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Total hip replacement in the congenitally dislocated hip using the Paavilainen technique: 19 hips followed for 1.5-10
Bjørn Thorup1, Inger Mechlenburg, Kjeld Søballe
1Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark.
Insights
The Paavilainen technique for total hip replacement in congenital hip dislocation offers functional improvement and pain relief with few complications. However, polyethylene liner wear remains an issue requiring further attention.
Area of Science:
- Orthopedic Surgery
- Hip Reconstruction
- Congenital Hip Dysplasia
Background:
- Congenital hip dislocation (CDH) presents complex surgical challenges.
- The Paavilainen technique for total hip replacement (THR) in CDH involves acetabular cup placement in the native acetabulum and extended trochanteric osteotomy with distal advancement.
- Limited outcome data exists for this specific THR technique.
Purpose of the Study:
- To evaluate the clinical and radiographic outcomes of 19 total hip replacements performed using the Paavilainen technique for congenital hip dislocation.
- To assess the efficacy and complication rates of this surgical approach in a cohort of patients.
Main Methods:
- A retrospective review of 19 THRs performed using the Paavilainen technique in 15 patients (10 female, 5 male) with CDH.
- Patients had a mean age of 38 years (range 16-73) at surgery and were followed for a mean of 4.8 years (range 1.5-10).
- Clinical assessment utilized the Harris Hip Score (HHS), and radiographic evaluation employed the Gruen and Charnley classifications.
Main Results:
- Significant improvements in walking ability and pain relief were observed in all patients.
- Positive Trendelenburg test resolved in most cases (18 pre-op to 1 post-op).
- Complications included transient peroneal palsy (1), intraoperative femur fissures (4), and hip dislocations (3), with polyethylene liner wear necessitating replacement in 3 patients. No infections or aseptic loosening occurred.
Conclusions:
- The Paavilainen technique demonstrates potential for achieving a functional hip replacement in patients with CDH, offering intermediate to long-term benefits.
- The complication rate is relatively limited, though polyethylene liner wear persists as a challenge.
- This study contributes valuable outcome data for the Paavilainen THR technique in CDH.
Background And Purpose:
Total hip replacement (THR) in congenitally dislocated hips (CDHs) according to Paavilainen includes placement of the cup in the original acetabulum and an extended trochanteric osteotomy with distal advancement of the trochanter. There have only been a few reports describing the outcome of this technique. Thus, we report the results of 19 THRs using the Paavilainen technique.
Methods:
10 women and 5 men with an average age of 38 (16-73) years at the time of surgery (19 hips) were followed for mean 4.8 (1.5-10) years. The patients were evaluated clinically with the Harris hip score (HHS) and radiographically using the Gruen and Charnley classification.
Results:
All patients experienced substantial improvement in walking ability and relief of pain. Trendelenburg test was positive in 18 hips preoperatively, and only in 1 postoperatively. 1 case had transient incomplete peroneal palsy. There were 4 cases of intraoperative fissures of the proximal femur. No infections occurred, and no aseptic loosening was observed. 3 hips dislocated in the follow-up period; 2 were reduced open and 1 had a closed reduction. Due to wear of the polyethylene, 3 patients needed replacement of the liner.
Interpretation:
These intermediate to long-term results indicate that the Paavilainen technique provides a functional hip with a limited rate of complications. Wear of the polyethylene liner is, however, still an unresolved issue.