Total hip arthroplasty in developmental dysplasia of the hip: Review of anatomy, techniques and outcomes (original) (raw)

Midterm Results Of Total Hip Arthroplasty (THA) In Developmental Dysplasia Of The Hip (DDH)

Objectives Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) is a challenging procedure. We analysed 51 patients with this condition. The focus of this article is to provide our experience; the results and complications of THA in DDH. Patients and Methods In a retrospective approach, 51 patients with 59 hip arthrosis secondary to developmental dysplasia of the hip were included. Eight patients with 8 hips were lost to follow-up. Forty three patients with 51 hip arthrosis secondary to developmental dysplasia of hip were available for clinical and radiological evaluation at a mean follow-up time of 57 months (20 to 81 months). Results According to Crowe, 27 hip were Type 1, 12 hips were Type 2, 5 hips were Type 3, and 7 hips were Type 4. Mean Harris hip score was improved from 31 to 93,23. Complications were 2 acetabular cup migration and 1 femoral stem migration in the early period as well as dislocation in 5 hips during the early postoperative period. During i...

Long-term results of total hip arthroplasty in developmental dysplasia of hip patients

Joint Diseases and Related Surgery, 2020

Developmental dysplasia of hip (DDH) is one of the well-known orthopedic pathologies that cause coxarthrosis. [1] Pelvic bandage, traction, open or closed reduction, femoral, and pelvic osteotomies are the treatment alternatives for DDH in the pediatric age group. [2,3] For end-stage osteoarthritis, total hip arthroplasty (THA) is the standard treatment. [4,5] In the literature, several studies have reported that the anatomical hip center reconstruction yields favorable biomechanical results among those patients. [6,7] Both acetabular and femoral abnormal anatomy make this re-establishment challenging for surgeons. Among those patients, complication rates are higher than the normal arthroplasty operations due to the pathological anatomy. In DDH patient population, changing abnormal anatomy to normal and to reduce complication rates and prolong prosthesis survival, specially designed implants are needed. In this study, we aimed to report the physiological and radiological long-term results of THA combined with or without subtrochanteric osteotomy in a group of DDH patients. PATIENTS AND METHODS A total of 90 hips of 59 patients (3 males, 56 females; mean age 45.7±10.9 years; range, 24 to 67 years) who Objectives: This study aims to report the physiological and radiological long-term results of total hip arthroplasty (THA) combined with or without subtrochanteric osteotomy in a group of developmental dysplasia of hip (DDH) patients. Patients and methods: This retrospective study included 90 hips of 59 patients (3 males, 56 females; mean age 45.7±10.9 years; range, 24 to 67 years) who underwent THA between January 1979 and March 2006. Thirteen patients needed subtrochanteric shortening. The evaluation was performed through Harris hip scores, physical examination, and radiological imaging. Results: The follow-up period ranged from 5 to 32 years, and the mean follow-up period was 10.3±6.4 years. Revision was required in 17 hips out of 90. Twelve revisions were needed because of aseptic loosening of femoral or acetabular component, three were for fracture of the femoral stem, and two for protrusio acetabuli. Four patients had transient nerve palsy, and one had permanent nerve function loss. In one patient, nonunion was observed around the femoral osteotomy site. Harris hip score was remarkably improved compared to top preoperative values (48 vs. 88.2, p<0.01). Conclusion: Although revision rates tend to increase in long-term follow-up, THA is one of the best treatment options in DDH patients to relieve pain, improve daily activity levels, and minimize the damage of the knee and lumbar region.

Developmental Dysplasia of the Hip — Good Results of Later Total Hip Arthroplasty

The Journal of Arthroplasty, 2008

The purpose of the present article was to compare the results of primary total hip arthroplasty (THA) done because of developmental dysplasia of the hip (DDH) with the results of THA done because of idiopathic coxarthrosis (osteoarthritis) using data from the nationwide Norwegian Arthroplasty Register (NAR). In the period from 1987 to 2003, 84 871 primary THAs were reported to the NAR. Of these, 6347 (7.5%) were performed because of sequelae after DDH, 788 (0.9%) because of sequelae after DDH with complete dislocation of the femoral head, and 59 774 (71.0%) because of idiopathic coxarthrosis. The results of THAs after DDH were the same as those of THAs after idiopathic coxarthrosis after adjustments for younger age and for the use of more uncemented prostheses in patients with DDH.

Challenges in Total Hip Arthroplasty in the Setting of Developmental Dysplasia of the Hip

Background: Developmental dysplasia of the hip (DDH) is a recognized cause of secondary arthritis which may eventually lead to total hip arthroplasty (THA). An understanding of the common acetabular and femoral morphologic abnormalities will aid the surgeon in preparing for the complexity of the surgical case. Methods: We present the challenges associated with acetabular and femoral morphologies that may be present in the dysplastic hip and discuss surgical options to consider when performing THA. Additionally, common complications associated with this population are reviewed. Results: The complexity of THA in the DDH patient is due to a broad range of pathomorphologic changes of the acetabulum and femur, as well as the diverse and often younger age of these patients. As such, THA in the DDH patient may offer a typical primary hip replacement, or be a highly complex reconstruction. It is important to be familiar with all the subtleties associated with DDH in the THA population. The surgeon must be prepared for bone deficiency when reconstructing the acetabulum and should place the component low and medial (at the anatomic hip center), and avoid oversizing the acetabular component. Femoral dysplasia is also complex and variable, and the surgeon must be prepared for different stem choices that allow for decoupling of the metaphyseal stem fit from the implanted stem version. In Crowe III and IV dysplasia, femoral derotation/shortening osteotomy may be required. Many of the complications associated with THA in the DDH patient may be mitigated with careful planning and surgical technique. Conclusion: Performed correctly, THA can yield excellent results in this complex patient population.