- See:
Total Hip Replacement Menu:
- Discussion:
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natural history of DDH:
- acetabular rim syndrome:
- results from dysplastic hip, which stresses the labrum, resulting in labral degeneration;
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hip arthroscopy and debridement in these patients may provide the patient w/ a few additional years before total hip arthroplasty is required;
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THR p
reoperative considerations:
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center edge angle
- note that
revision THR shares many of the problems encountered with the dysplastic hip;
- when the hip is located in the native acetabulum, the acetabulum is often shallow, abducted, and significantly anteverted;
- soft tissue adaptive changes may include hyperlordosis, adduction contracture, and leg length descrepancy;
- risk of component dislocation may be especially prevalent in these patients;
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considerations for alternative procedures:
- in patients less than 45-50 yrs, alternative procedures should always be considered;
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pelvic osteotomy in DDH: (
Chiari, Shelf,
Ganz, and Penberton osteotomies are considered);
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femoral osteotomy in DDH
- Crowe Classification: (
Paprosky classification)
- Technical Considerations for the Acetabulum:
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acetabular component menu:
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bone grafting for THR:
- autogenous femoral head grafting for anterolateral acetabular deficiency:
- in the report by MJ. Spangehl et al, 44 hips in 35 patients w/ DDH were treated with primary THR with use of
an uncemented porous-coated titanium cup fixed with screws and an autogenous bulk femoral head graft;
- patients were followed clinically in a prospective fashion for five to 12.3 years and radiographs were analyzed retrospectively;
- four acetabular components were revised: two, because of severe polyethylene wear and osteolysis
one, because of aseptic loosening; and one, because of fracture of the acetabular shell;
- 43 of the 44 hips had no radiographic evidence of resorption of the graft or had radiographic evidence
of resorption limited to the nonstressed area of the graft lateral to the edge of the cup;
- references:
- Uncemented Acetabular Components with Bulk Femoral Head Autograft for Acetabular Reconstruction in Developmental Dysplasia
of the Hip Results at Five to Twelve Years. MJ. Spangehl, MD JBJS (Am) 83:1484-1489 (2001)
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Total Hip Replacement with the CLS Expansion Shell and a Structural Femoral Head Autograft for Patients with Congenital Hip Disease.
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Total Hip Arthroplasty with Cement and without Acetabular Bone Graft for Severe Hip Dysplasia.
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acetabular component position:
- key question is whether to place acetabulum cup in an anatomic (inferior) or a non-anatomic (superior) position;
- where there is the greatest bone stock so that the osseous coverage of the acetabulum can be optimized;
- how much shortening of the femur is required;
- up to 4 cm of lengthening is usually safe;
- it is impotant to template how much femoral shortening will be required to avoid maximal lengthening;
- note the tension on the nerve both at the beginning and the end of the case;
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anatomic position:
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non-anatomic positioning: (high hip center)
- ref:
Outcome of revision hip arthroplasty in patients with a previous total hip replacement for developmental dysplasia of the hip.
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cotyloplasty technique / medial protrusio technique:
- cotyloplasty technique: by
G. Hartofilakidis M.D. et al. (JBJS 1996)
- technique creates a controlled comminuted fracture of the medial wall which allows for medialization of the cup;
- acetabulum is reamed w/ small reamers;
- rearmers are direted postero-superiorly to avoid the thin anterior column;
- reaming progresses until the outer surface of the inner wall is reached;
- using osteotomes, create a controlled fracture of the thin medial wall, but care is taken not to perforate the inner layer of periosteum;
- autogenous cancellous graft is then sandwhiched against the medial wall;
- the bone graft and medial acetabular wall are then pushed inward;
- the acetabular component is then cemented into place;
- ref:
Treatment of High Dislocation of the Hip in Adults with THA. Operative Technique and Long-Term Clinical Results
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medial protrusio technique:
- medial wall of a dysplastic acetabulum is intentionally perforated to allow coverage of the acetabular component without bone-graft support;
- results in placement of the medial aspect of the dome of the acetabular component medial to the Kohler line;
- references:
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Acetabular Cup Revision With the Use of the Medial Protrusio Technique at an Average Follow-up of 6.6 Years.
