Richard F. Santore, M.D.

"The large majority of cases previously thought to be primary or idiopathic osteoarthritis of the hip are actually secondary to mild developmental abnormalities, which in the past have been overlooked or unrecognized. In some series, such cases are reported to represent more than 50% of the cases of degenerative joint disease." -- William H. Harris, M.D., Clin Ortho 213:20, December 1986.

Management considerations for the orthopaedic surgeon treating a patient with primary and/or secondary idiopathic osteoarthritis of the hip joint are many. All management decisions take into account patient age and activity level. Today's younger, more active patients are often candidates for noncemented press-fit or bony-ingrowth arthroplasty procedures. The decision for such interventive treatment is often delayed as long as the patient is willing to tolerate experienced pain and a diminished lifestyle. An often overlooked intermediary treatment option has been the proximal femoral osteotomy.

Historically, osteotomies have been (and continue to be) performed in relatively great numbers in Europe, and with only limited use and mixed reviews in the United States. This demanding, sophisticated procedure is truly a relevant piece of armamentarium in the retinue of the hip surgeon. Considering the active lifestyles of Americans in their mid-to-later years of life, a viable alternative to arthroplasty which yields good-to-excellent reliable results is a must.

Dr. Richard F. Santore, after having served a fellowship with Professor Dr. Renato Bombelli in 1982, has continued to advocate the use of the proximal femoral osteotomy for a multitude of patients who would otherwise be candidates for total arthroplasty procedures.

Says Dr. Santore: "There is still no satisfactory arthroplasty solution that will permit patients to return to athletic and/or active endeavors other than a biologic solution. Osteotomies provide favorable results 75-80% of the time. Patients are restored to a relatively pain-free state with enhanced functional capabilities that are sufficient to gain ten, fifteen or more years before consideration of implant arthroplasty."

The VJO visited Dr. Santore in San Diego where he surgically demonstrated this relevant reliable technique in two separate cases: 1) for the treatment of a patient requiring a valgus osteotomy and 2) for a patient requiring a varus osteotomy. Dr. Santore thoroughly reviews the preoperative assessment of these two patients, including computer digitization and planning techniques.

It is an operation with clear indications today. The importance of it is approximately 1% of the live births in this country have CDH (3.6 million live births, 1980 census), so that calculates to an extremely significant number of new cases of dysplasia each year." (Richard Santore, M.D.)

References
1. Harris WH Etiology of Osteoarthritis of the Hip Clin Orthop 213:20-33, Dec 1986
2. Lloyd-Roberts GC Osteoarthritis of the Hip. A Study of the Clinical Pathology JBJS 37B:8, 1955
3. Stulberg SD, Harris WH Acetabular Dysplasia and Development of Osteoarthritis of the Hip In: Harris WH (ed) The Hip, Proceedings of the Second Open Scientific Meeting of The Hip Society St. Louis, C.V. Mosby 1974 p. 83

• Total Run Time: 14:48 minutes
• Catalog Number: 4008
• Publication Date: June 1989

• DVD/iPod: $95.00