An Attempt to Throw Light on Congenital Hip Disease Terminology and Anticipation of Clinical Outcomes when Treated with Total Hip Arthroplasty

Abstract

The terminology of the wide spectrum of hip deformities seen during the neonatal, infantile and adult life period remains controversial, mainly due to the indiscriminate use of the terms dysplasia, subluxation, congenital hip disease, developmental hip disease, congenital dislocation, etc. This has a serious implication on the anticipation of clinical outcomes, complications and comparison of different reconstructive techniques when these patients are treated with total hip arthroplasty in adulthood. Journals, specialising in this field, should publish homogeneous series (type of the disease, reconstruction technique, implants) in order to clarify arguments and anticipate clinical outcomes.

Congenital Hip Dislocation with a Genu Recurvatum in Togo: A Case Report

“…Due to the fact that different reconstructive challenges are addressed in each type of the disease. Moreover, different techniques and implants are used, making the comparative evaluation of the results a difficult task [18].…”

Cementless modular total hip arthroplasty with subtrochanteric transverse shortening osteotomy for high hip dislocations

“…Indeed, appropriate evaluation of the hip bone structure and proper implant selection are critical to successful outcomes [ 1 – 3 ]. The difficulties in identifying and preparing the acetabulum and achieving stable fixation of the acetabular component are well described in the literature [ 1 , 4 – 8 ]. When considering the femur, the most notable morphological variations are excessive femoral anteversion and a high valgus neck-shaft angle that reduces acetabular coverage of the femoral head [ 1 ].…”

“…A key component of acetabular reconstruction is the restoration of the anatomical hip center, with reduction of the femoral head into the true acetabulum being important in achieving better hip biomechanics and bone support for implantation, as well as longer THA survival [ 3 , 4 , 10 ]. However, achieving and maintaining reduction of the femoral head into the true acetabulum is difficult in patients with high hip dislocations due to severe soft tissue contracture, leg length discrepancy, impairment in abductor muscle function, and abnormal bone morphology [ 10 ].…”

“…In these cases, achieving rotational stability and compression at the osteotomy site is essential in preventing non-union [ 14 ]. However, obtaining a straight femoral canal and selecting the appropriate fit and fill implant is difficult using mono-block femoral implants [ 4 ]. Fitting of the femoral implant is further complicated by the sub-trochanteric osteotomy itself, which produces incongruence between the diameters of the metaphyseal and diaphyseal canals, increasing the risk for non-union [ 4 , 15 – 18 ].…”

Reply to the comment on the editorial “An attempt to throw light on congenital hip disease terminology and anticipation of clinical outcomes when treated with total hip arthroplasty” made by Denisov A

“…We have read the comments made by Denisov A and colleagues related to our editorial with great interest. 1,2 The authors are correct in stating that classification of the different types of congenital hip disease is sometimes difficult and that further sub-division is needed. For this reason, we have already described sup-types of low and high dislocation hips 3 for the validated Hartofilakis classification.…”