Abstract
Introduction: 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: Very proximal, Subtrochanteric, Distal.
Management: 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: Too proximal to ignore, Too distal to bypass.
Main treatment options: Resurfacing THA, Short stem THA, Corrective osteotomy with THA.
Corrective osteotomy with THA: Perform osteotomy at level of deformity, In most cases a corrective osteotomy that creates a transverse osteotomy junction is simplest, Use an implant that provides reliable fixation in the femur (usually uncemented), Use implant that provides fixation of the proximal and distal fragments
Conclusions: Majority of proximal femoral deformities managed with one-stage procedure: Excise deformity and replace with metal, Implants that allow ignoring deformity, Corrective osteotomy.
