![[object Object],[object Object],[object Object],[object Object],Hip & Knee Surgery Center @ Rozzano - Milano - Italy](https://image.slidesharecdn.com/cdhmadrid-100620132511-phpapp02/85/displasia-congenita-anca-efort-madrid-2010-1-320.jpg)
![[object Object],60,0 % Japan 16% in our experience the prevalence is about 5,7 % U.S.A.](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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- 4. CDH patients Crowe grade 1 to 3 Crowe grade 4 THA performed 2.308 1267 476 565 21.538 1984 - 2009 osteotomies sequelae Santa Corona Hospital, Pietra Ligure Humanitas Clinical Institute, Milano
- 5. 1984 - 2009 Santa Corona Hospital, Pietra Ligure Humanitas Clinical Institute (2010), Milano THA and osteotomy Subtrochanteric osteotomies ( 21 last 2 y. ) GT osteotomies THAs on CDH 148 67 52 12 2.308 Combined procedures 9 Distal femur ostheotomies
- 6. Proximal Femoral Deformities in C.D.H. • increase in antiversion angle • G.T. posterior displacement • L.T. anterior displacement • diafiseal diameter reduction • ipoplasia of metaphisys
- 7. Acetabular alterations in CDH (3D) (*) ischiatic prevalence ischiatic overload bone stock increase @ posterior column (*) anterior column defect Pubic branch ipoplasia secondary to loss of charge
- 9. The Surgeon has to keep in mind the local and peripheral abnormal anatomy of CDH A B C C B A E E’ D and try to restore the normal hip biomechanics A = gluteus maior B = gluteus medius C = gluteus minor D = ileopsoas E = short adductor E’= long adductor A B C C B A D
- 10. 1970 Surgical technique evolution Cemented stem Proximal osteotomy and lowering of GT 70 ’s
- 11. 17/4/1996 12/4/1996 13/9/1995 13/9/1995
- 12. Surgical technique evolutions 1970 1980 Distal shortening Osteotomy and femoral derotation 80 ’s
- 13. • cemented stem implant according to CDH anteversion • distal femur shortening & derotation (according to preoperative planning) Surgical technique: shortening osteotomy and distal derotation
- 16. 4/11/2000 it is possible to perform THA with a femoral shortening osteotomy at the same time. I.D. 17688 In patients affected by Crowe IV CDH
- 18. Rebuilding “ theoric anatomical” rotational center I.D. 7367
- 23. I.D. 7823 9/4/1995 22/2/1996
- 24. I.D. 7823 14 ys F. up
- 25. 17230 3 ys F-up
- 26. 16679
- 27. post-op i.d. 14416 Conclusions Crowe 3 / 4 treatment, specially in association with torsional deviation, is complex and technically demanding, with considerable influence on implant survival
- 28. i.d. 14416 In Crowe IV patients, one time THA & shortening osteotomy is a technycally demanding but reasonable option
- 29. 300 Consecutive T.H.R. Dec. 1983 - Apr. 1985 1757 f-up 13y ...still high wear for overloading of the cup 0 0.2 0.4 0.6 0.8 1.0 Cum. Survival 0 2 4 6 8 10 12 14 16 CUP 70,0% 89,4% 1st series CLS stem 18 STEM 94,0% 20 Yrs
- 30. % first implants revisions implants Diagnosis vs implant failure F-up 6 y F-up 7,5 y I.D. 54
- 31. 9882 4 ys F. up 8 ys F. up 9 ys F. up
- 32. F.N.19744 - f. 26 ys
- 33. F.N.19744 - f. 26 ys 9 months F-UP
- 34. F.N.19744 - f. 26 ys 9 months F-UP
- 35. F.N.19744 - f. 26 ys 21 months F-UP
- 36. Livio Sciutto F O N D A Z I O N E www.fondazione.it THANK YOU VERY MUCH FOR YOUR ATTENTION