Reconstruction of neglected developmental dysplasia by total hip arthroplasty with subtrochanteric shortening osteotomy

Abstract

Patients with neglected developmental dysplasia (DDH) face with early osteoarthritis of the hip, limb length inequality and marked disability while total hip reconstruction is the only available choice.DDH has severe morphologic consequences, with distorted bony anatomy and soft tissue contractures around the hip. It is critical to evaluate patients thoroughly before surgery.Anatomic reconstruction at the level of true acetabulum with uncemented implant is the mainstay of treatment. This requires a subtrochanteric shortening osteotomy, which can be realised using different osteotomy and fixation options.Although a demanding technique with a high rate of related complications, once anatomic reconstruction of the hip is achieved, patients have a remarkably good functional capacity and implant survival during long follow-up periods. Cite this article: Atilla B. Reconstruction of neglected developmental dysplasia by total hip arthroplasty with subtrochanteric shortening osteotomy. EFORT Open Rev 2016;1:65-71. DOI: 10.1302/2058-5241.1.000026.

Keywords: Hip; developmental hip dysplasia; subtrochanteric shortening; total hip arthroplasty.

Fig. 1

A 21-year-old female patient with right hip dysplasia. She had had a previous subtrochanteric femoral valgus support osteotomy at the age of 14 years. Dysplasia is never confined to the hip joint alone but, as in this case, the whole pelvis is hypoplastic and has rotational deformity including soft tissue abnormality.

Fig. 2

Hartofilakidis Classification of Hip Dyspalsia. (Type A) femoral head is within the dysplastic acetabulum. (Type B) part of femoral head is in contact with the acetabulum. (Type C) superiorly dislocated femoral head has no contact with true acetabulum.

Fig. 3

Ranawat’s Triangle: diagram showing Ranawat triangle to determine anatomical hip centre. Height of the isoscheles triangle is one fifth of the measured pelvic height (h).

Fig. 4

Demonstration of the author’s preferred technique of anatomical reconstruction with subtrochanteric osteotomy and uni-cortical plate fixation.

Fig. 5

A 54-year-old female patient presenting with bilateral deformity. She had received bilateral hip prosthesis nine months apart; 11 years after the index procedure she has maintained good function and a stable posture.

Fig. 6

Joint kinematics from hip, knee and ankle joints. The positive values of the vertical axis correspond to the flexion and adduction in the hip, flexion and varus in the knee, and dorsiflexion and in-toeing of the ankle. A continuous line in the graphs indicates a normal average, and dotted lines indicate patient status. a), b): pre-operative gait analysis; c), d): post-operative gait analysis.