1. Congenital Hip
Dislocation

2. Introduction
THA in the DDH patient presents a difficult challenge to the reconstructive hip surgeon

3. Introduction
Mild dysplastic hips (Crowe I and II) usually have adequate bone stock and can accept standard components
Crowe I
Crowe II

4. Introduction
Crowe III
Crowe IV

5. Introduction
Crowe III and IV dysplastic hips can be difficult to reconstruct and have the potential for more intra-operative and postoperative complications

6. 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

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

8. 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

9. Study Design Average pt age = 49.5 yrs 48% were Crowe III
52% were Crowe IV
Average Follow-up was 5.5 years

10. Technique All surgeries were performed through a posterior approach
Acetabular Reaming routinely resulted in medial and superior placement of a standard cup.

11. Results
No structural allografts were utilized during acetabular preparation

12. 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

13. Results
21% (6 pts) required a shortening osteotomy
All were type IV

14. Complications Dislocations - 6.8% (2 pts)
(both eventually required conversion to a captured liner)
Aseptic Poly Wear % (4 pts)
one required revision

15. Complications Symptomatic H.O. - 3.4% (1 pt)
(Booker III, no surgery was required)
No Sciatic or Femoral Nerve complications

16. PM
Pre

17. PM
14 days PM OR

18. PM
Post 2 PM
18 mths

19. MC
Pre MC
Post MC
3yr

20. JG
5yrs. JG
Pre

21. 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

22. 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

23. 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)

24. 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