title: [Hip arthroplasty after corrective osteotomies : Pelvis and proximal femur].
abstract: BACKGROUND
  Pelvic and femoral osteotomies are frequently performed in patients with hip dysplasia. The aim of these surgeries are optimal biomechanical conditions of the hip joint thereby avoiding the occurrence of hip osteoarthritis or the delay of initial hip osteoarthritis progression.
  
  
  METHODS
  Nevertheless even with good biomechanical conditions of the hip joint, progression of hip osteoarthritis can be recognized postoperatively. A total hip arthroplasty is indicated even more after a time period with conservative treatment. In preparation for the operation, a detailed documentation of the initial clinical situation, appropriate imaging, implant selection and preoperative planning are mandatory. In addition, a biomechanical model representing the desired pre- and postoperative situation can be included in the preoperative planning. According to the previous osteotomy, the size and shape of the acetabulum after the osteotomy and the current pivot centre of the hip joint should be considered. Depending on these observations the acetabular cup can be directly inserted into the bone stock of the acetabulum or an acetabular plasty is necessary before implantation of the acetabular cup. With respect to the previous osteotomy of the femur, it needs to be clarified wether hardware removal will be necessary before total hip replacement; moreover, the anatomy of the proximal femur is critical. In addition, if necessary, a re-osteotomy of the femur is required to enable a hip stem implantation.
  
  
  CONCLUSIONS
  Cementless total hip replacement should be preferred due to the younger patient age. The load of the hip replacement depends on the osseous anchoring and primary stability of the acetabular and femoral component.
authors.affiliation: Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland. brath@ukaachen.de.
authors.forename: B
authors.initials: B
authors.lastname: Rath
authors.affiliation: Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.|Lehrstuhl für Medizintechnik, Helmholtz Institut Aachen, Pauwelsstraße 20, 52074, Aachen, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Eschweiler
authors.affiliation: Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Betsch
authors.affiliation: Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
authors.forename: V
authors.initials: V
authors.lastname: Quack
authors.affiliation: Klinik für Orthopädie, Klinikum Dortmund, Beurhausstraße 40, 44137, Dortmund, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Lüring
authors.affiliation: Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Tingart
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D019317:Evidence-Based Medicine; D005270:Femur Head / Q000000981:diagnostic imaging / Q000601:surgery*; D006617:Hip Dislocation / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D010027:Osteotomy / Q000379:methods*; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome
keywords: Femur; Hip Dysplasia; Osteotomy; Pelvic region; Total hip replacement