josephine,
Can you tell me how long it will be before i can walk totally unaided, ihave been on crutches
on and off for the past three years, how long does it take to completely recover from an osteotomy i'm really
looking forward to just walking out.
 
Oh that's a tough question, William. But given that you are an otherwise fit, healthy young man and that the bone healing progresses well, you could be looking at about 6-8 weeks I would think. But I have to be totally honest and say that that is an educated guess on my part! So many things would influence it - surgeon's preference, type of fixation, general progress. I think I may be pretty near the mark, though!
 
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