Untreated congenital and posttraumatic high dislocation of the hip treated by replacement in adult age22 hips in 16 patients followed for 18 years

Hip Arthroplasty in Highly Dislocated Hips

“…The joint capsule is elongated, inelastic and thickened, while the surrounding muscles are without any strength, shortened and grown to the capsule. The neurovascular structures are shortened and dislocated from their anatomic positions (Carrlson et al, 2003;Holinka et al, 2010;Paavilainen et al, 1990). In the past there were numerous unsuccessful attempts to perform total hip arthroplasty in adults at the location of high luxation caused by developmental disorder.…”

“…This is the only way to expect good joint function, being the only mode to establish the physiological distance between the ends of the muscular initiators of hip motion, thus enabling their full strength. However, there is no full agreement as to the preparation and positioning of the proximal femur at the required level of the primary acetabulum (Carrlson et al, 2003;Crowe et al, 1979;Dunn & Hess, 1976;Eskelinen et al, 2006;Hartofilakidis et al, 1996Hartofilakidis et al, , 1998Hartofilakidis et al, , 2004Holinka et al, 2010;Lai et al, 1996Lai et al, , 2005Paavilainen et al, 1990). Many surgical techniques have been described by authors discussing the type and modes of femoral abbreviation osteotomies.…”

“…Arthroplasty is to follow as a new operative technique, where the entire operative procedure is performed in two acts. (Carrlson et al, 2003;Eskelinen et al, 2006;Hartofilakidis et al, 1996;Holinka et al, 2010;Lai et al, 1996Lai et al, , 2005Paavilainen et al, 1990).…”

“…In the literature it was described by Lai et al in 1996 and2005, and then by Holinka et al in 2010(Carrlson et al, 2003Eskelinen et al, 2006;Holinka et al, 2010;Lai et al, 1996Lai et al, , 2005. The leading idea of this surgical procedure is based on the hypothesis that operative procedures with femoral abbreviation osteotomies, regardless of the type, could generally leave a considerable leg-length discrepancy, as well as muscular weakness of hip motion starters.…”

“…The principles of total arthroplasty with positioning of the acetabular ring into the paleoacetabulum and the stem in the femoral channel are standard. (Carrlson et al, 2003;Holinka et al, 2010;Lai et al, 1996Lai et al, , 2005Paavilainen et al, 1990). Such a surgical procedure is very complicated and requires long-term hospitalization and inactivity of the patient.…”