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

Results 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) ****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

PM Pre

PM 14 days PM OR

PM Post 2 PM 18 mths

MC Pre MC Post MC 3yr

JG 5yrs. JG Pre

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