The management of version abnormalities and angular deformities in developmental dysplasia of the hip

Implantation of a femoral stem in a dysplastic femur poses many problems. Most common abnormalities are excessive anteversion and valgus angle of the femoral neck. This makes it impossible to use conventional stems. Suitable options are distally fixed stems with small metaphysis or proximally modular stems. Femurs with previous varus or valgus osteotomies show more severe deformities that sometimes require performing an osteotomy to obtain adequate correction. Again, distally fixed stems or proximally modular stems are suitable, the latter having the advantage that, by loading the femur proximally, they load the osteotomy therefore enhancing the healing.