- See: THR dislocation:
- Checklist:
- need complete muscular relaxation;
- irrigate any debris from acetabulum;
- Difficult Reduction:
- capsule might have to be further released, esp if head and neck segment was short preoperatively;
- if reduction is not possible & leg is lengthened, then recut neck;
- Leg Length:
- note position of trial head relative to greater trochanter (& compare this distance to that templated from x-rays);
- replace drill bit into greater troch & measure distance Steinman pin;
- finally note degree of telescoping of thigh w/ traction;
- a loose hip is usually result of high placement of the cup, inadequate femoral neck length, or short neck prosthesis;
- Anterior Instability:
- if hip cannot be brought into full extension then use shorter neck;
- if there was a severe flexion contracture preop, release psoas tendon;
- in extension & neutral abduction, there should be no impingement of posterior polyethylene rim at 45 deg of external rotation;
- consider 20 deg lipped liner is substituted to relieve impingement;
- posterior trochanter:
- if trochanter is located posteriorly, as in DDH, postraumatic disorders, hypertropic arthritis
- perform osteotomy of greater trochanter & transfer it laterally;
- w/ impingment in external rotation, consider removing bone from the posterior greater trochanter;
- Posterior Instability:
- at 90 deg of flexion & neutral abduction, internal rotation should be w/o impingment or instability to at least 45 deg,
- note point of subluxation w/ hip in flexion, adduction & Int. rotation;
- look for anterior osteophytes which might cause impingement and subsequent posterior subluxation;
- also that impingment results from too short femoral neck;
- if hip dislocates easily & head can be manually distracted from socket > few milimeters, then use longer neck length;
- use longer neck, becuase femoral component has angle < 45 to horizontal, hence longer neck increases offset > verticle ht;
- if excessive lengthening of extermity would result from longer neck length, then osteotomize greater troch & transfer it distally to help
stabilize the hip;
- also consider recutting femoral neck & then increasing neck length
- Impingement in Abduction:
- remove a small amount of bone from tip of greater trochanter