Non-Arthroplasty Hip Surgery. Javad Parvizi MD FRCS Professor of Orthopaedic Surgery
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1 Non-Arthroplasty Hip Surgery Javad Parvizi MD FRCS Professor of Orthopaedic Surgery
2 Subcapital reduction osteotomy Relative lengthening of femoral neck (Perthes) AVN surgery Femoral osteotomy Trap door technique FAI surgery Hip Arthroscopy Mini-open technique Surgical dislocation Joint Preservation Periacetabular osteotomy
3 Osteoarthrits: FAI Femoro-Acetabular Impingement (FAI) R. Ganz, Parvizi J, Leunig M. Clin Orthop 2003 Chronic anterior impingement causes damage to the acetabular rim and the adjacent acetabular cartilage
4 FAI: Types Cam (Ito K. J Bone Joint Surg 2001) Pincer
5 FAI: Treatment Options Non-operative NSAIDS Activity modification Unsuccessful Surgery Surgical dislocation Arthroscopy Mini-open (direct anterior) Redirectional osteotomy
6 FAI: Treatment Goal Femoral neck osteoplasty Acetabular osteoplasty
7 Hip Arthroscopy Numerous Limitations (currently) Confined space (Hip is not the knee or shoulder Labral repair
8 Surgical Treatment of FAI Mini-open Anterior Approach
9
10 FAI: Mini-Open
11 FAI Pre-op AP
12
13 Mini-open: Protocol Day surgery or overnight stay Oral analgesia 2 weeks of Crutches 6 weeks of hip precautions PT- ROM /strengthening starting at 4 weeks
14 Mini-open Osteoplasty Started 2005 >500 Average operative time = 51 minutes (32-90 minutes) Labral repair =398 cases Patient satisfaction Return to sports Pain relief Work No analgesia Modified Harris Hip Score/Sushi 82% Excellent to Very Good outcome 4 conversions to THA
15 Mini-open Osteoplasty Predictors of Failure Pre-existent arthritis <3 mm of joint space (p<0.0001) Posteroinferios osteophyte (p<0.001) Labral debridement vs repair (p<0.003) Workman s comp (p<0.001) Previous surgery (arthroscopy)(p<0.05)
16 Hip Pain In Young Adult 15 year girl LaCrosse player Constant groin Pain
17 DDH Presentation Groin Pain Subluxation of femoral head Reproduced with hyperextension/er Labral pathology = catching, locking, giving way
18 DDH Preoperative Evaluation Plain radiographs AP Pelvis Lateral Hip Abduction view (30/neutral) False profile
19 DDH Types Anterolateral Anterior Lateral Posterolateral
20 DDH Preoperative studies CT arthrogram/3d MR-arthrogram GMERIC Kim JBJS 2006
21 Dysplasia Treatment Options Acetabular Osteotomy Femoral Osteotomy Combined Osteotomy
22 Osteotomy Rationale Reorient the articulating surfaces Increased joint congruity Decrease load Medialize hip center (lower JRF) = reduced pain, possibly protect articular cartilage
23 Osteotomy Indications Young patients with symptomatic hip dysplasia Without excessive proximal migration of hip center of rotation preserved ROM Mild degenerative changes at most Rothman Institute of Orthopaedics at Thomas Jefferson University
24 Rothman Institute of Orthopaedics at Thomas Jefferson University
25 Rothman Institute of Orthopaedics at Thomas Jefferson University
26 Rothman Institute of Orthopaedics at Thomas Jefferson University
27 Rothman Institute of Orthopaedics at Thomas Jefferson University
28 Rothman Institute of Orthopaedics at Thomas Jefferson University
29 Rothman Institute of Orthopaedics at Thomas Jefferson University
30 Rothman Institute of Orthopaedics at Thomas Jefferson University
31 Rothman Institute of Orthopaedics at Thomas Jefferson University
32
33 PAO Outcome 887 PAO 42 THA Mean interval : 8.2 years 87% had grade II or III arthritis at PAO More than 10 years of symptom relief for 85% Parvizi J. Ganz R.: Clin Orthop 2003
34 PAO Outcome Proficiency in correction Labral pathology Pre-existant arthritis
35
36 PAO Outcome
37
38
39 Благодарю за внимание
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Medical Coverage Policy Total Joint Arthroplasty Hip and Knee EFFECTIVE DATE: 08/01/2017 POLICY LAST UPDATED: 06/06/2017 OVERVIEW Joint replacement surgery, also known as arthroplasty, has proved to be