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Reconstruction of the Acetabulum in Developmental Dysplasia of the Hip in total hip replacement
Vasileios I Sakellariou1, Michael Christodoulou1, Gregory Sasalos1
1Vasileios I. Sakellariou MD, Michael Christodoulou MD, Gregory Sasalos MD, 1st Department of Orthopaedics, University of Athens, Medical School, ATTIKON University General Hospital, Chaidari, Athens, Greece.
Insights
Developmental dysplasia of the hip (DDH) is a common childhood disorder. Total hip arthroplasty (THA) in adults with DDH presents unique challenges and outcomes compared to osteoarthritis, with long-term improvements in pain and motion.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Adult Reconstruction
Background:
- Developmental dysplasia of the hip (DDH), also known as congenital hip dysplasia (CDH), is the most common developmental hip disorder in children.
- It encompasses a range of hip abnormalities, from mild dysplasia to complete dislocation.
- Neglected DDH in adults has a variable natural history with symptom onset typically in early to mid-adulthood.
Purpose of the Study:
- To highlight the importance of understanding bony and soft tissue deformities in DDH for successful total hip arthroplasty (THA).
- To emphasize the challenges and considerations for acetabular reconstruction in DDH patients.
- To compare THA outcomes in DDH patients versus those with primary hip osteoarthritis.
Main Methods:
- Review of the natural history and clinical presentation of adult DDH.
- Discussion of the principles of three-dimensional acetabular evaluation and customized correction.
- Analysis of complication rates and functional outcomes following THA in DDH.
Main Results:
- Symptom onset in adult DDH varies based on the type and severity of dysplasia.
- THA in DDH patients is associated with higher complication rates than in osteoarthritis patients.
- Despite potential challenges, THA in DDH patients shows long-term improvements in pain and range of motion, though function scores may decline with age.
Conclusions:
- Successful THA in DDH requires thorough understanding and precise management of acetabular deformities.
- THA outcomes in DDH differ from osteoarthritis, influenced by patient age and activity levels.
- Long-term benefits of THA for DDH include significant pain reduction and improved joint mobility.
Abstract:
Developmental dysplasia of the hip (DDH) or congenital hip dysplasia (CDH) is the most prevalent developmental childhood hip disorder. It includes a wide spectrum of hip abnormalities ranging from dysplasia to subluxation and complete dislocation of the hip joint. The natural history of neglected DDH in adults is highly variable. The mean age of onset of symptoms is 34.5 years for dysplastic DDH, 32.5 years for low dislocation, 31.2 years for high dislocation with a false acetabulum, and 46.4 years for high dislocation without a false acetabulum. Thorough understanding of the bony and soft tissue deformities induced by dysplasia is crucial for the success of total hip arthroplasty. It is important to evaluate the existing acetabular deformity three-dimensionally, and customize the correction in accordance with the quantity and location of ace tabular deficiencies. Acetabular reconstruction in patients with DDH is challenging. Interpretation of published data is difficult and should be done with caution because most series include patients with different types of hip disease. In general, the complication rate associated with THA is higher in patients with hip dysplasia than it is in patients with osteoarthritis. Overall, clinical and functional outcomes following THA in patients hip dysplasia (DDH) differ from those treated for primary hip osteoarthritis, possibly due to the lower age and level of activity. Although function scores decline with age, the scores for pain and range of motion presented with a statistically significant improvement in the long-term.
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