HIP OSTEOTOMY SURGICAL PROCEDURE
Category: Orthopedic Surgery
Abstract : A hip osteotomy is a surgical procedure in which the bones of the hip joint are
cut, reoriented, and fixed in a new position. Healthy cartilage is placed in the
weightbearing area of the joint, followed by reconstruction of the joint
in a more normal position.
Purpose To understand hip surgery, it is helpful to have a brief
description of the structure of the human hip. The fem
A hip osteotomy is a surgical procedure in which the bones of the hip joint are
cut, reoriented, and fixed in a new position. Healthy cartilage is placed in the
weightbearing area of the joint, followed by reconstruction of the joint
in a more normal position.
Purpose
To understand hip surgery, it is helpful to have a brief
description of the structure of the human hip.
The femur, or thigh bone, is
connected to the knee at its lower end and forms part of the hip joint at its
upper end. The femur ends in a ball-shaped piece of bone called the femoral
head. The short, slanted segment of the femur that lies between the femoral head
and the long vertical femoral shaft is called the neck of the femur. In a normal
hip, the femoral head fits snugly into a socket called the acetabulum.
The
hip joint thus consists of two parts, the pelvic socket or acetabulum, and the
femoral head. The hip is susceptible to damage from a number of diseases and
disorders, including arthritis, traumatic injury, avascular necrosis, cerebral
palsy, or Legg-Calve- Perthes (LCP) disease in young patients. The hip socket
may be too shallow, too large, or too small, or the femoral head may lose its
proper round contour. Problems related to the shape of the bones in the hip
joint are usually referred to as hip dysplasia.
Hip replacement surgery
is often the preferred treatment for disorders of the hip in older patients.
Adolescents and young adults, however, are rarely considered for this type of
surgery due to their active lifestyle; they have few good options for
alleviating their pain and improving joint function if they are stricken by a
hip disorder. Osteotomies are performed in these patients, using the patient’s
own tissue in order to restore joint function in the hip and eliminate pain. An
osteotomy corrects a hip deformity by cutting and repositioning the bone, most
commonly in patients with misalignment of certain joints or mild osteoarthritis.
The procedure is also useful for people with osteoarthritis in only one hip who
are too young for a total joint replacement.
Demographics
The incidence of hip dysplasia is four per 1,000 live births
in the general world population, although it occurs much more frequently in
Lapps and Native Americans. In addition, the condition tends to run in families
and is more common among girls and firstborns. Acetabular dysplasia patients are
usually in their late teens to early thirties, with the female: male ratio in
the United States being 5:1.
Description
A hip osteotomy is performed under general anesthesia.Once the
patient has been anesthetized, the surgeon makes an incision to expose the hip
joint. The surgeon then proceeds to cut away portions of damaged bone and tissue
to change the way they fit together in the hip joint. This part of the procedure
may involve removing bone from the femoral head or from the acetabulum, allowing
the bone to be moved slightly within the joint. By changing the position of
these bones, the surgeon tries to shift the brunt of the patient’s weight from
damaged joint surfaces to healthier cartilage. He or she then inserts a metal
plate or pin to keep the bone in its new place and closes the incision.
There are different hip osteotomy procedures, depending on the type of bone
correction required. Two common procedures are:
• Varus rotational osteotomy
(VRO), also called a varus derotational osteotomy (VDO). In some patients, the
femoral neck is too straight and is not angled far enough toward the acetabulum.
This condition is called femoral neck valgus or just plain valgus. The VRO
procedure corrects the shape of the femoral neck. In other patients,the femoral
neck is not straight enough, in which casethe condition is referred to as a
femoral neck varus.
• Pelvic osteotomy. Many hip disorders are caused by adeformed acetabulum
that cannot accommodate the femoral head. In this procedure, the surgeon
redirects the acetabular cartilage or augments a deficient acetabulum with bone
taken from outside the joint.
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