Arthroplasty for Congenital Hip Deformity

Abstract

Development dysplasia of the hip is complex problem encompassing a spectrum of anatomical abnormalities. Total hip arthroplasty (THA) has emerged as the gold standard for management of secondary osteoarthritis due to hip dysplasia. Unique acetabular and femoral anatomy presents many challenges to reconstructive surgeons. However, the goals of THA for these patients mirror the goals of THA for nondysplastic patients. Classification systems, such as the Crowe and Hartofilakidis systems, have been created to facilitate discussion and management of these unique challenges, and numerous techniques have been described to meet these demands, with the goal of recreating normal anatomy for these patients. On the acetabular side, surgeons aim to restore the native hip center will ensuring adequate acetabular implant coverage, while on the femoral side, they seek to restore normal femoral anteversion and provide equal leg lengths. This article details the various challenges reconstructive surgeons face, and the tools at their disposal to achieve the stated goals. When properly executed, THA for development dysplasia of the hip has shown excellent results, with no difference in outcomes for mildly dysplastic hips, though higher rates of mechanical failure for severely dysplastic hips.