Background: It is generally agreed that the clinical and
radiographic results of total hip replacement performed for degenerative
arthritis secondary to congenital hip disease vary depending on the severity
of the anatomical abnormality. In this study, we report the mid-term and
long-term clinical and radiographic results of total hip arthroplasty
performed for each of the three different types of congenital hip disease.
Methods: Between 1976 and 1994, the senior author performed 229
consecutive primary total hip arthroplasties in 168 patients with
osteoarthritis secondary to congenital hip disease. Seventy-six hips were
dysplastic, sixty-nine had a low dislocation, and eighty-four had a high
dislocation. The Charnley low-friction technique was performed in 178 hips,
and the so-called hybrid technique was performed in forty-six hips. Cementless
arthroplasty was used in only five hips.
Results: After a minimum of seven years of follow-up, the rates of
revision of the acetabular components were 15% in the dysplastic hips, 21% in
the hips with a low dislocation, and 14% in those with a high dislocation. The
rates of revision of the femoral components were 14%, 14%, and 16%,
respectively. Survivorship analysis predicted an overall rate of prosthetic
survival at fifteen years of 88.8% ± 4.8% in the dysplastic hips, 73.9%
± 7.2% in the hips with a low dislocation, and 76.4% ± 8.1% in
those with a high dislocation.
Conclusions: An understanding of the anatomical abnormalities and
the use of appropriate techniques and implants make total hip arthroplasty
feasible for treatment of the three types of congenital hip disease. In
patients with a low dislocation, the major technical problem is reconstruction
of the natural acetabulum. In those with a high dislocation, the challenge is
to place the acetabular component inside the reconstructed true acetabulum and
to use an appropriate femoral implant in the hypoplastic narrow femoral
Level of Evidence: Prognostic study, Level II-1
(retrospective study). See Instructions to Authors for a complete description
of levels of evidence.