Total Hip Arthroplasty in Developmental High Dislocation of the Hip


      In total hip arthroplasty for developmental high dislocations, placement of the implant cup in the true acetabulum and femoral-shortening osteotomy can produce satisfactory results. We performed total hip arthroplasties in 25 high dislocated hips (22 patients) between 1992 and 2000, placing all cups in the true acetabula and using noncemented components and performing a femoral-shortening osteotomy in 22 hips. The overall complication rate was 36%. At follow-up evaluation at an average of 5 years later, patients' mean scores had improved as follows: pain, from 2.3 to 5.7; function scores, from 2.3 to 4.5; mobility scores, from 2.3 to 4.4; Harris hip scores, from 37.8 to 95. We recommend both placing the cup in the true acetabulum to maximize host-bone contact with the implant and preserve as much host bone as possible and femoral-shortening osteotomy for a lower incidence of nerve injury than with aggressive soft-tissue release.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Charnley J.
        • Feagin J.A.
        Low friction arthroplasty in congenital subluxation of the hip.
        Clin Orthop. 1973; 91: 98
        • Crowe J.F.
        • Mani V.J.
        • Ranawat C.S.
        Total hip replacement in congenital dislocation and dysplasia of the hip.
        J Bone Joint Surg. 1979; 61A: 15
        • Anwar M.M.
        • Sugano N.
        • Masuhara K.
        • et al.
        Total hip arthroplasty in the neglected congenital dislocation of the hip: a five- to 14- year follow-up study.
        Clin Orthop. 1993; 295: 127
        • Dunn H.K.
        • Hess W.E.
        Total hip reconstruction in chronically dislocated hips.
        J Bone Joint Surg. 1976; 58A: 838
        • Hess W.E.
        • Umber J.S.
        Total hip arthroplasty in chronically dislocated hips: follow-up study on the protrusio socket technique.
        J Bone Joint Surg. 1978; 60A: 948
        • Gerber S.D.
        • Harris W.H.
        Femoral head autografting to augment acetabular deficiency in patients requiring total hip replacement.
        J Bone Joint Surg. 1986; 68A: 1241
        • Harris W.H.
        • Crothers O.
        • Oh I.
        Total hip replacement and femoral-head bone-grafting for severe acetabular deficiency in adults.
        J Bone Joint Surg. 1977; 59A: 752
        • Hartofilakidis G.
        • Stamos K.
        • Ioannidis T.T.
        Low friction arthroplasty for old untreated congenital dislocation of the hip.
        J Bone Joint Surg. 1988; 70B: 182
        • Paavilainen T.
        Total hip replacement for developmental dysplasia of the hip: how I do it.
        Acta Orthop Scand. 1997; 68: 77
        • Paavilainen T.
        • Hoikka V.
        • Solonen K.A.
        Cementless total hip replacement for severely dysplastic or dislocated hips.
        J Bone Joint Surg. 1990; 72B: 205
        • Numair J.
        • Joshi A.B.
        • Murphy J.C.M.
        • et al.
        Total hip arthroplasty for congenital dysplasia or dislocation of the hip.
        J Bone Joint Surg. 1997; 79A: 1353
        • Paavilainen T.
        • Hoikka V.
        • Paavolainen P.
        Cementless total hip arthroplasty for congenitally dislocated or dysplastic hips: technique for replacement with a straight femoral component.
        Clin Orthop. 1993; 297: 71
        • Mackenzie J.R.
        • Kelley S.S.
        • Johnston R.C.
        Total hip replacement for coxarthrosis secondary to congenital dysplasia and dislocation of the hip: long-term results.
        J Bone Joint Surg. 1996; 78A: 55
        • Reikeraas O.
        • Lereim P.
        • Gabor I.
        • et al.
        Femoral shortening in total arthroplasty for completely dislocated hips.
        Acta Orthop Scand. 1996; 67: 33
        • Huo M.H.
        • Salvati E.A.
        • Lieberman J.R.
        • et al.
        Custom-designed femoral prostheses in total hip arthroplasty done with cement for severe dysplasia of the hip.
        J Bone Joint Surg. 1993; 75A: 1497
        • Symeonides P.P.
        • Pournanas J.
        • Petsatodes G.
        • et al.
