Hip Surgery and Hip Joint Function : A Discussion with Anatomical Basis

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  • NAGOYA Satoshi
    Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University

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  • 股関節手術と股関節の運動機能—臓器別診療科との対話—
  • 教育講演 股関節手術と股関節の運動機能 : 臓器別診療科との対話
  • キョウイク コウエン コ カンセツ シュジュツ ト コ カンセツ ノ ウンドウ キノウ : ゾウキ ベツ シンリョウカ ト ノ タイワ

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Abstract

In Japan, hip joint degenerative diseases are based on acetabular dysplasia and the treatment strategy has been focused primarily on how to maintain the hip joint function and how to achieve pain relief. We employed total hip arthroplasty (THA) to treat end-stage OA of the hip joint. There are many possible complications in THA including infection, dislocation and nerve palsy. Especially in patients with Crowe IV dislocation, THA should be accompanied by simultaneous subtrochanteric shortening osteotomy to prevent sciatic nerve palsy. There is concern that the small metal head and posterior approach without re-attachment of posterior soft tissue commonly used in THA may be susceptible to postoperative dislocation. To avoid this scenario, we developed a modified less invasive total hip arthroplasty surgical approach that uses the anterolateral approach of the modified Watson-Jones approach. By using this approach, the risk of postoperative dislocation can be greatly reduced due to the intact posterior stabilizing soft tissue of the hip joint. Recently, a new concept in hip pathology describing femoroacetabular impingement (FAI) including retroversion of the acetabulum was proposed by Professor Ganz in 2003. Patients with acetabular dysplasia were also assumed to have acetabular retroversion. In patients with acetabular dysplasia to prevent further pathology of the hip joint, we developed a reorientation rotational acetabular osteotomy using a navigation system to obtain accurate direction and alignment in the reorientated hip joint. Orthopedic surgeons and rehabilitation doctors need to understand each other well in their respective fields of pathology and treatment strategy to ensure the optimal treatment of motor diseases.

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