Osteotomy & total hip replacement

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GEM

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Hello out there:
I had an Osteotomy surgery when I was 25 years old which was necessary because of a hereditary hip dysplasia (malformation of the hip joint) .

Forty years later, I am now face with the prospect of having a total hip replacement. However, because of the malformation of the hip joint the THR is not a conventional one. I probably will need bone graff and the surgeon tells me the surgery can last up to five hours.

I have seen 3 surgeons to date and they all have a different approach to the surgery using different implants.

I would like to hear from someone who has had a THR following an Osteotomy as I am somewhat confused on what direction to take.
 
Welcome to the board GEM! I'm sorry I don't have a relating story to contribute, but hopefully someone on here is in your situation. Otherwise, our wonderful moderators may be able to offer advice.

GOOD LUCK!
Melissa
 
Oh they will all have their own pet ways of approaching such a case! I remember we used to do lots of these osteotomies in the 60s and 70s but no longer as it became more acceptable for THRs to be done in younger patients instead. What have you had suggested thus far? And was the osteotomy an off-set one to reduce pain in the joint? Have you got an xray you can post?

Do give me more detail and I will do my best to advise you.

I very much doubt you will find anyone who has been there before you on this forum. I've not heard of anyone, anyway.
 
Welcome, GEM. So glad you decided to post here at BoneSmart. Our forum nurse, Josephine, will hopefully be able to give you information from a medical perspective regarding your very unique situation. I don't recall anyone who has posted with a similar question either, but it's possible there are others on the forum as "guests" who would be interested to read the options you have heard. Thanks for adding a totally new thread for us!
 
Hello GEM! I am a 27 year old that had severe hip dysplasia diagnosis in both hips, which caused severe arthritis, bone spurs, impingement, yadda yadda.... and obviously severe PAIN! I saw several OS's and finally decided on a THR on both rather than the osteotomy, as Jo said, they are not seen as unacceptable anymore. I am now 7 weeks post-op from my left and 1 week pre-op for my right, and I'll tell you, my dr used a screw to hold the socket cup in place as additional support since my pelvis was formed incorrectly in the first place. He said that would be sure that it wouldn't tilt or move at all, or loosen with time, since my bone stock did not present significant coverage around where the socket should be placed to ensure stability and alignment. What kind of osteotomy did you have? Where your femurs repositioned as well, or just the joint spaces in the pelvis?
 
I take it you had a cemented hip then, prinny? I've seen quite a few of those where we put a screw or two in the rim of the acetabulum and then cemented over them before putting the cup in. It gave the cement a good anchorage where the bone was insufficient.
 
I also had a screw put in for additional stability (you can count the threads on that screw in the xrays, it shows up so well!) but mine is uncemented.
 
I take it you had a cemented hip then, prinny? I've seen quite a few of those where we put a screw or two in the rim of the acetabulum and then cemented over them before putting the cup in. It gave the cement a good anchorage where the bone was insufficient.

Hi Josephine,
Mine was uncemented, but does have a screw in the acetabulum (bone was sufficient according to my OS). Is this unusual in uncemented?
Nick
 
No mine was uncemented as well... he said he just put the screw in just to be sure nothing moved since I didn't have sufficient bone coverage around the cup because of the dysplasia. I have heard time and time again, my OS is VERY meticulous, and makes ABSOLUTELY sure that he takes all necessary precautions for a successful surgery. I'm VERY happy with him! :)
 
Hello,

My experience was similar to Prinny. I looked into osteotomy as a physiotherapist acquaintance of mine had good success with this from a doc in Switzerland 20 yrs ago. All evidence I saw pointed towards THR, however. So that's what I did.

My OS is sort of the "dysplasia guy" in town here. I ran across a few of his publications during my research that described methods of THR after someone has had an osteotomy or other procedures. I've become pretty busy now that I'm back to work, but I'll try to find some citations for you if you're interested. PubMed is actually a pretty good resource.
 
Alright. . . I have more time on my hands than I let on.

If you search pubmed with Peters CL [author] and osteotomy, the 7th article seems relevant. It talks about TIO (triple innominate osteotomy) followed by THR. They have only 11 pts with 13 hips with previous TIO going in for THR compared with the same number of patients going in for primary THR and then compare them. Bascially sounds like the surgery is a more difficult and final results may not be quite as good for those with prior osteotomy as people who are getting the operation "fresh", I you will. I summarized because he doesn't like to - data only! (i.e. boring) That's my surgeon!

Below is a different, but larger series. I'm not sure if TIO and Bernese osteotomy are the same - I don't think so. This study has more enrollees, but no control group - just a descriptive study. Basically states that it's more technical, but in the right hands, you'll do fine (typical surgery study - we did this, we had excellent technique and our technique is awesome! Egos?)

Previous Bernese periacetabular osteotomy does not compromise the results of total hip arthroplasty.

Parvizi J, Burmeister H, Ganz R.
Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA. [email protected]
It is not known if a previous periacetabular osteotomy poses technical difficulties and may increase the incidence of complications after total hip arthroplasty. The records of 41 patients who had THA after periacetabular osteotomy were evaluated. Followup averaged 6.9 years (range, 2-14 years). The average interval from osteotomy to total hip arthroplasty was 6.3 years (range, 4 months-14 years). Total hip arthroplasty provided significant relief of pain and improvement in function for all the patients. The acetabulum was judged to be retroverted in 23 patients and special attention to component positioning was needed. An abnormal proximal femoral anatomy secondary to previous intertrochanteric osteotomy or underlying dysplasia, or trochanteric overgrowth necessitated the use of trochanteric osteotomy for exposure in 24 patients. There were an acceptable number of complications and two revisions in the series. Aseptic loosening of the femoral component in one patient (one hip) and acetabular component in another patient (one hip) were the reasons for the two revisions. Total hip arthroplasty with technical consideration and careful evaluation of the acetabular version and relocated teardrop can be done safely in patients with a previous periacetabular osteotomy and should provide excellent results.


Sorry I couldn't find much on specific implants, etc. I suspect every surgeon has their own technique. Find an excellent surgeon!!!!
 
That's a good point, Dave. GEM, is your osteotomy femoral or pelvic?


But looks like she hasn't been back since she posted this ....
 
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