[Acetabular reconstruction of total hip replacement in the treatment of dysplastic hip]

Bin Shen, Fu-xing Pei, Jing Yang
Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery] 2004 August 22, 42 (16): 1001-5

OBJECTIVE: To summarize the surgical experience of acetabular reconstruction of total hip replacement in the treatment of dysplastic hip.

METHODS: From April 1998 to April 2002, 96 adult cases with osteoarthritis secondary to dysplastic hip were adopted in the study. Among them, there were 89 females and 7 males, age from 27 approximately 68 years. According to Hartofilakidis classification system, there were dysplasia in 73 hips, low dislocation in 18 hips and high dislocation in 21 hips. All patients received total hip replacement, 16 cases with bilateral replacement and 80 cases with unilateral replacement. Kocher-LangenBeck approach was used during operation and all the acetabular cups were reconstructed at the original anatomic location. The fixation methods were as follows: cement cup for 16 hips, cementless cup for 96 hips and bone graft in 11 hips. The reconstructive methods were as follows: regular replacement for 83 hips; installing a smaller cup after deeper reaming the acetabulum for 27 hips; installing a smaller cup after autofemoral grafting on the superior lip for 2 hips.

RESULTS: The incision healed primarily and no infection or nerve injury occurred. Follow-up for 1 approximately 5 years (average for 3.5 years) in 85 patients, the Harris score increased from 33.9 preoperatively to 89.3 postoperatively, and 95 hips had good or excellent clinical results. Radiographically, the positions of the prostheses were normal, the average abduction angle of the cup was 44 degrees, the average superolateral bone coverage of the hips was 96.6%, no radiolucent line was observed at the acetabular side. All the bone grafts fused with the host bone successfully.

CONCLUSIONS: Total hip replacement is an effective operation in the treatment of osteoarthritis secondary to dysplastic hip. The four specific factors that should be considered in acetabular reconstruction are: (1) the surgical approach, (2) the reconstructive position of the acetabulum, (3) the reconstructive method of the acetabulum, (4) the leg-length discrepancies. It's a challenging to the orthopaedic surgeon. Careful preoperative preparation is recommended.

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