Full Description
In the first edition, published in 1976, Professor BOMBELLI demonstrated a clear alternative to total hip replacement that is also useful in cases of advanced osteoarthritis. Since then the number of osteotomies perfor- med has reached 2500, which together with the longer follow-up of the original cases means that the author has significantly more experience with his new techniques. He has refined his previous concepts of the pathogenesis and treatment of osteoarthritis, and with the benefit of his experience has further clari- fied the indications and contra-indications of valgus-extension and varus osteotomy. Valgus-extension osteotomy has been proven to be particu- larly effective in cases with well-formed osteophytes and elliptical femoral heads. On the other hand, the indication for varus osteotomy has mostly been restricted to cases in which the femoral head is spherical. The role of CHIARI and SALTER pelvic osteotomies in those cases in which the coverage of the femoral head is insufficient is not neglected.Osteotomy is capable of complementing and accelerating the healing process, particularly in young patients in whom hip function is still well preserved and in whom there is early radiological evidence of sponta- neous, osteophyte-dependent repair. Whenever feasible, pre-existing or anticipated leg length inequalities are adjusted intra-operatively, but when this is technically impossible a postoperative lift may be required.
Contents
1 Introduction.- 1.1 Histology of the Osteophytes.- 2 Biomechanics of the Normal Static and Dynamic Hip.- 2.1 Static.- 2.1.1 Centre of Gravity S4: Bipedal Support.- 2.1.2 Centre of Gravity S5: Monopodal Support.- 2.1.3 Force of Abductors (M): Magnitude and Direction of Resultant Force R.- 2.1.4 "Sourcil".- 2.1.5 "Gothic Arch".- 2.1.6 "Hourglass".- 2.1.7 Spherical Sector.- 2.1.8 Centre of Stress.- 2.2 Dynamic.- 2.2.1 Division of Gait into 26 and 31 Phases: Path of Centre of Gravity S6 (Fischer).- 2.2.2 Path of Centre of Gravity S5(Pauwels).- 3 Biomechanics of the Osteoarthritic Hip.- 3.1 Effect of Inclination of the Weight-Bearing Surface on the Magnitude and Direction of the Component Forces of Forces R and R1.- 3.1.1 Craniolateral Inclination.- 3.1.2 Craniomedial Inchnation.- 4 Classification of Osteoarthritis of the Hip.- 4.1 Etiology.- 4.1.1 Mechanical.- 4.1.2 Metabolic.- 4.1.3 Combined.- 4.2 Morphology.- 4.2.1 Superolateral.- 4.2.2 Concentric.- 4.2.3 Medial.- 4.2.4 Inferomedial.- 4.3 Biological Reaction.- 4.3.1 Atrophic.- 4.3.2 Normotrophic.- 4.3.3 Hypertrophic.- 4.4 Range of Motion.- 5 Pathogenesis of Superolateral Types a), b) and c) Osteoarthritis.- 5.1 Anterocraniolateral Inclination of the Weight-Bearing Surface.- 5.1.1 Locating CR, CR1 and CS from X-ray of a Deformed Elliptical Femoral Head.- 5.2 Osteophytes.- 5.2.1 Positive Tension Osteophytes.- 5.2.2 Negative Tension Osteophyte.- 5.2.3 Fatigue Fractures of Osteophytes.- 6 Therapy of Superolateral Types b) and c) and Medial Osteoarthritis.- 6.1 Valgus-Extension Osteotomy.- 6.1.1 Effect of Valgus-Extension Osteotomy.- 6.1.2 Indications for Valgus-Extension Osteotomy.- 6.1.3 Evolution of the Technique of Valgus Osteotomy.- 6.1.4 Aims of Present Operation.- 6.1.5 How to Plan a Valgus-Extension Osteotomy.- 6.1.6 Present Operation Technique.- 6.1.7 Postoperative Treatment.- 6.2 Effect of Valgus Osteotomy on the Knee.- 6.3 Results of Osteotomy for Superolateral Osteoarthritis.- 6.3.1 Cases of Superolateral Type b).- 6.3.2 Cases of Superolateral Type c).- 6.3.3 Statistics on Superolateral Type b).- 6.3.4 Statistics on Mechanical, Superolateral Type c).- 6.4 Results of Osteotomy for Medial Types a) and b) Osteoarthritis.- 7 Acetabuloplasty and Pelvic Osteotomy.- 7.1 Surgical Technique.- 7.2 Results.- 7.3 Statistics.- 7.3.1 Simple Pelvic Osteotomy.- 7.3.2 Pelvic Osteotomy Combined with Intertrochanteric Osteotomy.- 8 Therapy of Superolateral Type a) and Concentric Osteoarthritis.- 8.1 Varus and Varus-Extension Osteotomy.- 8.1.1 How to Calculate the Angle of Varus.- 8.1.2 Technique of Varus Osteotomy.- 8.1.3 Postoperative Treatment.- 8.2 Effect of Varus Osteotomy on the Knee.- 8.3 Results.- 8.4 Statistics.- 9 Pathogenesis of Superolateral Types d1) and d2) Osteoarthritis.- 10 Therapy of Superolateral Types d1 and d2) Osteoarthritis.- 10.1 Varus-Extension Osteotomy for Type d1.- 10.1.1 Reduction of Compressive Force.- 10.1.2 Increase in Width of Weight-Bearing Surface.- 10.1.3 Statistics.- 10.2 Valgus-Extension Osteotomy for Type d2).- 10.2.1 Reduction of Compressive Force.- 10.2.2 Increase in Width of Weight-Bearing Surface.- 10.2.3 Results.- 10.2.4 Statistics.- 11 What to Consider When Faced with a Patient Suffering from Osteoarthritis of the Hip.- 11.1 Errors to Be Avoided.- 11.2 Indications for Osteotomy and Total Hip Replacement.- 12 How to Reduce Stress in the Hip Joint.- 12.1 Shifting the Centre of Gravity (S5) Towards the Supporting Limb.- 12.2 Using One Stick.- 12.2.1 One Stick on Healthy Side.- 12.2.2 One Stick on Diseased Side.- 12.3 Using Two Sticks.- 12.4 Carrying a Weight.- 12.5 Conclusion.- 13 Summary.- 14 Appendix: Notes on Principles of Mechanics and Dynamics.- 14.1 Principles of Mechanics.- 14.2 Principles of Dynamics.- 14.3 Culmann's Theorem.- References.
