Congenital hip disease in adults

Abstract

This paper reviews the current knowledge relating to the management of adult patients with congenital hip disease. Orthopaedic surgeons who treat these patients with a total hip replacement should be familiar with the arguments concerning its terminology, be able to recognise the different anatomical abnormalities and to undertake thorough pre-operative planning in order to replace the hip using an appropriate surgical technique and the correct implants and be able to anticipate the clinical outcome and the complications.

The Effect of Dislocation Type (Crowe Types I–IV) on Pelvic Development in Developmental Dysplasia of the Hip

“…In our study, the mean change in the acetabular area distally was 5 mm in Crowe type II hips, 8 mm in type III hips, and 11 mm in type IV hips. In patients with DDH, a leg-length discrepancy occurs along with soft-tissue contractures [12][13][14].…”

Lessons learned from study of congenital hip disease in adults

“…High dislocation was subdivided into C1 and C2 subtypes, depending on the presence or the absence of a false acetabulum, respectively (Figures 3 and 4). The lesson learned by using this classification system is that “better comprehension of the pathologic anatomy and the specific characteristics of these hips, makes their THR reconstruction easier and more successful”[1-9]. …”

“…If this is not feasible, the cotyloplasty technique is an effective alternative. Cotyloplasty involves medialization of the acetabular floor through creation of a comminuted fracture of the entire medial wall, impaction of autogenous cancellous morselized bone grafts and implantation of a small, all-polyethylene (PE) implant, usually the offset-bore acetabular cup (Figure 9)[3,9,14]. The main mechanical advantage of this technique is that the weight-bearing area is allowed to shift to beneath the acetabular roof, while adequate anterior and posterior coverage of the cup is achieved.…”

“…Although the short-term results of this technique were excellent, a high failure rate after approximately 12 years has been reported[19]. This may be related to the complex pathological anatomy encountered at the level of the true acetabulum and the abnormal distribution of stresses, combined with the unfavourable long-term biological behaviour of structural grafts[3,9]. …”

“…We argue against leaving the greater trochanter in place and subtrochanteric femoral shortening osteotomy, because, in the majority of hips with high dislocation, the greater trochanter lies above the centre of rotation of the femoral head and its resection and advancement are essential (Figure 10). Besides, subtrochanteric osteotomy resembles an artificial fracture which needs additional osteosynthesis and may subsequently cause undesirable complications[9]. …”