The custom femoral component is an effective option for congenital hip dysplasia

Although custom-designed femoral prostheses seem more likely to be successful than off-the-shelf components for treatment of patients with osteoarthritis secondary to congenital hip dysplasia, published short-term results of custom stems with a smooth surface or titanium proximal mesh pads are no better than results for off-the-shelf components. To determine whether cementless custom femoral components with sandblasted surfaces provide better results than other custom stems, we prospectively evaluated 77 consecutive patients (99 hips) with a mean age of 54 years who had osteo-arthritis secondary to congenital hip dysplasia. The mean followup was 9 years 3 months. Forty-seven hips were classified as having Crowe Type I deformity, 41 were classified as having Crowe Type II deformity, and 11 were classified as having Crowe Type III deformity. The average Harris hip score was 97.6 points at the last followup. Radiographically, 88 hips (89%) showed bone ongrowth, seven hips (7%) showed stable fibrous fixation, and four hips (4%) showed unstable fixation. There were two intraoperative femoral fractures and varus malpositioning of four stems in the hips with stable fibrous fixation and the unstable hips. One femoral component was revised 6 years postoperatively. Although the anatomic cementless custom-designed femoral components with sandblasted surfaces provided favorable results in patients with Crowe Types I, II, and III deformities, intra-operative technical errors prevented bone ongrowth fixation.