Total hip replacement for developmental dysplasia of the hip

Total hip arthroplasty relieves pain and improves function for many patients with endstage arthritis secondary to developmental dysplasia of the hip. Acetabular dysplasia, however, presents a special problem for total hip reconstruction in these patients. Structural bone grafting with femoral head autografting to the dysplastic acetabulum and cementing acetabular components into the graft provides satisfactory short-term results, but longer-term followup data show high acetabular component failure rates. At a mean followup period of 7 years, 20% of components were loose, and at a mean followup period of 12 years, 46% were loose. Noncemented porous-coated hemispherical acetabular components have considerably expanded the success of total hip replacement without the need for structural bone grafting in such patients. At a mean followup period of almost 7 years, none of the acetabular components were reported to be loose in 1 series. For most patients, the acetabular dysplasia can be managed by techniques such as reaming deeper, using small-diameter porous-coated acetabular components, using screws to provide rigid initial stability for the components, increasing the height of the prosthetic hip center, and covering small portions of the components with bone graft chips if necessary.