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The Triple Reverse of Hip Surgery
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| Using anatomical models and computer illustrations, orthopaedic surgeon Marc Hungerford explains how he performs his complex procedure for young patients with hip dysplasia. |
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If the triple pelvic osteotomy sounds like a triple back flip by a trapeze artist, there's good reason. The procedure, designed for the 20-to-40 year old patient with a severely degenerative and misshaped hip, called developmental hip dysplasia, is complex and risky. Indeed, only a handful of orthopaedic surgeons around the world attempt it.
"It's complicated because you're operating fairly deep in the body around structures like the femoral artery and the sciatic nerve that can be injured with drastic results," says orthopaedic surgeon Marc Hungerford, M.D. "Most surgeons don't feel comfortable with this procedure."
But Hungerford, who learned the procedure in Dortmund, Germany, prefers it to the traditional treatment, total hip replacement, in almost all of his dysplasia patients. A new artificial hip relieves the pain caused by friction in an abnormal hip, he says, but it may cause infections, fall out of place or wear out over time, requiring a second operation.
With the triple pelvic osteotomy, natural bone is realigned and restored, reducing the risk of displacement, infection and wear and tear. But pulling the procedure off is no easy trick. Hungerford first makes three small incisions over the buttock, hip and pubic areas, then cuts the pelvis in each place to free the hip socket, or acetabulum, from the pelvis. Using X-ray guidance, he rotates and repositions the socket fragment, fixing it with screws and wires. Correct rotation of the acetabulum is critical to success, as the newly positioned socket has to be able to hold the ball-like head of the thigh bone. Dysplasia patients' sockets don't adequately cover the ball of the femur, which results in the early degeneration.
All this must be done while deftly feeling for hidden underlying arteries and nerves.
Once the hip fragment is rotated into place, it will heal -- and eventually function -- naturally. "It's a durable, natural hip that has a normal distribution of forces across the joint," Hungerford says.
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