Background: The optimal surgical treatment for patients with high
congenital dislocation of the hip remains controversial. The purpose of our
study was to evaluate the mid-term to long-term results of cementless total
hip arthroplasty in such patients.
Methods: The study included sixty-eight total hip replacements
performed between 1989 and 1994 in fifty-six consecutive patients with high
congenital hip dislocation at our hospital. The cup was placed at the level of
the true acetabulum, and a shortening osteotomy of the proximal part of the
femur and distal advancement of the greater trochanter were performed in 90%
of the hips. At the time of final follow-up, at a mean of 12.3 years
postoperatively, fifty-two patients (sixty-four hips) were evaluated by us
with a physical examination, determination of Harris hip scores, and
Results: The mean Harris hip score increased from 54 points
preoperatively to 84 points at the time of final follow-up (p < 0.001).
There was a negative Trendelenburg sign in fifty-nine (92%) of the sixty-four
hips. There were thirteen perioperative complications (19%): three peroneal
nerve palsies, one femoral nerve palsy, one superior gluteal nerve palsy, four
nondisplaced fractures of the proximal part of the femur, one malpositioned
stem perforating the posteromedial cortex of the femur, one superficial wound
infection, and two early dislocations. With revision because of aseptic
loosening as the end point, the ten-year survival rate for press-fit,
porous-coated acetabular components was 94.9% (95% confidence interval, 89.3%
to 100%). Eight of nine threaded acetabular components were revised, and the
ninth was radiographically loose at the time of the last follow-up
examination. The rate of survival for the CDH femoral components, with
revision because of aseptic loosening as the end point, was 98.4% (95%
confidence interval, 96.8% to 100%) at ten years.
Conclusions: Total hip arthroplasty, with placement of the cup at
the level of the true acetabulum, distal advancement of the greater
trochanter, and femoral shortening osteotomy, can be recommended for patients
with high congenital hip dislocation. Complications such as wear, osteolysis,
and cup revision were secondary to the suboptimal design of the acetabular
components used in this series.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.