Surgical planning, technique improve results of THA for developmental dysplasia of the hip
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Total hip arthroplasty for patients with developmental dysplasia of the hip may yield promising results; however, careful planning and surgical techniques are required to improve survivorship and reduce complications, a speaker said.
“Hip dysplasia today predisposes the hip to early degenerative osteoarthritis,” Christopher L. Peters, MD, said in his presentation at the Current Concepts in Joint Replacement Meeting. “We see a large morphology variation in patients with [developmental dysplasia of the hip] DDH that can occur both on the socket side, as well as the femoral side,” he added.
Peters said morphological variation can present challenges for surgeons performing THA on patients with DDH. Additionally, acetabular bone deficiencies in these patients often require restoration of the anatomical hip center, which can lead to increased risk of complications, such as aseptic loosening, hip instability, polyethylene wear and intraoperative femoral fractures. In these cases, femoral shortening is warranted, he said.
According to Peters, surgeons can also run into problems when placing the acetabular component in dysplastic hips. Surgeons should avoid chasing the pseudoacetabulum, which can lead to the placement of an oversized cup in a superolateral position. This creates challenges with fixation, stability and restoration of the appropriate hip biomechanics, he added.
“Don’t go big,” Peters said.
Attempting to use a big socket for tight fit can also lead to residual psoas, rectus and capsular pain. Peters noted that excess anteversion and high valgus neck angles on the femoral side can also create challenges for surgeons.
Peters said the selection of proper primary or modular stem designs can assist surgeons when restoring appropriate femoral version and hip mechanics, and the utilization of contemporary bearing surface options can decrease wear and risk of complications.
Peters highlighted his latest research, which showed a slightly decreased THA survivorship for patients with DDH; however, after removing metal-on-metal implants, Peters and colleagues found similar survivorship rates for patients with DDH compared with patients with OA.
“Dysplastic total hip replacement patients present with a broad age spectrum, predominantly young females – a spectrum of deformity,” Peters said. “The principles on the acetabular side – think low, medium and small. Beware of femoral anteversion and beware that most of these patients can have a variable outcome compared to traditional osteoarthritic patients,” he concluded.
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Peters CL, et al. Management of DDH with THA. Presented at: Current Concepts in Joint Replacement Meeting; Dec. 7-10, 2022; Orlando (hybrid meeting).
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