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General Orthopaedics


Current Concepts in Joint Replacement (CCJR) – Spring 2015


The goal is to avoid letting femoral deformity force suboptimal implant position/fixation. Suboptimal implant position has an adverse effect on hip biomechanics and often on hip function and durability.

Classification - Practical approach to femoral deformities: categorise into 3 main groups: 1.) Very proximal, 2.) Subtrochanteric, 3.) Distal.

Management of distal deformities: Most can be ignored if there is sufficient room to place conventional femoral implant.

Management of proximal deformities: Option 1: Use implants that allow satisfactory positioning despite deformity…or… Option 2: Remove the deformity.

Management of subtrochanteric level deformities: These are the most difficult. Problems: 1.) Too proximal to ignore, 2.) Too distal to bypass. Main treatment options: 1.) Resurfacing THA, 2.) Short stem THA, 3.) Corrective osteotomy with THA.

Corrective osteotomy with THA: 1.) Perform osteotomy at level of deformity, 2.) In most cases a corrective osteotomy that creates a transverse osteotomy junction is simplest, 3.) Use an implant that provides reliable fixation in the femur (usually uncemented), 4.) Use implant that provides fixation of the proximal and distal fragments.

Majority of proximal femoral deformities managed with one-stage procedure: 1.) Excise deformity and replace with metal, 2.) Implants that allow ignoring deformity, 3.) Corrective osteotomy.