Total hip arthroplasty in dysplasia and dislocation of the hip
Developmental dysplasia of the hip encompasses a wide spectrum of hip pathology ranging from a shallow acetabulum to a completely dislocated “high-riding” hip. It is a common cause of secondary osteoarthritis and is the underlying diagnosis in the majority of young adults requiring total hip arthroplasty (THA) for coxarthrosis. It is clear we still do not have an agreed and correct terminology covering the entire pathology of congenital deformities of the hip. We recommend the use of the term “Dysplasia and Dislocation of the Hip (DDH)” that is by definition the most suitable term to describe the total spectrum of related deformities in adults. Various systems of classification of DDH in the adults are in use. The most practical classification seems to be that of Hartofilakidis et al. We propose a classification system of DDH in adults based on the CT of the pelvis to supplement the existing classification systems and to be used in the preoperative planning of a THA. The acetabular deficiency is classified, according to Crowe or Hartofilakidis classification, in the frontal plane based on a plain AP radiograph, and then further classified as “neutral”, “anteverted” or “retroverted” in the transverse plane based on the CT scan of the pelvis. Careful attention to the morphology of the acetabulum, femur, pelvis, lumbar spine and knee in plain radiographs and CT scans in patients with DDH, is necessary, primarily to accurately classify the deformity and predict the bone deficiencies that will be encountered during THA. This will facilitate the selection of the proper reconstruction method and implants. In the present article useful surgical techniques and implants are presented for the management of these patients with a THA that presents difficulties because the majority of them are young with a considerable demand on their implants and they may require complex reconstruction on both sides of the joint.
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