        Total hip arthroplasty in neglected congenital dislocation of the hip.
        Clin Orthop. 1997; 341: 55
        • Bruce W.J.M.
        • Rizkallah S.M.
        • Kwon Y.
        • et al.
        A new technique of subtrochanteric shortening in total hip arthroplasty: surgical technique and results of 9 cases.
        J Arthroplasty. 2000; 15: 617
        • Garvin K.L.
        • Bowen M.K.
        • Salvati E.A.
        • et al.
        Long-term results of total hip arthroplasty in congenital dislocation and dysplasia of the hip: a follow-up note.
        J Bone Joint Surg. 1991; 73A: 1348
        • Jasty M.
        • Anderson M.J.
        • Harris W.H.
        Total hip replacement for developmental dysplasia of the hip.
        Clin Orthop. 1995; 311: 40
        • Hartofilakidis G.
        • Stamos K.
        • Karachalios T.
        • et al.
        Congenital hip disease in adults: classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty.
        J Bone Joint Surg. 1996; 78A: 683
        • Eftekhar N.S.
        (Chapter title)Principles of total hip arthroplasty. Mosby, St. Louis (Mo)1978: 437
        • Kerboul M.
        • Mathieu M.
        • Sauzieres P.
        Total hip replacement for congenital dislocation of the hip.
        in: Postel M. Kerboul M. Evrard J. Total hip replacement. Springer, New York1998: 51
        • Mendes D.G.
        • Said M.
        • Aslan K.
        Classification of adult congenital hip dysplasia for total hip arthroplasty.
        Orthopedics. 1996; 19: 881
        • Schanz A.
        Zur Behandlung der veralteten angeborenen Hüftverrenkung.
        Münch Med Wschr. 1922; 69: 930
        • Charnley J.
        The long-term results of low-friction arthroplasty of the hip performed as a primary intervention.
        J Bone Joint Surg. 1972; 54B: 61
        • Russotti G.M.
        • Harris W.H.
        Proximal placement of the acetabular component in total hip arthroplasty: a long-term follow-up study.
        J Bone Joint Surg. 1991; 73A: 587
        • Gruen T.A.
        • McNeice G.M.
        • Amstuzt H.C.
        Modes of failure of cemented stem-type femoral components: a radiographic analysis of loosening.
        Clin Orthop. 1979; 141: 17
        • Linde F.
        • Jensen J.
        Socket loosening in arthroplasty for congenital dislocation of the hip.
        Acta Orthop Scand. 1988; 59: 254
        • Sener N.
        • Tozun I.R.
        • Asik M.
        Femoral shortening and cementless arthroplasty in high congenital dislocation of the hip.
        J Arthroplasty. 2002; 17: 41
        • Kelley S.S.
        High hip center in revision arthroplasty.
        J Arthroplasty. 1994; 9: 503
        • Pagnano M.W.
        • Hanssen A.D.
        • Lewallen D.G.
        • et al.
        The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty: long-term results in patients who have Crowe type II congenital dysplasia of the hip.
        J Bone Joint Surg. 1996; 78A: 1004
        • Gill T.J.
        • Sledge J.B.
        • Müller M.E.
        Total hip arthroplasty with use of an acetabular reinforcement ring in patients who have congenital dysplasia of the hip: results at five to fifteen years.
        J Bone Joint Surg. 1998; 80: 969
        • Torisu T.
        • Izumi H.
        • Fujikawa Y.
        • et al.
        Bipolar hip arthroplasty without acetabular bone-grafting for dysplastic osteoarthritis: results after 6-9 years.
        J Arthroplasty. 1995; 10: 15
        • Edwards B.N.
        • Tullos H.S.
        • Nobel P.C.
        Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty.
        Clin Orthop. 1998; 218: 136
        • Becker D.A.
        • Gustilo R.B.
        Double-chevron subtrochanteric shortening derotational femoral osteotomy combined with total hip arthroplasty for the treatment of complete congenital dislocation of the hip in the adult: preliminary report and description of a new surgical technique.
        J Arthroplasty. 1995; 10: 313
        • Papagelopoulos P.J.
        • Trousdale R.T.
        • Lewallen D.G.
        Total hip arthroplasty with femoral osteotomy for proximal femoral deformity.
        Clin Orthop. 1996; 332: 151