Congenital HipDislocation
Introduction• THA in the DDH
patient presents a difficult challenge to the reconstructive hip surgeon
Introduction• Mild dysplastic
hips (Crowe I and II) usually have adequate bone stock and can accept standard components
Crowe I Crowe II
Introduction
Crowe III Crowe IV
Introduction• Crowe III and IV
dysplastic hips can be difficult to reconstruct and have the potential for more intra-operative and postoperative complications
Introduction• Surgical Options are Numerous:
? High Hip Center? Controlled Protusio? Structural Grafting? Specialized Components (e.g. Custom)? Oblong Cups? Cementation and/or Cemented Cups
Each has potential problems
Study Aim• The aim of the current
study is to present our midterm results after primary THA in DDH (Crowe III and IV) patients
Study Design• Between 1990 to 2000 twenty -nine (29)
cementless primary THA were performed in 24 patients(Crowe III and IV DDH patients)
• 17 Female and 7 Male
• Five pts had staged bilateral THA
Study Design• Average pt age = 49.5 yrs
• 48% were Crowe III
• 52% were Crowe IV
• Average Follow-up was 5.5 years
Technique• All surgeries were
performed through a posterior approach
• Acetabular Reaming routinely resulted in medial and superior placement of a standard cup.
Results• No
structural allografts were utilized during acetabular preparation
• Average Cup Size = 51 mm Range (42mm to 66 mm)
• Average Stem Size = 12.0 mm
Range (9.0mm to 16.5 mm)
• Average Head Size = 28 mm Range (22mm to 32 mm)
Results
****Note that these are standard implant sizes
Results• 21% (6 pts)
required a shortening osteotomy
• All were type IV
Complications• Dislocations - 6.8% (2 pts)
• (both eventually required conversion to a captured liner)
• Aseptic Poly Wear - 13.8% (4 pts) • one required revision
Complications• Symptomatic H.O. - 3.4% (1 pt)
(Booker III, no surgery was required)
• No Sciatic or Femoral Nerve complications
PMPre
PMOR
PM14 days
PMPost 2
PM18 mths
MCPre
MCPost
MC3yr
JG5yrs.
JGPre
Conclusions• Crowe III and IV dysplastic hips can be
routinely done without the use of structural allograft
• Total Hip Arthroplasty (Crowe III/IVpts) can be routinely performed without the need for specialized components
Conclusions• Complications were low in
this series
No Femoral or Sciatic Nerve Complications were observed
Dislocation rate of 6.8%Only one poly exchange at
5.5 yrs
Conclusions• A Femoral Osteotomy is rarely required
in Crowe III pts and only occasionally in Crowe IV pts
• A Femoral Osteotomy was required in 6 Crowe IV pts (21%) No Crowe III pts required a femoral osteotomy (in this series)
Conclusions• Primary Total Hip Arthroplasty can be
safely perfomed without the use of structural acetabular allograft in Crowe III/IV pts
• Standard components can be utilized in a majority of cases and lesson the need for smaller “specialized” implants