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Medial Protrusio Technique for Placement of a Porous-Coated Acetabular Component w/o Cement in a THR in Patients Who Have Acetabular Dysplasia.
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Total hip reconstruction in chronically dislocated hips.
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Total hip arthroplasty in chronically dislocated hips. Follow-up study on the protrusio socket technique.
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Acetabular Medial Wall Displacement Osteotomy in THR. A Technique to Optimize the Acetabular Reconstruction in Acetabular Dysplasia
- Technical Considerations of the Femur in DDH: 
- significant anteversion of the femoral neck;
- w/ more than 40 deg of anteversion, consider derotation with subtrochanteric osteotomy;
- femoral medullary canal is narrow;
- this may be managed by splitting the proximal 8-10 cm of the femoral shaft both anteriorly and posteriorly and then establishing
rigid fixation after the stem has been inserted;
- medullary canal may be distorted from previous osteotomies (in which case a subtrochanteric osteotomy may be required);
- short femoral neck;
- distorsion of proximal femoral shape from previous osteotomies;
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leg length descrepancy:
- significant leg length descrepancy is seen in high dislocations;
- attempts at leg length equalization may result in sciatic neuropraxia;
- as pointed out by, Kavanagh et al 1991, no patients that had leg lengthing of less than 4 cm developed a palsy;
- when lengthening was more than 4 cm, 28% of patients developed a palsy;
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femoral shortening
- may be performed by proximal shortening or by subtroch osteotomy (step cut or oblique subtrochanteric osteotomy);
- proximal shortening is not be performed distal to the lesser trochanter because there is not be enough of a
metaphyseal flare left to support the femoral implant;
Femoral head autografting with total hip arthroplasty for lateral acetabular dysplasia. A 12-year experience.
Coxarthrosis after congenital dysplasia. Treatment by total hip arthroplasty without acetabular bone-grafting.
Custom-Designed Femoral Prostheses in Total Hip Arthroplasty Done with Cement for Severe Dysplasia of the Hip.
Total hip replacement for coxarthrosis secondary to congenital dysplasia and dislocation of the hip. Long-term results.
Double-chevron subtroch shortening derotational femoral osteotomy combined w/ THR for the treatment of complete CDH in the adult.
Bateman bipolar hips with autologous bone graft reinforcement for dysplastic acetabula.
Modular noncemented total hip arthroplasty for congenital dislocation of the hip. Case report and design rationale.
Modular noncemented total hip arthroplasty for congenital dislocation of the hip. Case report and design rationale.
Coxarthrosis after congenital dysplasia. Treatment by total hip arthroplasty without acetabular bone-grafting.
Long-Term Results of Total Hip Arthroplasty in Congenital Dislocation and Dysplasia of the Hip. A Follow-Up Note.
Treatment of osteoarthrosis secondary to congenital dislocation of the hip. Primary cemented surface replacement compared with conventional total hip replacement.
Autogenous bone grafting from the femoral head for treatment of acetabular deficiency in primary total hip arthroplasty with cement: Long term results.
JA Rodriquez et al. JBJS 77-A. 1995. p 1227-1233.
Arthroplasty in high congenital dislocation: 21 hips with minimum 5 years follow up. H. Fredin et al. JBJS 76-B. p 735-739.
THR coxarthrosis secondary to congenital dysplasia and dislocation of the hip. Long Term Results. JR MacKenzie et al. JBJS Vol 78-A. No 1. Jan 1996. p 55.
Total Hip Arthroplasty for Congenital Hip Disease.
Cementless Acetabular Reconstruction and Structural Bone-Grafting in Dysplastic Hips. /
JBJS Surgical Technique:
