Total Hip Arthroplasty for Congenital Hip Disease

BACKGROUND: It is generally agreed that the clinical and radiographic results of total hip replacement performed for degenerative arthritis secondary to congenital hip disease vary depending on the severity of the anatomical abnormality. In this study, we report the mid-term and long-term clinical and radiographic results of total hip arthroplasty performed for each of the three different types of congenital hip disease. METHODS: Between 1976 and 1994, the senior author performed 229 consecutive primary total hip arthroplasties in 168 patients with osteoarthritis secondary to congenital hip disease. Seventy-six hips were dysplastic, sixty-nine had a low dislocation, and eighty-four had a high dislocation. The Charnley low-friction technique was performed in 178 hips, and the so-called hybrid technique was performed in forty-six hips. Cementless arthroplasty was used in only five hips. RESULTS: After a minimum of seven years of follow-up, the rates of revision of the acetabular components were 15% in the dysplastic hips, 21% in the hips with a low dislocation, and 14% in those with a high dislocation. The rates of revision of the femoral components were 14%, 14%, and 16%, respectively. Survivorship analysis predicted an overall rate of prosthetic survival at fifteen years of 88.8% +/- 4.8% in the dysplastic hips, 73.9% +/- 7.2% in the hips with a low dislocation, and 76.4% +/- 8.1% in those with a high dislocation. CONCLUSIONS: An understanding of the anatomical abnormalities and the use of appropriate techniques and implants make total hip arthroplasty feasible for treatment of the three types of congenital hip disease. In patients with a low dislocation, the major technical problem is reconstruction of the natural acetabulum. In those with a high dislocation, the challenge is to place the acetabular component inside the reconstructed true acetabulum and to use an appropriate femoral implant in the hypoplastic narrow femoral diaphysis.