G. BOU. F. 75 y. 1 m60 61 Kg

R.H : ankylosed in adductionL.H : dislocated with a femoral Schanz osteotomyLumbar spine arthritic partially fixed Right knee in varus, painfullLeft knee in valgus, painlessMajor leg length discrepancy mechanically 8.5 cmanatomically 6 cm

She just complains about lumbar spine and right knee

What would you do?

1985

1985

1985

G. BOU

1985 1987 1988

After THA on the left side withfemoral alignment osteotomy,the standing position isimproved.The valgus deformation of the left knee is completely reduced and leg length discrepancy decreasedThe pelvic tilt as well as thevarus of the right knee persist.Leg length inequality is still 4.5 cm

After THA on the right hip with shortening osteotomy of 3 cm, the standing position is perfect with a good alignment of the lower limbs but it persists a 10° pelvic tilt which could not be corrected.The lumbar spine pain has been greatly reduced as well as pain in the right knee for 12 years.

G. BOU

2003

18 y PO

The residual pelvic tilt has almost completely disappeared

F. FAV. F. 41 y. 1 m65 60 Kg

1976

Right hip dislocated with Schanz osteotomy Left hip displastic with anteversion 60° after previousadduction osteotomyPelvic tilt. Lumbar spine almost normal but painful

What would you do?

F. FAV

1977

THA on the right hip with alignment osteotomy of the femurNo modification of the pelvic tilt

F. FAV

19781978 1978

Because the left hip remained painful we decided to correct the hip anteversion by arotation osteotomy.The hip has been greatly improved for 12 years.

Left hip hyperanteversion 60°AP view of the left hip ininternal rotation 40° After rotation osteotomy

F. FAV

Deterioration of theleft hip

After THR on the left side, the pelvictilt significantly decreased but she complained of the valgus arthritic knee. It was aligned by a femoral lowosteotomy in 1994

1990

1991

1991

F. FAV

R.H : 27 y POL.H : 13 y PO

R.K : 10 y PO

2004

2004A 10° of pelvic tilt persists because the right femur is 1.5 cm shorter than the left.Despite this, the standing position is very good.Lumbar spine, hips and right knee are painless.