Proximal femur osteotomy to correct varus deformity
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Management = Operative for OLD or SEVERE OA?
This is a Complex primary hip
Pre-operative
Templating - assess leg length discrepancy (LLD), expect shortening, so plan for slight lengthening
Senior surgeon backup
Plan for hybrid fixation - uncemented cup, cemented stem
Intraoperative
Exposure - prepare for extensile Trochanteric osteotomy
Dislocation - If previous surgery, expect contractures and distorted anatomy; perform neck cut first. For contractures - release gluteus maximus and psoas
Identify true acetabulum using transverse acetabular ligament (TAL), placing acetabulum within the Lewinnek safe zones of inclination 40° ±10° and anteversion 15° ±10°
Standard cemented stem with appropriate anteversion and depth
Post-operative
Standard hip precautions
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