Lessons learned from study of congenital hip disease in adults

Abstract

Orthopaedic surgeons specialising in adult hip reconstruction surgery often face the problem of osteoarthritis secondary to congenital hip disease (CHD). To achieve better communication among physicians, better treatment planning and evaluation of the results of various treatment options, an agreed terminology is needed to describe the entire pathology. Furthermore, a generally accepted classification of the deformities is necessary. Herein, the authors propose the use of the term “congenital hip disease” and its classification as dysplasia, low dislocation and high dislocation. Knowledge of the CHD natural history facilitates comprehension of the potential development and progression of the disease, which differs among the aforementioned types. This can lead to better understanding of the anatomical abnormalities found in the different CHD types and thus facilitate preoperative planning and choice of the most appropriate management for adult patients. The basic principles for improved results of total hip replacement in patients with CHD, especially those with low and high dislocation, are: Wide exposure, restoration of the normal centre of rotation and the use of special techniques and implants for the reconstruction of the acetabulum and femur. Application of these principles during total hip replacement in young female patients born with severe deformities of the hip joint has led to radical improvement of their quality of life.

Introductory Chapter: Five-Dimensional Approach to the Developmental Dysplasia of the Hip

“…As for the cohort of non-recovering hips, it has been observed that DDH leads to significant loss of normal joint function [71]. Dysplastic hips have tendency to evolve over years into painful and debilitating osteoarthritis [72][73][74], while dislocated hips are accompanied with short posture and waddling gait throughout life, and if not reduced operatively within the first 8 years, painful syndrome may eventually develop [59,75]. In patients with untreated unilateral dislocation, pelvic obliquity deteriorates the distribution of hip force on contralateral hip joint, contributing to degeneration on that side as well, along with further compensatory dysfunctions of trunk and knees [11].…”

Total Hip Arthroplasty for Developmental Dysplasia of Hip vs Osteoarthritis: A Propensity Matched Pair Analysis

“…Developmental dysplasia of hip (DDH) is a spectrum of disease that comprises one of the leading causes of secondary degenerative osteoarthritis (OA) [ 5 ] and is associated with a variety of pathomorphologies, such as congenital hip dysplasia and pelvic malformation that can distort anatomy leading to a more technically demanding surgery at the time of THA [ 6 , 7 ]. Although some studies have shown satisfactory long-term results [ [8] , [9] , [10] ], other studies have suggested higher failure rates [ 11 ] or worse clinical outcomes [ 12 ] when THA is performed for DDH as opposed to primary OA.…”

Studying the Effects of Using Two Types of Afos on the Hip Joint Kinematics and Kinetics during Walking in the Sagittal Plane for a Patient with Severe DDH; Part 1

“…However, there is a huge number of DDH adult patients who had no treatment at their early age. Patients with untreated DDH are closely facing long-term morbidities such as avascular necrosis of the femoral head, degenerative hip osteoarthritis (OA), muscular fatigue and chronic pain, and specifically gait deviations [5]- [9]. Gait analysis is commonly performed to assess the walking patterns in different patients including study the kinematics and kinetics of the lower limb in all three planes Sagittal, frontal and transverse [10]- [12].…”