This case of DDH presented a challenge indeed. The original x-ray (below) shows severe bilateral DDH. An attempt was made back in the 60’s to relocate the femoral head into the natural acetabulum. This was clearly unsuccessful.
The current pre operative x-ray (below) shows the startling superior migration of the femoral heads up toward the iliac crest which caused extreme discomfort to the patient.
https://hipkneetumoursurgery.com.au/physician-information/case-presentations/hip-primary-ddh#sigProIde79346cde4
It was decided that the patient would undergo unilateral hip replacement following a shortening de-rotation osteotomy. Extensive pre-operative planning revealed a staggering 10cm of bone would need to be removed in order to allow the hip to function with the acetabular component implanted in the natural acetabulum.
https://hipkneetumoursurgery.com.au/physician-information/case-presentations/hip-primary-ddh#sigProId999d1d24f8
The net change in leg length was ostensibly zero meaning there was no compromise to the sciatic nerve.
The surgery was largely uneventful and the patient made very pleasing progress. The following images provide a view of the post-operative position of the implant and the close apposition of the osteotomy.
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https://hipkneetumoursurgery.com.au/physician-information/case-presentations/hip-primary-ddh#sigProId376d054ec7