Joint replacement in the dysplastic patient: Surgical considerations and techniques

Abstract

Arthroplasty for degenerative arthritis of the dysplastic hip increases in complexity depending on the patho-anatomy of the deformity and degree of subluxation/dislocation of the femur. Prosthetic replacement in the face of these deformities requires restoration of the normal joint center wherever possible to restore the normal biomechanics of the hip. Reconstruction of the dysplastic acetabulum requires medialization, combined with superolateral structural augmentation using a femoral head autograft/allograft or porous metal augments. On the femoral side, the variable anteversion of the canal changes the normal geometric relationship between the metaphysis and the diaphysis. Perhaps the greatest challenge in performing THR of the dysplastic hip occurs in cases where more than 3 cm of caudal displacement of the femur is required to restore the femoral head to the native hip center. Femoral shortening is performed to allow less traumatic hip reduction and to reduce the risk of traction sciatic nerve injury and foot drop.