SUPERhip 3

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The SUPERhip 3 procedure is indicated for CFD Type 2B cases, where the femoral head is significantly fused to the acetabulum or it is absent entirely. In these cases, a normal joint cannot be recreated by connecting the femoral head to the shaft of the femur. The SUPERhip 3 procedure is similar to the Pelvic Support Osteotomy. Both procedures aim to correct the hip deformity for CFD Type 2B. The SUPERhip 3 reconstructs the femoral head using the cartilage of the greater trochanter. Unlike the Pelvic Support Osteotomy, the SUPERhip 3 is performed prior to lengthening. Dr. Paley developed the SUPERhip 3 in 2013 (SUPER is an acronym for Systematic Utilitarian Procedure for Extremity Reconstruction). It is the newest SUPERhip procedure.

Muscle Releases

To start, Dr. Paley will perform the same incision and muscle releases as the SUPERhip 2. This includes release of the tensor fascia lata, the rectus femoris, the psoas, the piriformis, and the gluteus medius.

Next, Dr. Paley will expose the femoral head by resecting the surrounding capsule.

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Resection of the capsule surrounding the femoral head. © The Paley Foundation 2015

If the femoral head is present, it is completely removed.

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Removal of the femoral head. © The Paley Foundation 2015

Femoral Osteotomy

Next, Dr. Paley will perform the femoral osteotomy. The nature of the procedure will differ depending on the size of the upper femoral head. Version A is performed when the femoral head has sufficient hook and length to fit a blade plate. Version B is performed when there is insufficient hook of the upper femur and a blade plate will not fit.

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Version A on the left: femoral head has sufficient hook for blade plate. Version B on the right: insufficient hook for blade plate. © The Paley Foundation 2015

Version A

In Version A the femoral osteotomy is performed perpendicular to the length of the femur.

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Femoral Osteotomy for Version A. © The Paley Foundation 2015

Next, Dr. Paley will drill a hole through the upper femur and the hip joint. The cartilage of the greater trochanter is attached to the hip joint and then connected to the upper portion of the femur.

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Attachment of the upper femur to the hip joint. © The Paley Foundation 2015

The femur is cut a second time and it is then slotted into place.

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Second osteotomy of the femur. © The Paley Foundation 2015

A blade plate is then aligned along the edge of the femur and secured with screws.

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Application of the blade plate to the femur. © The Paley Foundation 2015

The final steps are to repair and reattach the muscles and apply the external fixator. In Version A the gluteus muscles are able to reach the femur and thus no abduction slide is necessary.

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Muscle repair. © The Paley Foundation 2015
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Application of the external fixator. © The Paley Foundation 2015

Version B

In Version B, the femoral osteotomy is performed at a forty-five degree angle.

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Femoral osteotomy for Version B. The cut is a 45-degree angle. © The Paley Foundation 2015

The cartilage of the greater trochanter is used to reconstruct the femoral head and connect the upper femur to the hip joint as in Version A. Before the femur can be reconnected to the upper femur, it must be externally rotated.

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External rotation of the femur before reconnecting to the upper femur. © The Paley Foundation 2015

The upper femur and hip joint is then connected to the side of the shaft of the femur. This results in a ninety degree orientation between the shaft of the femur and the pelvis.

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Orientation of the shaft of the femur to the reconstructed femoral head. © The Paley Foundation 2015

Two screws are then inserted to hold this alignment in place.

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Final orientation of the femur and hip joint for Version B. © The Paley Foundation 2015

The final step is to reattach the muscles. In Version B the gluteus muscles do not have sufficient length to reach the femur. Dr. Paley will therefore perform an abductor slide.

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An abductor slide is necessary to reconnect the gluteus muscles in Version B. © The Paley Foundation 2015

The final step is to apply the external fixator, as in Version A.

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Application of the external fixator. © The Paley Foundation 2015

This completes the SUPERhip 3 procedure.