Total hip arthroplasty in dysplasia and dislocation of the hip
Keywords:
total hip arthroplasty in developmental dysplasia of the hip, terminology of developmental dysplasia of the hip, classification of developmental dysplasia of the hip, reconstruction of the acetabulum, reconstruction of the femurAbstract
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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References
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2. Howorth MB. Congenital Dislocation of the Hip. Ann Surg 1947; 125(2):216-36.
3. Stanisavljevic S, Mitchell CL. Congenital Dysplasia, Subluxation, and Dislocation of the Hip in Stillborn and Newborn Infants. J Bone Joint Surg Am 1963; 45:1147-58.
4. Klisic PJ. Congenital dislocation of the hip--a misleading term: brief report. J Bone Joint Surg Br 1989; 71(1):136.
5. Hartofilakidis G, Babis GC. Congenital disease of the hip. Clin Orthop Relat Res 2009; 467(2):578-9; discussion 80-1.
6. Wedge JH, Wasylenko MJ. The natural history of congenital disease of the hip. J Bone Joint Surg Br 1979; 61-B(3):334-8.
7. Weinstein SL. Natural history of congenital hip dislocation (CDH) and hip dysplasia. Clin Orthop Relat Res 1987; (225):62-76.
8. Hartofilakidis G. Developmental dysplasia of the hip: An unsuitable term. J Bone Joint Surg [Internet]. 2004.
9. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am 1979; 61(1):15-23.
10. Eftekar NS. Variations in technique and specific considerations. In: Eftekar NS, editor. Principles of total hip arthroplasty. St. Louis: CV Mosby; 1978. p. 1-440.
11. Eftekhar NS. Congenital displasia and dislocation. Summary of essentials. In: Eftekhar NS, editor. Total hip arthroplasty. II. St. Louis, Mssouri: Mosby; 1993. p. 977.
12. Kerboul M, Mathieu M, Sauzieres P. Total hip replacement for congenital dislocation of the hip. In: Postel M, Kerboul M, Evrard J, Courpied JP, editors. Total hip replacement. New York: Springer; 1987. p. 51–66.
13. Mendes DG, Said MS, Aslan K. Classification of adult congenital hip dysplasia for total hip arthroplasty. Orthopedics 1996; 19(10):881-7; quiz 8-9.
14. Gaston MS, Gaston P, Donaldson P, et al. A new classification system for the adult dysplastic hip requiring total hip arthroplasty: a reliability study. Hip Int 2009; 19(2):96-101.
15. Hartofilakidis G, Stamos K, Ioannidis TT. Low friction arthroplasty for old untreated congenital dislocation of the hip. J Bone Joint Surg Br 1988; 70(2):182-6.
16. Hartofilakidis G, Stamos K, Karachalios T, et al. Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg Am 1996; 78(5):683-92.
17. Vlamis J, Kavroudakis E, Karabinas P, et al. Classification of DDH in adults using CT imaging. In: Macheras GA, editor. 9th Domestic Meeting of the EUROPEAN HIP SOCIETY; Athens, Greece, 2010; 20(03):p. 367.
18. Hartofilakidis G, Babis GC, Lampropoulou-Adamidou K. Congenital Hip Disease: General Aspects, Terminology and Classification. Congenital Hip Disease in Adults: Springer-Verlag Italia; 2014. p. 11-27.
19. Karachalios T, Hartofilakidis G. Congenital hip disease in adults: terminology, classification, pre-operative planning and management. J Bone Joint Surg Br 2010; 92(7):914-21.
20. Browning WH, Rosenkrantz H, Tarquinio T. Computed tomography in congenital hip dislocation. The role of acetabular anteversion. J Bone Joint Surg Am 1982; 64(1):27-31.
21. Buckley SL, Sponseller PD, Magid D. The acetabulum in congenital and neuromuscular hip instability. J Pediatr Orthop 1991; 11(4):498-501.
22. Kim SS, Frick SL, Wenger DR. Anteversion of the acetabulum in developmental dysplasia of the hip: analysis with computed tomography. J Pediatr Orthop 1999; 19(4):438-42.
23. Edelson JG, Hirsch M, Weinberg H, et al. Congenital dislocation of the hip and computerised axial tomography. J Bone Joint Surg Br 1984; 66(4):472-8.
24. Gugenheim JJ, Gerson LP, Sadler C, et al. Pathologic morphology of the acetabulum in paralytic and congenital hip instability. J Pediatr Orthop 1982; 2(4):397-400.
25. Murphy SB, Kijewski PK, Millis MB, et al. Acetabular dysplasia in the adolescent and young adult. Clin Orthop Relat Res 1990; (261):214-23.
