Total Hip Arthroplasty in the Neglected Developmental Dislocation of the Hip

SUMMARY We evaluated total hip arthroplasty in patients with neglected developmental dislocation of the hip with regard to surgical method and modifications, problems encountered during surgery, and follow-up results. A total of 25 hips (Hartofilakidis type 3, high dislocation) of 22 patients (22 women; mean age 44 years; range 28-61 years) who underwent total hip arthroplasty were clinically and radiologically evaluated. In all cases, cementless acetabular components were placed in the true acetabulum. Only one acetabula required structural autograft. Cementless stems were used on the femoral side. A subtrochanteric osteotomy was performed in 23 hips. The mean follow-up period was five years (range 2 to 10 years). The scale of Merle d'Aubigne and Postel, as modified by Charnley was used to evaluate the clinical results. Pain improved from a mean of 2.3 preoperatively to 5.7 postoperatively. Function improved from 2.3 to 4.5 and mobility from 2.3 to 4.4 at the final follow-up evaluation. No acetabular autograft resorption or non- union were observed. Intraoperatively femoral fissure occurred in 3 cases. One sciatic nerve palsy occurred. Brooker type IV heterotopic ossification was observed in one case. Three polyethylen wear, 1 DVT, 2 osteolysis were observed during the follow-up.Total hip arthroplasty proved successful in neglected developmental dislocation of the hip.