Indications
Severe LBP
- most common indication
Ipsilateral knee pain
- less beneficial
Malposition
- especially abduction
Contraindications
Absent abductor mechanism
Flail
Active infection
Insufficient bone stock
Examination
LLD
Assessment abductor function
1. Palpation whilst asking patient to contract
2. MRI
Issues
1. Difficulty prepping & draping
2. Exposure
- identify sciatic nerve
- perform GT osteotomy
- may require adductor & psoas tenotomy
3. LLD
- maximum 4cm lengthening
- use ASIS pin as LLD guide
Xrays
Results
Joshi et al JBJS Am 2002
- 208 hips converted at average 51 years
- average follow up 9 years
- 83% good to excellent function
- 96% 10 year survival
- 15 nerve palsies
Complications
Loosening
Infection
Sciatic nerve palsy
HO
Residual LLD
Poor abductor function