Is high hip center technique an acceptable choice for total hip arthroplasty of the developmental dysplasia of the hip?

Abstract

Total hip arthroplasty (THA) is a successful method to treat osteoarthritis secondary to the developmental dysplasia of the hip (DDH). As anatomic deformity of acetabulum, anatomic hip center placing of the socket may lead insufficient host bone coverage, therefore, high hip center (HHC) technique is an alternative choice. Location of the hip rotation center can be referenced by inter teardrop line, the highest point of the obturator foramen, summit of the iliac crests, ischial tuberosities and other anatomic landmarks. The HHC technique is supposed to increase host bone coverage of socket without structural bone grafts, simplify surgical procedures, reduce anesthetic and surgical time, conserve adequate healthy bone stock for revision, however, it leads to insufficiency of the abductor muscles, is speculated to increase the hip load, lower the range of hip flexion and internal rotation (IR). Loosening rates and polyethylene wear vary in different studies. Concerning about these factors, HHC technique is acceptable while center of rotation located at a horizontal level with distance less than 35 mm from the inter teardrop line, moreover, medialization of these HHC reconstructions is suggested.