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. 2008 Aug;466(8):1954-8.
doi: 10.1007/s11999-008-0292-6. Epub 2008 May 16.

Femoral shortening during hip arthroplasty through a modified lateral approach

Domagoj Delimar  1 , Goran Bicanic, Kresimir Korzinek
Affiliations

Femoral shortening during hip arthroplasty through a modified lateral approach

Domagoj Delimar et al. Clin Orthop Relat Res. 2008 Aug.

Abstract

We describe a modification of the direct lateral approach to the hip that provides excellent femoral and acetabular exposure and an easy way to shorten the proximal femur and equalize leg length. The approach also is useful for lower extremity elongation while preserving muscle continuity and minimizing postoperative complications. The exact amount of shortening can be calculated and planned preoperatively and measured and corrected intraoperatively if necessary. It avoids the necessity for osteotomies of the trochanter and transverse cuts or detachment of abductor muscles.

Level of evidence: Level IV, therapeutic study.

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Figures

Fig. 1A–F
Fig. 1A–F
A lateral view of the right hip is shown. The (A) anterior half of the continuous tendon of the gluteus medius and vastus lateralis is detached. The chisel is on the posterior half of the continuous tendon. (B) Anterior and posterior halves of the continuous tendon are detached with a chisel. (C) After femoral neck resection, the proximal femoral stump is moved posteriorly and exposure is continued to the level of the true acetabulum by removing fibrous tissue. (D) The acetabular cup is placed in the desired position in the level of the true acetabulum and additional proximal femoral shortening is performed. (E) The femoral head of the endoprosthesis is relocated distally into the acetabulum. The original tendinous attachment of the abductor muscles (with the flake of bone) remains proximal to its original insertion (which is moved distally). Raw surfaces of two flakes of bone are sutured together and are not reattached to its original position so the proximal part of the vastus lateralis will be proximal to the original attachment on the femur. (F) For closure, tendon suturing is performed. If there is any overlapping between the bone flakes and femoral stump, an additional one or two transosseous sutures are recommended.
Fig. 2A–B
Fig. 2A–B
(A) Preoperative and (B) postoperative radiographs are shown. The white dots outline the greater trochanter.
See this image and copyright information in PMC

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