Total hip arthroplasty for adult patients with developmental dysplasia and dislocation of the hip

Total hip arthroplasty (THA) is indicated for adult DDH patients with advanced arthritis and high dislocations. THA for patients with Crowe I, II, and III or Hartofilakidis dysplasia and low dislocation are not difficult for a surgeon experienced with hip reconstruction. Medialization of the acetabular cup with or without an autologous bone graft is advised for reconstruction of the cup. A protocol for symmetrize the lower limbs is proposed for Crowe IV (or Hartofilakidis high dislocation). This protocol includes iliofemoral distraction before THA, implanting the cup at the best bone stock, proximal femoral osteoplasty (greater trochanter osteotomy, expansion osteoplasty, interlocking wire fixation of the osteoplasty, and shortening-derotation osteotomy of the femur). Middle-term results of THA for DDH/CDH patients are similar to ordinary THA’s. But long-term results may be compromised by young age of the patients, small cups, and conventional polyethylene inserts. With improvement of the bearing materials, a better long-term result is expected.