Reverse Sleeve Placement in Complex Total Hip Arthroplasty for a Patient with Severe Valgus Deformity of the Trochanter-Surgical Technique and Case Report.

INTRODUCTION: It is rare to encounter a patient with severe valgus deformity of the greater trochanter with severe osteoarthritis of the hip joint. The treatment, that is total hip arthroplasty (THA) in such a case presents with a surgical challenge in proper placement of the femoral stem. Traditionally, an osteotomy procedure to correct the femoral deformity was warranted followed by THA. There are not many reported articles on such a case in English literature.

CASE REPORT: A 75-year-old gentleman a known case of diabetes and hypertension, with a body mass index of 31.6 presents with a painful right hip joint. History reveals an osteotomy of the proximal femur done approximately 30 years back. After a thorough clinical and radiological examination, he underwent THA at our center.

DISCUSSION: Trochanter valgus deformity is a rare deformity to come across. Often femoral osteotomy is considered to correct the deformity to aid in the insertion of the femoral stem. In this report, we state a different technique wherein the sleeve of the S-ROM femoral component (DePuy Orthopedics, Warsaw, Indiana) is placed in reverse fashion to overcome this complex situation, negating the need for osteotomy correction.

CONCLUSION: Deformity of the proximal femur can pose a significant technical challenge during THA. Modularity at the stem sleeve junction in the DePuy S-ROM system can prove to be efficient to secure good fixation in a femoral canal with deformities. Reverse sleeve placement proves to be reliable in the valgus deformity of the trochanter.