Current concept in dysplastic hip arthroplasty: Techniques for acetabular and femoral reconstruction

Abstract

Adult patients with developmental dysplasia of the hip develop secondary osteoarthritis and eventually end up with total hip arthroplasty (THA) at younger age. Because of altered anatomy of dysplastic hips, THA in these patients represents technically demanding procedure. Distorted anatomy of the acetabulum and proximal femur together with conjoined leg length discrepancy present major challenges during performing THA in patients with developmental dysplasia of the hip. In addition, most patients are at younger age, therefore, soft tissue balance is of great importance (especially the need to preserve the continuity of abductors) to maximise postoperative functional result. In this paper we present a variety of surgical techniques available for THA in dysplastic hips, their advantages and disadvantages. For acetabular reconstruction following techniques are described: Standard metal augments (prefabricated), Custom made acetabular augments (3D printing), Roof reconstruction with vascularized fibula, Roof reconstruction with pedicled iliac graft, Roof reconstruction with autologous bone graft, Roof reconstruction with homologous bone graft, Roof reconstruction with auto/homologous spongious bone, Reinforcement ring with the hook in combination with autologous graft augmentation, Cranial positioning of the acetabulum, Medial protrusion technique (cotyloplasty) with chisel, Medial protrusion technique (cotyloplasty) with reaming, Cotyloplasty without spongioplasty. For femoral reconstruction following techniques were described: Distraction with external fixator, Femoral shortening through a modified lateral approach, Transtrochanteric osteotomies, Paavilainen osteotomy, Lesser trochanter osteotomy, Double-chevron osteotomy, Subtrochanteric osteotomies, Diaphyseal osteotomies, Distal femoral osteotomies. At the end we present author's treatment method of choice: for acetabulum we perform cotyloplasty leaving only paper-thin medial wall, which we break during acetabular cup impacting. For femoral side first we peel of all rotators and posterior part of gluteus medius and vastus lateralis from greater trochanter on the very thin flake of bone. This method allows us to adequately shorten proximal femoral stump, with possibility of additional resection of proximal femur. Furthermore, several advantages and disadvantages of this procedure are also discussed.

Transverse Subtrochanteric Shortening Osteotomy During Cementless Total Hip Arthroplasty in Crowe Type-III or IV Developmental Dysplasia

“…Various techniques using different anatomic levels and cutting shapes have been described. Anatomic levels are greater trochanter, subtrochanteric region of the proximal femoral metaphysis, and distal femur [10][11][12]. Subtrochanteric osteotomies can be performed as transverse, oblique, Z-shaped, or double Chevron [7,8,[13][14][15][16].…”

Total hip arthroplasty in an adult patient with pelvic dysmorphism, unilateral sacroiliac joint autofusion, and developmental hip dysplasia

“…Developmental dysplasia of the hip (DDH) encompasses a spectrum of altered hip anatomy that often consists of an underdeveloped acetabulum, uncovered or dislocated femoral head, and acetabular retroversion [1]. Furthermore, additional deformities include a dysplastic femur with increased anteversion, a shorter femoral neck, and an elliptic femoral head [1]. These structures and subsequent altered biomechanics are thought to contribute to accelerated degeneration of the dysplastic hip joint [1,2].…”

“…Furthermore, additional deformities include a dysplastic femur with increased anteversion, a shorter femoral neck, and an elliptic femoral head [1]. These structures and subsequent altered biomechanics are thought to contribute to accelerated degeneration of the dysplastic hip joint [1,2]. A subset of these patients ultimately requires total hip arthroplasty (THA) due to the long-term sequelae of untreated DDH.…”

Challenges and outcome of total hip arthroplasty in patients with developmental dysplasia of the hip: a clinical series with a spectrum of disease manifestation and technical notes

“…Koulouvaris et al reported in 2008 an interesting combined procedure where distal femoral shortening procedure was performed as an addition to THR of dysplastic and difficult-to-reduce hips. 48,49 One of the major advantages of this technique is the possibility of combined correction of the ipsilateral knee valgus deformity, which can be performed simply by changing the shape of resection fragment.…”