Acetabular considerations during total hip arthroplasty for hip dysplasia

The wide spectrum of anatomic abnormalities that characterize hip dysplasia dictate the need for different reconstructive techniques when hip replacement is required. Multiple factors such as young age and high activity level of this patient population, coupled with the increased complexity of surgery, explain the somewhat elevated historical failure rate of hip arthroplasty in DDH and emphasize the need for careful analysis of each case and selection of the most appropriate reconstruction options. One particular problem specific to acetabular reconstruction is the deficient bone stock that may limit the ability to place the component fully on native bone at the true acetabular region. When standard techniques of reconstruction leave a significant portion of the component uncovered, the alternatives include acetabular augmentation with bone autograft, intentional high placement of the component, or medialization of the component with or without medial wall osteotomy. Uncemented sockets have provided promising midterm results with supplemental bone augmentation and are the authors' preferred method of treatment for hips with moderate dysplasia and anterolateral acetabular bone deficiency.