Total hip arthroplasty for sequelae of childhood hip disorders: Current review of management to achieve hip centre restoration

Figure 5 Prior femoral procedures produce distortion in the proximal and/or distal femur. A–E: Prior proximal femur valgus osteotomy and distal femur lengthening needed correction of the proximal angulation, shortening and judicious reaming distally to obtain optimum fixation length. Arrows indicating area of femur canal distortion; F–I: Childhood hip arthritis with significant shortening required extensive release and shortening osteotomy. Distal femoral canal changes with 15 angulation due to prior lengthening had to be managed with careful femur canal preparation for a long modular implant. Orange arrows show the canal distortion. Reaming was done gradually as significant resistance was encountered at that segment. Intraoperative imaging is important in these situations.