TY - JOUR
T1 - Trochanteric-sparing Proximal Femoral Resection for Arthritic Spastic Hips
AU - Bauer, Jennifer M.
AU - Butler, Marjorie P.
AU - Schoenecker, Perry L.
AU - Schoenecker, Jonathan G.
N1 - Publisher Copyright:
© 2020 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2020
Y1 - 2020
N2 - Progressive hip subluxation or dislocation leading to degenerative disease, in neuromuscular disease, is a significant cause of morbidity to the patient and burden to the caretaker. Surgical salvage procedures have unpredictable success. We hypothesized that modifying the Castle-type proximal femoral resection by securing a retained greater trochanter with its musculature to the capsular arthroplasty and femoral shaft would compartmentalize the femur to decrease proximal femoral migration and heterotopic ossification (HO), thereby precluding the need for traction and HO prophylaxis while improving pain and caretaker satisfaction. The purpose of this report is to describe the novel trochanteric-sparing proximal femoral resection (TS-PFR) technique. Seventeen hips in 13 patients were treated by the TS-PFR procedure. Twelve of 13 patients experienced complete pain relief, and all had improved sitting tolerance and perineal care. These results represent an improvement from prior salvage operations, without increase in blood loss, length of stay, proximal femoral migration, or HO. One patient underwent revision for failed soft tissue envelope. A retrospective review of patients treated at 2 institutions identified those who underwent TS-PFR for arthritic spastic hip. Perioperative course, radiologic evaluation for migration and HO, and caretaker satisfaction were compared with prior published surgical techniques. The TS-PFR technique is a safe alternative to previously described spastic hip salvage procedures and may improve upon them by creating a compartment for the proximal femur that precludes the need for traction and decreases HO. The technique improves patients' pain, sitting tolerance, perineal hygiene, and caretaker satisfaction.
AB - Progressive hip subluxation or dislocation leading to degenerative disease, in neuromuscular disease, is a significant cause of morbidity to the patient and burden to the caretaker. Surgical salvage procedures have unpredictable success. We hypothesized that modifying the Castle-type proximal femoral resection by securing a retained greater trochanter with its musculature to the capsular arthroplasty and femoral shaft would compartmentalize the femur to decrease proximal femoral migration and heterotopic ossification (HO), thereby precluding the need for traction and HO prophylaxis while improving pain and caretaker satisfaction. The purpose of this report is to describe the novel trochanteric-sparing proximal femoral resection (TS-PFR) technique. Seventeen hips in 13 patients were treated by the TS-PFR procedure. Twelve of 13 patients experienced complete pain relief, and all had improved sitting tolerance and perineal care. These results represent an improvement from prior salvage operations, without increase in blood loss, length of stay, proximal femoral migration, or HO. One patient underwent revision for failed soft tissue envelope. A retrospective review of patients treated at 2 institutions identified those who underwent TS-PFR for arthritic spastic hip. Perioperative course, radiologic evaluation for migration and HO, and caretaker satisfaction were compared with prior published surgical techniques. The TS-PFR technique is a safe alternative to previously described spastic hip salvage procedures and may improve upon them by creating a compartment for the proximal femur that precludes the need for traction and decreases HO. The technique improves patients' pain, sitting tolerance, perineal hygiene, and caretaker satisfaction.
KW - Castle resection
KW - neuromuscular spastic hip
KW - trochanteric-sparing proximal femoral resection
UR - http://www.scopus.com/inward/record.url?scp=85082989065&partnerID=8YFLogxK
U2 - 10.1097/BTO.0000000000000324
DO - 10.1097/BTO.0000000000000324
M3 - Article
AN - SCOPUS:85082989065
SN - 0885-9698
VL - 35
SP - 51
EP - 62
JO - Techniques in Orthopaedics
JF - Techniques in Orthopaedics
IS - 1
ER -