Securing the osteotomized greater trochanter (GT) during total hip arthroplasty (THA) for dislocated dysplastic hips (DDH) poses a significant challenge. This study evaluates the union rate and effectiveness of a 2-strand transverse wiring technique utilizing the lesser trochanter for wire anchorage and tensioning. A digastric anterior slide trochanteric osteotomy was performed in 106 patients (118 hips) undergoing THA for DDH. Following uncemented stem insertion, the GT was transferred and fixed to the lateral cortex of the proximal femur using monofilament stainless steel wires. In 72 out of 106 patients (80 hips), the GT was fixed with 2 transverse wire cerclages threaded through 2 drill holes in the base of the lesser trochanter, spaced vertically 5–10 millimeters apart. The wires were wrapped transversely over the GT and tightened, avoiding contact with its tendinous attachments. Patients were regularly monitored, and GT union was assessed clinically and radiographically. Patient ages ranged from 20 to 57 years (mean 35.5), with a follow-up period ranging from 1.5 to 12 years (mean 6.2). The mean union time was 3.3 months (range 2–7). Among all hips, two developed stable nonunion and single wire breakage, but no fragment displacement (2.5%). Two hips exhibited delayed union, eventually healing at 6 and 7 months after surgery. Reattachment of the greater trochanter utilizing a 2-strand transverse wire cerclage anchored at the base of the lesser trochanter demonstrated a high rate of union (97.5%) following THA in dislocated DDH cases.
Topographic anatomy and general distribution of LFCA is well described in anatomy textbooks. Its contribution to the vascularization of specific anatomic structures in the hip region is poorly defined. The purpose of this study was to demonstrate the importance of LFCA in hip circulation, especially in the vascularization of hip abductors. The LFCA was specifically studied in 30 hips from 26 fresh cadavers after injection of common iliac artery or aorta with colored silicone for a more extensive hip vascular study. 24 hours after intra-arterial setting of silicone, dissection was performed through the anterior iliofemoral approach to expose the artery and its branches from the origin to the terminal distribution. In all specimens, the ascending branch of the LFCA was found as consistent supplier of gluteus minimus, gluteus medius, and tensor fasciae latae muscles by a variable number of branches. The proximal part of the abductor muscles was mainly supplied by the superior gluteal artery. We conclude, that ligating the ascending branch of the LFCA during anterior approach to the hip joint is likely to affect the vascularity and function of the abductor muscles especially in situations when perfusion of these muscles by the superior gluteal artery is compromised.
The modified Smith–Petersen and Kocher–Langenbeck
approaches were used to expose the lateral cutaneous nerve of the
thigh and the femoral, obturator and sciatic nerves in order to
study the risk of injury to these structures during the dissection,
osteotomy, and acetabular reorientation stages of a Bernese peri-acetabular
osteotomy. Injury of the lateral cutaneous nerve of thigh was less likely
to occur if an osteotomy of the anterior superior iliac spine had
been carried out before exposing the hip. The obturator nerve was likely to be injured during unprotected
osteotomy of the pubis if the far cortex was penetrated by >
5 mm.
This could be avoided by inclining the osteotome 45° medially and
performing the osteotomy at least 2 cm medial to the iliopectineal
eminence. The sciatic nerve could be injured during the first and last
stages of the osteotomy if the osteotome perforated the lateral
cortex of ischium and the ilio-ischial junction by >
10 mm. The femoral nerve could be stretched or entrapped during osteotomy
of the pubis if there was significant rotational or linear displacement
of the acetabulum. Anterior or medial displacement of <
2 cm
and lateral tilt (retroversion) of <
30° were safe margins. The
combination of retroversion and anterior displacement could increase tension
on the nerve. Strict observation of anatomical details, proper handling of
the osteotomes and careful manipulation of the acetabular fragment
reduce the neurological complications of Bernese peri-acetabular
osteotomy. Cite this article:
