Mr Prim Achan, Chief of Orthopaedics at St Barts Healthcare Trust with a keen sub speciality interest in the young adult hip, including, complex hip and knee arthroplasty and hip preservation techniques, opens the afternoon session with an authoritative narrative on the proximal femur. What is helitorsion? Can we quantify it and its relationship to hip ante- version? Professor Martyn Porter interjects to stress the need for understanding the dynamics of the pelvis when talking about these key biomechanics parameters.

In Mr Achan’s young dysplastic patient practise, the theme appears to be the exaggerated retroversion of the neck, very clearly seen on the lateral X Ray view but any standardised 2D X Ray is not a substitute for 3D planning with HipPLAN® software. Mr Achan then goes on to describe the improved psychological profiles of this young adult population following successful joint replacement surgery with Custom implants, and the very particular challenges of post operative compliance!

In the 2nd part of this fascinating narrative, Mr Achan describes the need to balance the soft tissues of the hip in the Axial plane, so we assess not just abductor function and the effect of offset,  but the huge relevance of the transmission forces through the bearing surface and the possible effects of any imbalance on the torsional wear at the head neck trunion.

The questions that follow are searching and truly thought provoking. In summary, 3D gives surgeons a level of understanding not previously appreciated from the interpretation of 2D plain X Ray films. Professor Tim Board from Wrightington Hospital, confirms this and our further understanding of the joint rotation centre and the relevance to soft tissue balancing in the hip, as this session is brought to a close.


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