Organ-preserving surgeries on the hip joint – a possibility to avoid complicated procedure of endoprothesis replacement
Statistics indicate that: about 90% of patients under 50 years old suffer from first symptoms of impingement or dysplasia. At the same time, non-diagnosed dysplasia consistently leads to osteoarthritis of the hip joints. The situation can be corrected using the best practices of modern organ-preserving surgery, which techniques allow coping with avascular necrosis of the head of femur, femoroacetabular impingement and dysplasia successfully.
Hip joint dysplasia (before and after the treatment)
Femoroacetabular impingement (before and after the treatment)
Avascular necrosis of the head of femur (before and after the treatment)
Dysplastic disease of the hip joints, avascular necrosis of the head of femur and femoroacetabular impingement in the absence of signs of arthritis can be resolved in one of the following two methods:
- hip jointendoprothesis replacement;
- organ-preserving surgical procedure.
The second option is the most effective and safe for the patient, because the procedure involves the complete restoration of the anatomy and preservation of structural integrity of the joint.
Osteotomy
The surgical interference implicates the implementation of an artificial bone fracture. The existing deformities caused by the disease are eliminated, the function of the musculoskeletal system is corrected in the course of the procedure. Osteotomy is performed mostly on the bones of the limbs, which are placed into the correct position during the surgical interference.
Holes can be made along the osteotomy line, bone fragments are fixed using extra-focal synthesis apparatus, plates, spokes or screws. The plaster bandage is applied after the procedure only in special cases, which occur in practice very rarely.
Osteotomy of femur: a — in case of valgus deformity of the neck; b — in case of varus deformity of the neck; c – the McMurray osteotomy.
The procedure can cause a number of complications:
- purulence;
- fragment displacement;
- slow bonding;
- formation of false joints.
Periacetabular osteotomy of the pelvis. The method involves performing a transposition of the cotyloid cavity. The pelvic ring contour is not changed during the surgical interference. The procedure is aimed at preventing the development of early degenerative-dystrophic changes.
Acetabulofemoral joint or hip joint dysplasia is a pathological phenomenon where the cotyloid cavity covers the head of femur insufficiently causing a risk of joint dislocation, which can provoke progression of deforming arthrosis even among the younger generation.
The classification systems of dysplasia by J. Crowe and G. Hartofilakidis have been applied on a wide scale recently. They are based on the principle of determining the percentage between the degree of proximal migration of the head of femur in relation to the height of the pelvis or hip.
The process of periacetabular osteotomy (PAO by Ganz and Mast) was described in 1980 for the first time. During the surgical interference, the posterior column ensuring the correct blood supply to the bone transplant was retained, which is most crucial for patients of reproductive age.
The operation is performed using Smith-Petersen access. Partial osteotomy of the ischium with preservation of the integrity of the posterior colony, complete osteotomy of the branch of the pubic bone and biplanar osteotomy of the ilium are performed. After mobilization of the osteotomized fragment of the cavity, by installing the Chance Rod in the wing of the iliac bone, the graft is displaced inwards, rotated anteriorly and laterally (the calculated angle of anteversion is established), then fixed with 2-3 screws. The position of the acetabulum is assessed according to six criteria: the angle of the frontal inclination of the acetabulum, radiographic congruence of the femoral head with the center of the acetabulum, anteversion angle, medial displacement of the pubic part of the acetabulum without loss of contact with the upper pubic branch, medialization of the femoral head within 5-15mm relative to the oblique-sciatic line and the restoration of the line of Shenton after correction.
Periacetabular pelvic osteotomy
The surgery under Dunn-Ganz method (Dunn procedure in combination with a Ganz surgical dislocation of the hip) – effective method for treating femoroacetabular impingement. The following surgical treatment is carried out in the Department of Orthopedic Surgery (Adults): diagnostic arthroscopy and the surgery under Dunn-Ganz method.
The use of both modern equipment and the method approved by several generations of surgeons – all this allows you to restore the functions of the hip joints delaying the need of endoprosthesis replacement. The mobility of joints can be maintained for a few dozen years conditioned upon timely diagnosis and carrying out the surgery successfully, therefore, the procedure of endoprothesis may not be necessary.
Stages of Dunn-Ganz operation: access to the site of avascular necrosis of the femoral head
