Preoperative Planning for Total Hip Arthroplasty for Neglected Developmental Dysplasia of the Hip

Abstract

Developmental dysplasia of the hip (DDH) is accompanied by morphological alterations on both the acetabular and the femoral side. Total hip arthroplasty (THA) provides effective treatment in cases of neglected DDH but requires elaborate preoperative planning. To determine the morphological changes resulting from the dysplasia, the anatomic acetabular position, the height of the femur head dislocation, the height of the femur head dislocation, and the combined anteversion must all be established. In addition, a vital and complicated process of strategizing leg length balance must be conducted in cases of severe DDH. Each type of leg length discrepancy (LLD), including bony and functional and anatomical LLD, should be evaluated in the context of the presence or absence of a fixed pelvic tilt. Moreover, with severe unilateral dislocated hips, a more inferior change in the original rotational center of the hip must be accounted for. Due to these multiple morphological changes, the accurate size of the prosthesis and the cup position are difficult to predict. In comparison with other methods, CT scan‐based 3‐dimensional templating provides the best accuracy. Despite the presence of anatomic alterations, various types of acetabular and femoral prostheses have been developed to treat hip dysplasia. Both cemented and cementless cups are used in DDH cases. In DDH accompanied by insufficient acetabular bone stock, a cemented cup combined with bone graft provides a reliable treatment. Monoblock stems can be used when the combined anteversion is less than 55°, and a modular stem system when this parameter is greater than 55°. Customized stems can be designed for DDH coupled with severe proximal femoral distortion. A ceramic‐on‐ceramic bearing is considered optimal for young DDH patients.

One‐Stage Total Hip Arthroplasty with Modular S‐ROM Stem for Patients with Bilateral Crowe Type IV Developmental Dysplasia

“…Total hip arthroplasty for high‐riding DDH is a challenging and technically demanding procedure for surgeons in cases of acetabular and femoral morphologic abnormalities 7, 21 . Using one‐stage THA for bilateral coxarthritis is enticing because it reduces the length of hospital stay as well as costs, and patients recover quickly.…”

Total Hip Arthroplasty for Crowe Type IV Hip Dysplasia: Surgical Techniques and Postoperative Complications

“…After THA, the mean femur, acetabular, and combined anterversion extents were 17.9° ± 2.9°, 31.2° ± 2.5°, and 49.2° ± 2.6°. No dislocations occurred during 12 months of follow up. The main complications that occur following application of an anatomic hip center technique are summarized in Table .…”

Controlled fracture of the medial wall versus structural autograft with bulk femoral head to increase cup coverage by host bone for total hip arthroplasty in osteoarthritis secondary to developmental dysplasia of the hip: a retrospective cohort study

“…For patients without excessive femoral anteversion and narrow medullary cavity, monobloc stem can act as an alternative technique. And many studies have reported similar results [6][7][8]. But for the distorted acetabulum especially DDH Crowe II/III, it always manifests with pathomorphologic changes including shallow true acetabulum, formation of a neoacetabulum, and superolateral bony deficiency [1,[9][10][11], all of which make it more complicated and technically demanding to balance acetabular reconstruction at the anatomical location and rate of cup coverage by host bone [12,13].…”