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Scientific Articles   |    
Total Hip Arthroplasty for Congenital Hip Disease
George Hartofilakidis, MD1; Theofilos Karachalios, MD2
1 21 Fotiou Patriarchou Street, Athens 11471, Greece. E-mail address: hartofilakidis@yahoo.gr
2 Department of Orthopaedic Surgery, School of Health Studies, University of Thessaly, 22 Papakiziazi Street, Larisa, Greece 41222. E-mail address: kar@med.uth.gr
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this work. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Orthopaedic Department, University of Athens, Athens, Greece

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Feb 01;86(2):242-250
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Abstract

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 diaphysis.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

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    George Hartofilakidis MD FACS
    Posted on October 06, 2004
    Developmental Dysplasia of the Hip: An Unsuitable Term
    University of Athens

    In his brief report in JBJS-Br, January 1989, Klisic emphasized that congenital dislocation of the hip is a misleading term when used for the total spectrum of infant hip deformities (1). Instead he recommended the use of the term ‘developmental displacement’. Though many authors and the American Academy of Orthopaedic Surgeons, accepted the wording change of congenital to developmental, on the other hand, they replaced the wording of displacement with that of dyspalsia, and a new term ‘developmental dyspalsia of the hip’ was established. Nonetheless, despite the latest effort for an appropriate definition covering the total spectrum of the disease, inaccuracies still persist, reflecting the confusion as to the original cause. Specifically, the term developmental is not descriptive of the congenital nature of the deformity, while an undiscriminate use of the term dyspalsia does not reflect the variety of underlying pathology. Thus, unfortunately from a deficient term ‘congenital dislocation of the hip’ we ended up with a non specific and unsuitable one ‘developmental dysplasia of the hip’ without convincing arguments for the change.

    However, for better communication, treatment planning, and evaluation of results of various treatments, an agreed term is needed to cover the entire pathology of congenital hip deformities. Furthermore, a generally accepted classification of the deformities is necessary. The term ‘congenital hip disease’, covering all types of congenital abnormalities of the hip joint (2), appears to be more accurate as a general term, especially when reporting the results of total hip replacement (3). As for the classification of the deformity in infancy, that, in three radiographic types, dysplasia, subluxation, and complete dislocation (4), detected after three months of age, seems to be most effective. In dysplasia there is a poor development of the acetabulum and of the femoral head, with an intact Shenton’s line. In subluxation the Senton’s line is broken due to the proximal and lateral migration of the femoral head, without the latter overpassing the upper edge of the acetabulum. In dislocation the femoral head is completely out of the acetabulum. Untreated or uncompletely treated congenital hip disease at infancy leads to the adult congenital hip disease, followed by secondary osteoarthritis (Table 1). This author, based on the underlying pathology of the deformity, has described three types of congenital hip disease in adults (5). Type-1 hips are those with dyplasia, where the femoral head remains within the true acetabulum, regardless of the degree of subluxation. Type- 2 hips are those with low dislocation, where the femoral head articulates with a false acetabulum, partially covering the true acetabulum. Type-3 hips are those with high dislocation, where the femoral head has migrated superiorly and posteriorly in relation to the true acetabulum. Other classification systems of congenital hip disease in adults are those of Crowe et al and Eftecar.

    In summary, we strongly suggest the use of the general term congenital hip disease for the entire spectrum of related deformities, with the classification in dysplasia, subluxation, dislocation in infancy, and dysplasia, low dislocation, high dislocation in adults.

    References

    1. Klisic P.J. Congenital dislocation of the hip. A misleading term. Brief report. J Bone Join Surg (Br) 1989 ; 71-B : 136.

    2. Wedge J.H, Wasylenko MJ. The natural history of congenital disease of the hip. J Bone Joint Surg (Br) 1979 ; 61-B : 334-338.

    3. Hartofilakidis G, Karachalios Th. Total hip arthroplasty for congenital hip disease. J Bone Joint Surg 2004 ; 86-A : 242-250.

    4. Weinstein S.L, Mubarak S.J, Wenger D.R. Developmental hip dysplasia and dislocation. J Bone Joint Surg (Am) 2003 ; 85 : 1824-1832.

    5. Hartofilakidis G, Karachalios Th, Stamos K. Epidemiology demographics and natural history of congenital hip disease in adults. Orthopaedics 2000 ; 23 : 823-827.

    Infancy Adult life Dysplasia Dysplasia Subluxation Low dislocation Dislocation High dislocation

    Table 1. Classification of Congenital Hip Disease

    in Infancy and in Adult life.

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