THE RESECTION-ANGULATION OPERATION FOR HIP-JOINT DISABILITIES


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Abstract

In a series of fifty-six patients, sixty-four resection-angulation operations were performed. This series included nine patients who had non-union of fracture of the neck of the femur and forty-seven patients who had various types of non-traumatic hip disability. The operations were performed for relief of pain and the restoration of motion. Almost complete relief of pain was obtained in 67.2 per cent, and marked improvement in 25 per cent. Restoration of satisfactory motion was obtained in 53.1 per cent. and improved in 29.7 per cent. of the cases. In unilateral cases, the results were somewhat better than those obtained for the group as a whole (relief of pain, 82.8 per cent; diminution of pain, 13.8 per cent.). In unilateral cases, satisfactory motion was restored in 65.5 per cent. and improvement in motion was obtained in an additional 20 per cent.Pending the development of an ideal hip-joint prosthesis, there is a large group of patients for whom none of the present arthroplastic procedures is applicable or in whom one or another such procedure has already failed. For these there would appear to be but little choice other than the resection-angulation operation if painless motion is to be restored. Furthermore, on the basis of the present review of cases, this operation appears to be not only the "redemption operation" of choice, but merits careful consideration as a primary operation. Quite apart from its success in overcoming pain, it yields a very high percentage of good functional results, particularly in the patients with unilateral disability, for whom other types of prosthetic operations are now being recommended.The resection-angulation operation has several distinct advantages. It has universal applicability and can be employed by every adequately trained surgeon in any well equipped hospital. Apart from the general condition of the patient, there are no contraindications to its use. Any patient in whom there are a pelvic wall and a femoral shaft can be rehabilitated. It should be emphasized, however, that the resection-angulation operation is not an arthroplastic procedure. Although it does aim to restore painless stability and mobility, its most important contribution seems to be the release of the pelvis. Meticulous attention must, however, be given to (1) careful preoperative determination of the postosteotomy angle and (2) unremitting supervision of the period of postoperative re-education. These, rather than the elegance of surgical technique, are the essential elements in determining the success or failure of the procedure.

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