Abstract
For better communication, treatment planning and evaluation of results, a generally accepted classification is needed for determining the different types of congenital hip disease (usually referred to as developmental dysplasia of the hip) in adults. We have proposed the use of the following classification: Dysplasia, Low Dislocation, and High Dislocation. Knowledge of the local anatomical abnormalities in these three types of the disease is mandatory.
Total hip arthroplasty in all three types (especially in high dislocation) is a demanding operation and should be decided when there is an absolute indication. The acetabular component must be placed at the site of the true acetabulum, mainly for mechanical reasons. After the reaming process, if the remaining osseous cavity cannot accommodate a small cementless cup with at least 80% coverage of the implant, the cotyloplasty technique is recommended. This technique involves medial advancement of the acetabular floor by the creation of a controlled comminuted fracture, autogenous bone grafting, and the implantation of a small acetabular component with cement, usually the offset-bore acetabular cup of Charnley.
In order to facilitate reduction of the components and to avoid neurovascular complications, the femur is shortened at the level of the femoral neck, along with release of the psoas tendon and the small external rotators.
We believe that this operative technique of total hip arthroplasty is effective for the treatment of difficult conditions of highly dislocated hips.
The abstracts were prepared by David P. Davlin. Correspondence should be addressed to him at the Orthopedic Clinic Bulovka, Budínova 2, 18081 Prague 8, Czech Republic.
