Total Hip Arthroplasty for Neglected Hip Dislocation - Surgical Technique and Results

A rare but difficult condition to treat is neglected posterior dislocation of the hip. A delayed presentation results in soft-tissue contractures, poor bone stock, altered anatomy, and fibrous tissue formation in the acetabulum, all of which make reduction challenging. Despite the considerable risks and technical difficulties, total hip arthroplasty (THA) is frequently the recommended course of treatment in such chronic cases.

We report the case of a 48-year-old man who had a 1.5-year-old posterior hip dislocation that had been neglected. After undergoing closed reduction and skin traction at a nearby hospital, the patient experienced a secondary displacement shortly after being released. He was treated conservatively at several local centers since he lacked access to definitive care. The patient had a 7 cm limb shortening with fixed flexion, adduction, and internal rotation deformity when they arrived at our facility. Imaging showed a deformed anterior wall, a fragmented posterior acetabular wall, and a femoral head with total loss of articular cartilage.

A total hip replacement (THR) using cement was planned, and several backup plans, such as structural grafts, acetabular cages, dual mobility cups, and subtrochanteric osteotomy, were ready for any intraoperative difficulties. A posterior strategy was applied. Fibrous tissue and malformed bony walls covered the acetabulum; to medialize and stabilize the cup, careful dissection and gradual reaming were done. Osteotomy was performed on the femoral head. A medial calcar fracture was discovered during surgery, and cerclage wiring was used to treat it. The implant was a cemented stem with a highly porous acetabular cup.

Recovery from surgery went smoothly. The patient's limb length and function were restored along with a stable hip fixation.

In developing nations, where delayed presentation is common due to limited orthopedic access and reliance on traditional bone setters, neglected posterior hip dislocations with acetabular fractures present significant reconstructive challenges. In these situations, THR necessitates careful pre-operative planning, cautious intraoperative technique to prevent neurovascular damage, and methods to deal with bone loss and soft-tissue contracture.

THA, which provides pain relief and functional recovery, is the recommended treatment for chronic posterior hip dislocation with acetabular involvement. However, because of its technical complexity, it requires careful planning and execution.