CUSTOM ACETABULAR TRI-FLANGE AND FEMORAL OSSEOINTEGRATION COMPONENTS FOR THE TREATMENT OF SYMPTOMATIC IPSILATERAL HIP AND KNEE ARTHROPATHY IN A PATIENT WITH PROXIMAL FEMORAL FOCAL DEFICIENCY: A NOVEL SOLUTION TO A CHALLENGING PROBLEM

A. Sundaram; R.L. Carey Smith

doi:10.1302/1358-992X.2023.2.002

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CUSTOM ACETABULAR TRI-FLANGE AND FEMORAL OSSEOINTEGRATION COMPONENTS FOR THE TREATMENT OF SYMPTOMATIC IPSILATERAL HIP AND KNEE ARTHROPATHY IN A PATIENT WITH PROXIMAL FEMORAL FOCAL DEFICIENCY: A NOVEL SOLUTION TO A CHALLENGING PROBLEM

The New Zealand Orthopaedic Association and the Australian Orthopaedic Association (NZOA AOA) Combined Annual Scientific Meeting, Christchurch, New Zealand, 31 October – 3 November 2022. Part 1 of 2.

A. Sundaram
R.L. Carey Smith

CUSTOM ACETABULAR TRI-FLANGE AND FEMORAL OSSEOINTEGRATION COMPONENTS FOR THE TREATMENT OF SYMPTOMATIC IPSILATERAL HIP AND KNEE ARTHROPATHY IN A PATIENT WITH PROXIMAL FEMORAL FOCAL DEFICIENCY: A NOVEL SOLUTION TO A CHALLENGING PROBLEM

Sundaram A, Carey Smith R. CUSTOM ACETABULAR TRI-FLANGE AND FEMORAL OSSEOINTEGRATION COMPONENTS FOR THE TREATMENT OF SYMPTOMATIC IPSILATERAL HIP AND KNEE ARTHROPATHY IN A PATIENT WITH PROXIMAL FEMORAL FOCAL DEFICIENCY: A NOVEL SOLUTION TO A CHALLENGING PROBLEM. Orthop Procs. 2023;105-B(SUPP_2):2-2. doi:10.1302/1358-992X.2023.2.002

Sundaram, A., and R.L. Carey Smith. “CUSTOM ACETABULAR TRI-FLANGE AND FEMORAL OSSEOINTEGRATION COMPONENTS FOR THE TREATMENT OF SYMPTOMATIC IPSILATERAL HIP AND KNEE ARTHROPATHY IN A PATIENT WITH PROXIMAL FEMORAL FOCAL DEFICIENCY: A NOVEL SOLUTION TO A CHALLENGING PROBLEM.” Orthopaedic Proceedings, vol. 105-B, no. SUPP_2, 2023, pp. 2-2., https://doi.org/10.1302/1358-992X.2023.2.002

Sundaram, A., & Carey Smith, R. (2023). CUSTOM ACETABULAR TRI-FLANGE AND FEMORAL OSSEOINTEGRATION COMPONENTS FOR THE TREATMENT OF SYMPTOMATIC IPSILATERAL HIP AND KNEE ARTHROPATHY IN A PATIENT WITH PROXIMAL FEMORAL FOCAL DEFICIENCY: A NOVEL SOLUTION TO A CHALLENGING PROBLEM. Orthopaedic Proceedings, 105-B(SUPP_2), 2-2. https://doi.org/10.1302/1358-992X.2023.2.002

Sundaram, A. and Carey Smith, R. (2023) “CUSTOM ACETABULAR TRI-FLANGE AND FEMORAL OSSEOINTEGRATION COMPONENTS FOR THE TREATMENT OF SYMPTOMATIC IPSILATERAL HIP AND KNEE ARTHROPATHY IN A PATIENT WITH PROXIMAL FEMORAL FOCAL DEFICIENCY: A NOVEL SOLUTION TO A CHALLENGING PROBLEM.” Orthopaedic Proceedings, 105-B(SUPP_2), pp. 2-2. Available at: https://doi.org/10.1302/1358-992X.2023.2.002

Sundaram, A., and R.L. Carey Smith. “CUSTOM ACETABULAR TRI-FLANGE AND FEMORAL OSSEOINTEGRATION COMPONENTS FOR THE TREATMENT OF SYMPTOMATIC IPSILATERAL HIP AND KNEE ARTHROPATHY IN A PATIENT WITH PROXIMAL FEMORAL FOCAL DEFICIENCY: A NOVEL SOLUTION TO A CHALLENGING PROBLEM.” Orthopaedic Proceedings 105-B, no. SUPP_2 (2023): 2-2. https://doi.org/10.1302/1358-992X.2023.2.002

Sundaram A, Carey Smith R. CUSTOM ACETABULAR TRI-FLANGE AND FEMORAL OSSEOINTEGRATION COMPONENTS FOR THE TREATMENT OF SYMPTOMATIC IPSILATERAL HIP AND KNEE ARTHROPATHY IN A PATIENT WITH PROXIMAL FEMORAL FOCAL DEFICIENCY: A NOVEL SOLUTION TO A CHALLENGING PROBLEM. Orthop Procs. 2023 Feb 10;105-B(SUPP_2):2-2. https://doi.org/10.1302/1358-992X.2023.2.002

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Abstract

Proximal femoral focal deficiency is a congenital disorder of malformation of the proximal femur and/or the acetabulum. Patients present with limb length discrepancy and clinical features along a spectrum of severity. As these patients progress through to skeletal maturity and on to adulthood, altered biomechanical demands lead to progression of arthropathy in any joint within the lower limb. Abnormal anatomy presents a challenge to surgeons and conventional approaches and implants may not necessarily be applicable.

We present a case of a 62-year-old lady with unilateral proximal femoral focal deficiency (suspected Aitken Class A) who ambulated with an equinus prosthesis for her entire life. She presented with ipsilateral knee pain and instability due to knee arthritis but could not tolerate a total knee arthroplasty due to poor quadriceps control.

A custom osteointegration prosthesis was inserted with a view to converting to the proximal segment to a total hip replacement if required. The patient went on to develop ipsilateral symptomatic hip arthritis but altered acetabular anatomy required a custom tri-flange component (Ossis, Christchurch, New Zealand) and a custom proximal femoral component to link with the existing osseointegration component (Osseointegration Group of Australia, Sydney, Australia) were designed and implanted.

The 18 month follow up of the custom hip components showed that the patient had Oxford hip scores that were markedly improved from pre-operatively. Knee joint heights were successfully restored to equal when the patient's prosthesis was attached. The patient describes feeling like “a normal person”, walks unaided for short distances and can ambulate longer distances with crutches.

Advances in design and manufacture of implants have empowered surgeons to offer life improving treatments to patients with challenging anatomy. Using a custom acetabular tri-flange and osseointegration components is one possible solution to address symptomatic ipsilateral hip and knee arthropathy in the context of PFFD in adulthood.

Email: abay.sundaram@gmail.com