Congenital Hip Dislocation

Congenital Hip

Dislocation

Introduction• THA in the DDH

patient presents a difficult challenge to the reconstructive hip surgeon

Introduction• Mild dysplastic

hips (Crowe I and II) usually have adequate bone stock and can accept standard components

Crowe I Crowe II

Introduction

Crowe III Crowe IV

Introduction• Crowe III and IV

dysplastic hips can be difficult to reconstruct and have the potential for more intra-operative and postoperative complications

Introduction• Surgical Options are Numerous:

? High Hip Center? Controlled Protusio? Structural Grafting? Specialized Components (e.g. Custom)? Oblong Cups? Cementation and/or Cemented Cups

Each has potential problems

Study Aim

• The aim of the current study is to present our midterm results after primary THA in DDH (Crowe III and IV) patients

Study Design• Between 1990 to 2000 twenty -nine (29)

cementless primary THA were performed in 24 patients(Crowe III and IV DDH patients)

• 17 Female and 7 Male

• Five pts had staged bilateral THA

Study Design• Average pt age = 49.5 yrs

• 48% were Crowe III

• 52% were Crowe IV

• Average Follow-up was 5.5 years

Technique• All surgeries were

performed through a posterior approach

• Acetabular Reaming routinely resulted in medial and superior placement of a standard cup.

Results• No

structural allografts were utilized during acetabular preparation

• Average Cup Size = 51 mm Range (42mm to 66 mm)

• Average Stem Size = 12.0 mm

Range (9.0mm to 16.5 mm)

• Average Head Size = 28 mm Range (22mm to 32 mm)

Results

****Note that these are standard implant sizes

Results• 21% (6 pts)

required a shortening osteotomy

• All were type IV

Complications• Dislocations - 6.8% (2 pts)

• (both eventually required conversion to a captured liner)

• Aseptic Poly Wear - 13.8% (4 pts) • one required revision

Complications• Symptomatic H.O. - 3.4% (1 pt)

(Booker III, no surgery was required)

• No Sciatic or Femoral Nerve complications

PMPre

PMOR

PM14 days

PMPost 2

PM18 mths

MCPre

MCPost

MC3yr

JG5yrs.

JGPre

Conclusions• Crowe III and IV dysplastic hips can be

routinely done without the use of structural allograft

• Total Hip Arthroplasty (Crowe III/IVpts) can be routinely performed without the need for specialized components

Conclusions• Complications were low in

this series

No Femoral or Sciatic Nerve Complications were observed

Dislocation rate of 6.8%Only one poly exchange at

5.5 yrs

Conclusions• A Femoral Osteotomy is rarely required

in Crowe III pts and only occasionally in Crowe IV pts

• A Femoral Osteotomy was required in 6 Crowe IV pts (21%) No Crowe III pts required a femoral osteotomy (in this series)

Conclusions• Primary Total Hip Arthroplasty can be

safely perfomed without the use of structural acetabular allograft in Crowe III/IV pts

• Standard components can be utilized in a majority of cases and lesson the need for smaller “specialized” implants