THE CLASSIC: The Reconstruction Operation for Arthritis Deformans of the Hip Joint

The reconstruction operation may be defined as a mechanical adaptation of a hip joint disabled by injury or disease to the essential requirements of locomotion. Originally, it was devised for ununited fracture, particularly for a class of cases in which the neck of the femur had been in great part absorbed or worn away, so that direct union of the fragments by any means was doubtful, and in which, even at best, function must be impaired greatly by loss of the neck and consequent limitation of abduction. In this operation the head of the femur is removed, and the trochanter is cut from the shaft in an oblique direction with all its attached muscles so that the additional area thus obtained, together with the part of the neck that remains, may provide a secure weight-bearing surface. The reconstructed neck having been inserted into the acetabulum, the limb is abducted sufficiently to permit the trochanter to be drawn down and implanted upon the outer surface of the shaft. Thus by muscular tension, security of the new articulation is maintained, while the reconstructed neck and the transplanted trochanter restore the leverage for the hip muscles and permit a range of controlled motion that enables the patient to walk with security and to sit with comfort.

Recently, the scope of the operation has been enlarged to include a number of other conditions, such as pathologic dislocation or subluxations secondary to disease, in which the articulation has been in part destroyed.