CONGENITAL HIP DISLOCATION IN TOTAL HIP ARTHROPLASTY

Abstract

In our country total hip arthroplasty (THA) has increased in cases with congenital hip dislocation or dysplasia in parallel to increase in the standard THA. Therefore, in the present study we aim to present classification, preoperative evaluation, solution to technical problems and the results of THA in cases with reviews in literature. In cases with congenital dislocation and dysplasia THA depends on severe pain and inability to do daily activities, secondary osteoarthritic changes, availabilty of bone stock, age and functional expectations of the patient. In such cases technical difficulties and complications in THA are more than those in standart practices. The most important stage in reconstruction is to obtain a reasonable bone coverage of acetabular component. In placement of acetabular component into true acetabulum a reasonable bone coverage is quite important in providing adequate stability. This coverage in many cemented and cementless THA can be secured by using small acetabular component, deep reamerisation or by medialization of prothesis with controlled fractures on medial acetabuler wall (cotyloplasty). In addition to these, femoral head is used as autograft to inadequate superoposterior part of acetabulum in particularly Crowe type III and some type II and IV cases or it may be necassary to place acetabular component slightly above true acetabulum. Femoral osteotomy improves rotation deformity and makes it possible to obtain lengthing in lower extremity although it leads shortening in femur. Femoral shortening osteotomy can be performed at trochanteric or subtrochanteric region.