Total Hip Arthroplasty for a neglected Slipped Capital Femoral Epiphysis in 24F

Video Description

This lady sought me out because of a painful & deformed left hip which she's been living with for the past 16 years. She's 24 years old, and recalls suffering a fall when she was around 8 years old. She apparently had consults for the left hip problem on several occasions throughout her history, but was diagnosed as having "developmental dysplastic hip" or DDH (formerly known as congenital hip dysplasia). But as diagnostic imaging shows, her left hip is not dysplastic. What happened was that her fall at age 8 actually fractured her hip in the middle, along the cartilage growth plate (a.k.a. "physis" or "physeal plate"), thus allowing the rest of her femur to displace upward whenever she put weight on the left lower limb. The dome of her femoral head (a.k.a. "femoral epiphysis") remained stuck in her old hip socket (a.k.a. "acetabulum") while the rest of her femur (the "metaphysis" & "diaphysis") pushed upward into the main mass of her gluteal (butt) muscles as the years went by. This condition is thus CORRECTLY diagnosed as "Slipped Capital Femoral Epiphysis" or SCFE. Ideally, when she sustained the fracture at age 8, it should've been reduced like any other displaced fracture, and fixed in properly restored "anatomic" position -- but since she never got diagnosed correctly (and thus, was never treated appropriately), the fracture deformity of her left hip joint persisted for the next 16 years, giving her the functional problems & deformities that she has today.

So how do you fix a dysfunctional, chronically neglected SCFE? Well, you recreate/reconstruct the original hip joint -- restore both ball & socket to form a stable functioning joint, and equalize leg length to as much as can be equalized (without putting too much stretch on the sciatic nerve - more than 4 cm of lengthening is associated with sciatic nerve damage). And for that, we need correctly sized hip joint implants -- smaller than average so as to accommodate the patient's weird anatomy (brought about through the years by the neglected fracture), and of the "cementless" type so as to assure the longest life possible in a young individual with a total hip implant.