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

• Published in: The Journal of arthroplasty Vol. 32; no. 9; pp. S38 - S44
• Main Authors: Greber, Eric M., MD, Pelt, Christopher E., MD, Gililland, Jeremy M., MD, Anderson, Mike B., MSc, Erickson, Jill A., BSc, PA-C, Peters, Christopher L., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017
• Subjects: Acetabulum - surgery; Adolescent; Adult; Aged; Arthroplasty, Replacement, Hip; complications; developmental dysplasia of the hip; Femur - surgery; Hip Dislocation - surgery; Hip Dislocation, Congenital - surgery; Humans; Kaplan-Meier Estimate; Middle Aged; modular stems; Orthopedics; Osteotomy; subtrochanteric osteotomy; Surface Properties; total hip arthroplasty; Treatment Outcome; Young Adult; modular stems; total hip arthroplasty; developmental dysplasia of the hip; complications; subtrochanteric osteotomy
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2017.02.024

Abstract 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. In addition, 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 arthroplasty 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 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.