Abstract
Developmental dysplasia of the hip (DDH) represents a heterogeneous group of deformities that are commonly associated with secondary osteoarthritis. Affected hips may require total hip arthroplasty (THA) for endstage disease and these cases can present unique challenges for the reconstructive surgeon. While the severity of deformity varies greatly, optimizing THA can be challenging even in the “mildly” dysplastic hip. These disorders are commonly characterised by acetabular deficiency with inadequate coverage of the anterolateral femoral head and proximal femoral abnormalities including excessive femoral antetorsion, coxa valga and femoral stenosis. In more severe cases, major femoral head subluxation or dislocation can add additional complexity to the procedure. In addition to the primary deformities of DDH, secondary deformities from previous acetabular or proximal femoral osteotomies may also impact the primary THA. Primary THA in the DDH hip can be optimised by detailed understanding of the bony anatomy, careful pre-operative planning, and an appropriate spectrum of techniques and implants for the given case. This presentation will review the abnormal hip morphologies encountered in the dysplastic hip and will focus on the more challenging aspects of THA. These include acetabular reconstruction of the severely deficient socket and in the setting of total dislocation, femoral implant procedures combined with corrective osteotomy or shortening, and issues related to arthroplasty in the setting of previous pelvic osteotomy. Despite the complexity of reconstruction for various dysplastic variants the clinical outcomes and survivorship of these procedures are good to excellent for most patients. Nevertheless, more complex procedures are associated with an increased complication rate and this should be considered in the surgical decision-making process.
