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World J Orthop. Sep 18, 2014; 5(4): 412-424
Published online Sep 18, 2014. doi: 10.5312/wjo.v5.i4.412
Current concept in dysplastic hip arthroplasty: Techniques for acetabular and femoral reconstruction
Goran Bicanic, Katarina Barbaric, Ivan Bohacek, Ana Aljinovic, Domagoj Delimar
Goran Bicanic, Domagoj Delimar, Department of Orthopaedic Surgery, University of Zagreb, School of Medicine, 10000 Zagreb, Croatia
Goran Bicanic, Katarina Barbaric, Ivan Bohacek, Ana Aljinovic, Domagoj Delimar, Department of Orthopaedic Surgery, Clinical Hospital Centre Zagreb, 10000 Zagreb, Croatia
Author contributions: Bicanic G designed, prepared, partially wrote and revised manuscript; Barbaric K contributed to conception of the study, wrote part of the manuscript, helped with obtaining and drawing of figures; Bohacek I contributed in study design, wrote part of the manuscript, helped with references, editing and preparing the manuscript; Aljinovic A contributed to study conception, wrote part of the manuscript, helped with the references and figures and revised manuscript; Delimar D helped with design of the study and figures, helped in preparation and revision of the manuscript and editing; all authors approved final version to be published.
Correspondence to: Ivan Bohacek, MD, PhD, Department of Orthopaedic Surgery, Clinical Hospital Centre Zagreb, Salata 7, 10000 Zagreb, Croatia. gbic@mef.hr
Telephone: +385-1-2368911 Fax: +385-1-2379913
Received: December 28, 2013
Revised: March 23, 2014
Accepted: June 10, 2014
Published online: September 18, 2014
Abstract

Adult patients with developmental dysplasia of the hip develop secondary osteoarthritis and eventually end up with total hip arthroplasty (THA) at younger age. Because of altered anatomy of dysplastic hips, THA in these patients represents technically demanding procedure. Distorted anatomy of the acetabulum and proximal femur together with conjoined leg length discrepancy present major challenges during performing THA in patients with developmental dysplasia of the hip. In addition, most patients are at younger age, therefore, soft tissue balance is of great importance (especially the need to preserve the continuity of abductors) to maximise postoperative functional result. In this paper we present a variety of surgical techniques available for THA in dysplastic hips, their advantages and disadvantages. For acetabular reconstruction following techniques are described: Standard metal augments (prefabricated), Custom made acetabular augments (3D printing), Roof reconstruction with vascularized fibula, Roof reconstruction with pedicled iliac graft, Roof reconstruction with autologous bone graft, Roof reconstruction with homologous bone graft, Roof reconstruction with auto/homologous spongious bone, Reinforcement ring with the hook in combination with autologous graft augmentation, Cranial positioning of the acetabulum, Medial protrusion technique (cotyloplasty) with chisel, Medial protrusion technique (cotyloplasty) with reaming, Cotyloplasty without spongioplasty. For femoral reconstruction following techniques were described: Distraction with external fixator, Femoral shortening through a modified lateral approach, Transtrochanteric osteotomies, Paavilainen osteotomy, Lesser trochanter osteotomy, Double-chevron osteotomy, Subtrochanteric osteotomies, Diaphyseal osteotomies, Distal femoral osteotomies. At the end we present author’s treatment method of choice: for acetabulum we perform cotyloplasty leaving only paper-thin medial wall, which we break during acetabular cup impacting. For femoral side first we peel of all rotators and posterior part of gluteus medius and vastus lateralis from greater trochanter on the very thin flake of bone. This method allows us to adequately shorten proximal femoral stump, with possibility of additional resection of proximal femur. Furthermore, several advantages and disadvantages of this procedure are also discussed.

Keywords: Hip, Arthroplasty, Dysplasia, Reconstruction, Techniques, Acetabulum, Femur, Osteoarthritis, Developmental dysplasia of the hip

Core tip: Total hip arthroplasty (THA) in adult patients with developmental dysplasia of the hip is technically demanding procedure. In this paper we present a variety of surgical techniques available for THA in dysplastic hips, their advantages and drawbacks, ending with the author’s treatment method of choice.