There are a number of childhood conditions such as Perthes disease, Hip Dysplasia and Slipped Upper Femoral Epiphysis (SUFE) which can cause significant abnormalities in the immature hip. There are a variety of ways of treating these conditions but traditionally, they would have been treated with surgery to change the shape of the femur. The picture below shows an x-ray of the right hip in a 40 year old male who had undergone a previous valgus osteotomy. While it gave him relief for some years, he then began to get increasing pain in his hip. X-rays showed that arthritis had set in due to his abnormal anatomy.
Figure 3: Post-operative x-ray showing a hip replacement after corrective osteotomy
These are difficult cases to manage surgically. Because of his previous operation, the shape of his upper femur made a normal hip replacement impossible. To get around this problem, the femur was split again and a corrective osteotomy performed. This allowed the use of a revision stem (s-rom) and a standard uncemented cup with ceramic bearings. While this was a major procedure, it did mean that normal anatomy was restored and the optimal bearings could be used.