26. Johnston CE, 2nd, Wenger DR, Roberts JM, et al. Acetabular coverage: three-dimensional anatomy and radiographic evaluation. J Pediatr Orthop 1986; 6(5):548-58.
27. Crockarell J, Jr., Trousdale RT, Cabanela ME, et al. Early experience and results with the periacetabular osteotomy. The Mayo Clinic experience. Clin Orthop Relat Res 1999; (363):45-53.
28. Ganz R, Klaue K, Vinh TS, et al. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res 1988; (232):26-36.
29. Hussell JG, Rodriguez JA, Ganz R. Technical complications of the Bernese periacetabular osteotomy. Clin Orthop Relat Res 1999; (363):81-92.
30. Myers SR, Eijer H, Ganz R. Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop Relat Res 1999; (363):93-9.
31. Rab GT. Biomechanical aspects of Salter osteotomy. Clin Orthop Relat Res 1978; (132):82-7.
32. Rab GT. Containment of the hip: a theoretical comparison of osteotomies. Clin Orthop Relat Res 1981; (154):191-6.
33. Salter RB. Role of innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip in the older child. J Bone Joint Surg Am 1966; 48(7):1413-39.
34. Tachdjian MO. Salter’s innominate osteotomy to detorate the maldirected acetabulum. In: Tachdjian MO, editor. Congenital dislocation of the hip: New York: Churchill Livingstone; 1982. p. 525-41.
35. Dora C, Mascard E, Mladenov K, et al. Retroversion of the acetabular dome after Salter and triple pelvic osteotomy for congenital dislocation of the hip. J Pediatr Orthop B 2002; 11(1):34-40.
36. Sugano N, Noble PC, Kamaric E, et al. The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg Br 1998; 80(4):711-9.
37. Liu S, Zuo J, Li Z, et al. Study of three-dimensional morphology of the proximal femur in developmental adult dysplasia of the hip suggests that the on-shelf modular prosthesis may not be an ideal choice for patients with Crowe type IV hips. Int Orthop 2017; 41(4):707-13.
38. Xu H, Zhou Y, Liu Q, et al. Femoral morphologic differences in subtypes of high developmental dislocation of the hip. Clin Orthop Relat Res 2010; 468(12):3371-6.
39. Sanchez-Sotelo J, Trousdale RT, Berry DJ, et al. Surgical treatment of developmental dysplasia of the hip in adults: I. Nonarthroplasty options. J Am Acad Orthop Surg 2002; 10(5):321-33.
40. Ganz R, Klaue K, Vinh TS, et al. A new periacetabular osteotomy for the treatment of hip dysplasias: technique and preliminary results. 1988. Clin Orthop Relat Res 2004; (418):3-8.
41. Hartofilakidis G, Babis GC, Georgiades G, et al. Trochanteric osteotomy in total hip replacement for congenital hip disease. J Bone Joint Surg Br 2011; 93(5):601-7.
42. Lakstein D, Backstein DJ, Safir O, et al. Modified trochanteric slide for complex hip arthroplasty: clinical outcomes and complication rates. J Arthroplasty 2010; 25(3):363-8.
43. Ollivier M, Abdel MP, Krych AJ, et al. Long-Term Results of Total Hip Arthroplasty With Shortening Subtrochanteric Osteotomy in Crowe IV Developmental Dysplasia. J Arthroplasty 2016; 31(8):1756-60.
44. Mu W, Yang D, Xu B, et al. Midterm Outcome of Cementless Total Hip Arthroplasty in Crowe IV-Hartofilakidis Type III Developmental Dysplasia of the Hip. J Arthroplasty 2016; 31(3):668-75.
45. Karachalios T, Roidis N, Lampropoulou-Adamidou K, et al. Acetabular reconstruction in patients with low and high dislocation: 20- to 32-year survival of an impaction grafting technique (named cotyloplasty). Bone Joint J 2013; 95-B(7):887-92.
46. Hartofilakidis G, Georgiades G, Babis GC, et al. Evaluation of two surgical techniques for acetabular reconstruction in total hip replacement for congenital hip disease: results after a minimum ten-year follow-up. J Bone Joint Surg Br 2008; 90(6):724-30.
47. Malizos KN, Bargiotas K, Papatheodorou L, et al. Survivorship of monoblock trabecular metal cups in primary THA : midterm results. Clin Orthop Relat Res 2008; 466(1):159-66.
48. Dorr LD, Tawakkol S, Moorthy M, et al. Medial protrusio technique for placement of a porous-coated, hemispherical acetabular component without cement in a total hip arthroplasty in patients who have acetabular dysplasia. J Bone Joint Surg Am 1999; 81(1):83-92.
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