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Surgical Treatment of Developmental Dysplasia of the Hip in Adults: II. Arthroplasty Options

Dr. Sanchez-Sotelo is Special Fellow, Adult Reconstruction, Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN. Dr. Berry is Consultant, Department of Orthopaedic Surgery, Mayo Clinic, and Associate Professor, Department of Orthopaedic Surgery, Mayo Medical School. Dr. Trousdale is Consultant, Department of Orthopaedic Surgery, Mayo Clinic, and Associate Professor, Department of Orthopaedic Surgery, Mayo Medical School. Dr. Cabanela is Consultant, Department of Orthopaedic Surgery, Mayo Clinic, and Professor, Department of Orthopaedic Surgery, Mayo Medical School.

Reprint requests: Dr. Berry, 200 First Street SW, Rochester, MN 55905.

Total hip arthroplasty is the procedure of choice for most patients with symptomatic end-stage coxarthrosis secondary to hip dysplasia. The anatomic abnormalities associated with the dysplastic hip increase the complexity of hip arthroplasty. When pelvic bone stock allows, it is desirable to reconstruct the socket at or near the normal anatomic acetabular location. To obtain sufficient bony coverage of the acetabular component, the socket can be medialized or elevated, or a lateral bone graft can be applied. Uncemented acetabular components allow biologic fixation with potentially improved results compared with cemented cups, especially in young patients. The location of the acetabular reconstruction and the desired leg length influence the type of femoral reconstruction. Cemented and uncemented implants can be used in femoral reconstruction, depending on the clinical situation. Femoral shortening is required in some cases and can be performed by metaphyseal resection with a greater trochanteric osteotomy and advancement or by a shortening subtrochanteric osteotomy. The results of total hip arthroplasty demonstrate a high rate of pain relief and functional improvement. The long-term durability of cemented total hip arthroplasty reconstruction in these patients is inferior to that in the general population. The results of uncemented implants are promising, but only limited early and midterm data are available.

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