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Congenital Hip Disease in Adults

G. Hartofilakidis, G. C. Babis, K. Lampropoulou-Adamidou. pp. 200 Springer, 2014. ISBN: 978-8847054912

This book would be better entitled ‘Cemented Total Hip Replacement for Congenital Dislocation of the Hip’ as it summarises Professor Hartofilakidis’ long experience in this operation for this disease, however Hartofilakidis does not like either the term ‘congenital dislocation of the hip’ or its replacement, from the early 1990’s ‘developmental dysplasia of the hip’, preferring the term ‘congenital disease of the hip’. I suspect this name will not catch on, given that many insurers do not cover ‘congenital’ conditions.

The blurb on the back cover is a little misleading – it states ‘the now limited role of femoral and pelvic osteotomies is carefully evaluated’ – when only about 200 words are devoted to this subject.

Femoral osteotomy is properly dismissed as unhelpful in most cases, though, inexplicably, this is illustrated by radiographs showing long term survival of hips, in spite of, or because of, femoral osteotomies.

The more topical subject of pelvic osteotomy is  discussed in about 100 words, and essentially dismissed with the comment ‘in our days, intertrochanteric and pelvic osteotomies in adults seldom are performed and as surgeons have limited experience in this type of operations should be decided with caution.’

So, any readers looking for information on non-total hip replacement (THR) approaches to ‘congenital hip disease’ (CHD) will be disappointed, but those interested in THR will be fairly well rewarded.

In fact, Hartofilakidis accurately describes the book as an attempt to ‘inform about CHD, terminology, classification, natural history and treatment with THR.’

This book describes the classification of CHD, comparing Hartofilakidis’ own system to that of Crowe and others.

In principle he recommends restoring the anatomy as accurately as possible by placing the centre of rotation in the correct location, and then, if needed, shortening the femur.

Professor Hartofilakidis has a lifetime of experience with cemented THR, and, with the aid of X-rays and diagrams, explains the cotyloplasty technique for fixing a cup into a shallow acetabulum – the socket is deepened with a reamer, thinning out the medial wall which is then fractured by using the reamer as a punch. Small pieces of bone graft are packed into the hole, retained by the periosteum on the inner table of the pelvis. The acetabular cup is cemented to the bone graft by standard techniques.

Good long-term outcomes are shown.

His colleague Professor Babis favours uncemented THRs, and we are told these also produce good results as long as there is ’70-80% coverage’ of the acetabular cup, but there are few radiographs of cementless implants.

Hartofilakidis favours the transtrochanteric approach, and shows that in his hands it provides adequate exposure for an accurate operation with a low rate of complications associated with the trochanteric osteotomy and impressively few neurological complications.

Radiographic essays are enjoyable – surgeons are drawn to radiographs like moths to the flame – but the accompanying captions could be much longer and more informative – a typical entry ‘THR was performed’ could be expanded to cover Prof Hartofilakidis assessment of the post-operative radiograph: Is it perfect, were compromises made, are these likely to affect the outcome etc?

The production quality is below the standard we have come to expect from Springer – the thin matte paper seems to obscure the detail of the radiographs – the quality seems closer to domestic inkjet than commercial printing, and the book would have benefited from tighter editing, from simple things like minor grammatical/typographical errors and some slightly unclear language through to the editors teasing out of Prof Hartofilakidis the answers to the questions we would all like to ask him – particularly his advice for young surgeons – does he still recommend the implants and techniques he has used successfully throughout his career, or would he do things differently if he were starting afresh today?

Reviewed by Jason Brockwell, Hip Surgeon