[General therapeutic indications in congenital hip dislocation in adults]

The author discusses all the elements which should be considered in the decision for surgical treatment of CDH in adults: precise evaluation of the dysplasia, age of the patient, significance of the secondary osteoarthritis and good knowledge of the results of the proposed operation. After a shelf operation there are good results in 85% of the cases for an average of 13 years. After varisation osteotomy with a good joint for a femoral, acetabular or combined displacement, in patients aged 30 years or less, the results are good in 95% of the cases for 20 years. Varisation osteotomy, combined with a shelf procedure, increases the efficacity of the operation, especially in cases of major dysplasia of the acetabulum. There are good results in 97% of hips without osteoarthritis for more or less 20 years. The results of valgisation osteotomy are most disappointing after more than 10 years, with bad results in 50% of the cases. The Chiari osteotomy gives good results early, but after 10 years the fraction of good results drops to only 66% and there is a further decrease in the efficacity after 12 years. The peri-acetabular osteotomy of Ganz is a very logical operation, but the follow-up is too short and the technique is not easy. Total hip replacement is still indicated in many cases; there should be a very thorough preoperative evaluation, and the positioning of the cup should allow for the acetabular dysplasia.