Hip Reconstruction in
45 year old Navy Captain.
This gentleman had central fracture dislocation
of his left hip that was initially treated non-operatively
resulting in persistent central dislocation of the femoral
head with gap non-union of the acetabulum.
On analysis of the 3D model, it
was realized that the patient had deficiency of posterior
wall and the central part of the acetabulum with impression
fracture of the femoral head. The bone model also revealed
that the acetabulum orientation had changed into retroversion.
The alternate strategies considered
were :-
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Figure
1 : Protrusion Ring being
placed on the fratured acetabulum model
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Figure
2 : Side view showing the
areas that require
grafting.
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A. |
use of acetabular cage / anti
protrusio ring with a cemented cup. |
B. |
use of allograft for reconstruction |
C. |
sacrifice the femoral head |
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Figure
1 : Acetabular cup placed
on the fractured hip joint
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Figure
2 : Side view of the Acetabular
Cup strategy highlights the graft requirement
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A. |
use it as bone graft to reconstruct
the major posterior wall deficiency |
B. |
to use iliac crest graft to
fill up the medial wall defect |
C. |
place acetabular cup in proper
orientation on the graft bed |
In plan A, there is more dependence
on metal as compared to other options. In plan C the patient's
own tissues from the local area was used. This also reduced
the cost of the surgery but also improve the quality of results.
In plan B, the literature shows that may fail over a period
of time compared to autograft that was used in plan C giving
a longer lasting result.
After, analyzing different options
with the help of bone-model the best surgical plan that was
devised was to use plan C.
The exact extent of machining and
positioning of the femoral head graft was made easy by working
with the bone model.
Using the bone graft it was realized
that the difficulties in this case would be to bring down
the center of acetabulum to its correct level and orientation
in 3D will require extensive exterior and medial wall post
grafting and this was helped by mock surgery on the bone model.
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