Total hip replacement in dysplastic hip joint dislocation

Abstract

Objective: to assess current approaches to hip joint (HJ) ar­throplasty with high dysplastic dislocation and to evaluate out­comes. Methods: we studied the literature on the problem of to­tal hip arthroplasty under conditions of dysplastic coxarthrosis (DC) Crowe III–IV type classification and results of treatment in 322 patients (126 (39.1 %) — DC type III, 4 (4.4 %) — IV), wth domestic arthroplasty modular system with two types of ta­pered legs and two «dysplastic» with a square profile. Results: the main problem of hip joint arthroplasty in patients with DC Crowe III–IV type — selection of the optimal method of the femo­ral head construction, setting the cup on implant bed in the acetabulum (AC), prevention of cardiovascular and neurological complications. The method of low intertrochanteric osteotomy, femoral neck used in 126 cases (90 %) during the arthroplasty and length of limb offset from 2.8 to 4.5 cm without complica­tions. In 11 patients cup set to AC into true bed after osteotomy T. Paavilainen. In 3 cases subtrochanteric osteotomy performed with partial resection of the bone segment from 4 to 5 cm. Posi­tive results were obtained in 94.6 % of patients. Conclusions: in patients with DC III–IV type for Srowe when shortening the limb to 4 cm, treatment can be performed on the level or over minor trochanter intertrochanteric osteotomy, the release AC zone and immobilization of the proximal femur that saves its metaphysis and HJ muscular balance. In the case of complete dislocation of the femoral head with dysplastic genesis and shortening of the limbs over than 4 cm we recommend shorten­ing osteotomy together with the restoration of anatomic center of rotation of the head implant, ie setting the cup to the anatomic bed of AC combined with bone grafting defect in AC and use inserts 10o and 20o shed for prevent dislocation of the implant.