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Congenital Hip Dislocation

Congenital Hip Dislocation. Introduction. THA in the DDH patient presents a difficult challenge to the reconstructive hip surgeon. Introduction. Mild dysplastic hips (Crowe I and II) usually have adequate bone stock and can accept standard components . Crowe II. Crowe I. Introduction.

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Congenital Hip Dislocation

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  1. Congenital Hip Dislocation

  2. Introduction • THA in the DDH patient presents a difficult challenge to the reconstructive hip surgeon

  3. Introduction • Mild dysplastic hips (Crowe I and II) usually have adequate bone stock and can accept standard components Crowe II Crowe I

  4. Introduction Crowe III Crowe IV

  5. Introduction • Crowe III and IV dysplastic hips can be difficult to reconstruct and have the potential for more intra-operative and postoperative complications

  6. Introduction • Surgical Options are Numerous: • ? High Hip Center • ? Controlled Protusio • ? Structural Grafting • ? Specialized Components (e.g. Custom) • ? Oblong Cups • ? Cementation and/or Cemented Cups • Each has potential problems

  7. Study Aim • The aim of the current study is to present our midterm results after primary THA in DDH (Crowe III and IV) patients

  8. Study Design • Between 1990 to 2000 twenty -nine (29) cementless primary THA were performed in 24 patients (Crowe III and IV DDH patients) • 17 Female and 7 Male • Five pts had staged bilateral THA

  9. Study Design • Average pt age = 49.5 yrs • 48% were Crowe III • 52% were Crowe IV • Average Follow-up was 5.5 years

  10. Technique • All surgeries were performed through a posterior approach • Acetabular Reaming routinely resulted in medial and superior placement of a standard cup.

  11. Results • No structural allografts were utilized during acetabular preparation

  12. Results • Average Cup Size = 51 mm Range (42mm to 66 mm) • Average Stem Size = 12.0 mm Range (9.0mm to 16.5 mm) • Average Head Size = 28 mm Range (22mm to 32 mm) ****Note that these are standard implant sizes

  13. Results • 21% (6 pts) required a shortening osteotomy • All were type IV

  14. Complications • Dislocations - 6.8% (2 pts) • (both eventually required conversion to a captured liner) • Aseptic Poly Wear - 13.8% (4 pts) • one required revision

  15. Complications • Symptomatic H.O. - 3.4% (1 pt) • (Booker III, no surgery was required) • No Sciatic or Femoral Nerve complications

  16. PM Pre

  17. PM 14 days PM OR

  18. PM Post 2 PM 18 mths

  19. MC Pre MC Post MC 3yr

  20. JG 5yrs. JG Pre

  21. Conclusions • Crowe III and IV dysplastic hips can be routinely done without the use of structural allograft • Total Hip Arthroplasty (Crowe III/IVpts) can be routinely performed without the need for specialized components

  22. Conclusions • Complications were low in this series • No Femoral or Sciatic Nerve Complications were observed • Dislocation rate of 6.8% • Only one poly exchange at 5.5 yrs

  23. Conclusions • A Femoral Osteotomy is rarely required in Crowe III pts and only occasionally in Crowe IV pts • A Femoral Osteotomy was required in 6 Crowe IV pts (21%) No Crowe III pts required a femoral osteotomy (in this series)

  24. Conclusions • Primary Total Hip Arthroplasty can be safely perfomed without the use of structural acetabular allograft in Crowe III/IV pts • Standard components can be utilized in a majority of cases and lesson the need for smaller “specialized” implants

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