Congenital Hip Dislocation
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Transcript of Congenital Hip Dislocation
Congenital Hip
Dislocation
Introduction• THA in the DDH
patient presents a difficult challenge to the reconstructive hip surgeon
Introduction• Mild dysplastic
hips (Crowe I and II) usually have adequate bone stock and can accept standard components
Crowe I Crowe II
Introduction
Crowe III Crowe IV
Introduction• Crowe III and IV
dysplastic hips can be difficult to reconstruct and have the potential for more intra-operative and postoperative complications
Introduction• Surgical Options are Numerous:
? High Hip Center? Controlled Protusio? Structural Grafting? Specialized Components (e.g. Custom)? Oblong Cups? Cementation and/or Cemented Cups
Each has potential problems
Study Aim
• The aim of the current study is to present our midterm results after primary THA in DDH (Crowe III and IV) patients
Study Design• Between 1990 to 2000 twenty -nine (29)
cementless primary THA were performed in 24 patients(Crowe III and IV DDH patients)
• 17 Female and 7 Male
• Five pts had staged bilateral THA
Study Design• Average pt age = 49.5 yrs
• 48% were Crowe III
• 52% were Crowe IV
• Average Follow-up was 5.5 years
Technique• All surgeries were
performed through a posterior approach
• Acetabular Reaming routinely resulted in medial and superior placement of a standard cup.
Results• No
structural allografts were utilized during acetabular preparation
• Average Cup Size = 51 mm Range (42mm to 66 mm)
• Average Stem Size = 12.0 mm
Range (9.0mm to 16.5 mm)
• Average Head Size = 28 mm Range (22mm to 32 mm)
Results
****Note that these are standard implant sizes
Results• 21% (6 pts)
required a shortening osteotomy
• All were type IV
Complications• Dislocations - 6.8% (2 pts)
• (both eventually required conversion to a captured liner)
• Aseptic Poly Wear - 13.8% (4 pts) • one required revision
Complications• Symptomatic H.O. - 3.4% (1 pt)
(Booker III, no surgery was required)
• No Sciatic or Femoral Nerve complications
PMPre
PMOR
PM14 days
PMPost 2
PM18 mths
MCPre
MCPost
MC3yr
JG5yrs.
JGPre
Conclusions• Crowe III and IV dysplastic hips can be
routinely done without the use of structural allograft
• Total Hip Arthroplasty (Crowe III/IVpts) can be routinely performed without the need for specialized components
Conclusions• Complications were low in
this series
No Femoral or Sciatic Nerve Complications were observed
Dislocation rate of 6.8%Only one poly exchange at
5.5 yrs
Conclusions• A Femoral Osteotomy is rarely required
in Crowe III pts and only occasionally in Crowe IV pts
• A Femoral Osteotomy was required in 6 Crowe IV pts (21%) No Crowe III pts required a femoral osteotomy (in this series)
Conclusions• Primary Total Hip Arthroplasty can be
safely perfomed without the use of structural acetabular allograft in Crowe III/IV pts
• Standard components can be utilized in a majority of cases and lesson the need for smaller “specialized” implants