Resurfacing Hip Arthroplasty for Developmental Dysplasia

Abstract

There have been many reports of increasing numbers of resurfacing hip arthroplasty revisions because of unexplained pain and adverse local tissue reactions, especially with the Articular Surface Replacement system. Thus, the use of many resurfacing hip replacements has been declining. In contrast, the Birmingham Hip Resurfacing system has shown excellent long-term survivorship compared with other resurfacing prostheses, especially for young and active patients with osteoarthritis. Some reports on primary total resurfacing hip arthroplasty for developmental dysplasia of the hip (DDH) showed a higher rate of revision than primary osteoarthritis, but it is controversial whether a diagnosis of DDH itself is an independent risk factor for failure of hip resurfacing or it is related to its characteristics of female dominant gender and smaller component size. With most resurfacing prostheses, small components have a small coverage arc, indicating that small acetabular components have a narrower safe zone for the alignment against edge loading. Thus, strict control of acetabular component alignment is essential to prevent adverse wear for patients with DDH. It also requires surgical skill to fix an acetabular component using the press-fit technique alone. With a severely deformed femoral head, it is technically demanding to determine the proper insertion position and alignment of the guidewire while avoiding notch formation and preparing a healthy host bone with sufficient stability for the femoral components. Sufficient surgical experience, a properly designed prosthesis, and dedicated alignment control via intraoperative radiographic checks and/or computer technology (e.g., navigation or a patient-specific surgical guidance) would be required to improve implant survival of hip resurfacing for patients with DDH. We believe that DDH itself is not a contraindication for primary total hip resurfacing arthroplasty.