THA

SCFE

 

SCFE OA

 

Indications for THA

 

Osteoarthritis

- abnormal morphology

- loss of head neck offset

- bony impingement on acetabulum

 

AVN

 

Arthroplasty

Indications

 

Patient > 70

 

Gjertsen et al JBJS Am 2010

- 4335 patients > 70 with displaced subcapital fractures

- minimum 1 year follow up

- 1 year mortality same in each group / 25%

- 22% reoperation in ORIF v 3% in hemiarthroplasty

- more pain / higher dissatisfaction / lower quality life in ORIF group

 

Options

 

Hemiarthroplasty

- unipolar monoblock

- unipolar modular

Perthes

Issues

 

Femur

 

Multiplanar deformity

- worsend by previous surgery

- may require osteotomy

 

Acetabulum

 

Dysplasia often present

- not as severe as in DDH

 

LLD

 

Can be significant

 

Abductors

 

Have been short for long time

- difficult to restore length

Paget's Disease

Definition

 

Chronic, non metabolic bone disorder

Characterised by increased bone resorption, bone formation and remodelling

 

Epidemiology

 

Rare < 40

1 – 3 % population over 60

M > F

 

Aetiology

 

Unknown

 

Paramyxovirus implicated

- measles

- RSV

- canine distemper virus

 

Electron Microscope

Vascular Injury

Vessels at risk

 

Extra-pelvic blood vessels

 

Femoral Artery

MCFA

LCFA

Profunda Femoris

Obturator artery

 

Intrapelvic vessels

 

External iliac artery and vein

Obturator artery

Superior and inferior gluteal

 

External Iliac Vessels

 

Anatomy

- anterior division of common iliacs / L5-S1