Specific approach to total hip arthroplasty in patients with childhood hip disorders sequelae

Abstract

Hip arthroplasty in patients with a history of paediatric hip disorders presents a significant challenge for orthopaedic surgeons. These patients are typically younger and have greater functional demands. Therefore, achieving optimal biomechanical conditions is crucial, involving placement of the acetabulum at the ideal centre of rotation and securing a stable femoral component with good offset to preserve abductor muscle function and restore leg length. The altered anatomy in these cases makes total hip arthroplasty more complex, necessitating thorough preoperative imaging and an individualised surgical approach. Various techniques may be employed to optimise biomechanical outcomes. We propose a modified lateral hip approach, offering exceptional visualisation of the acetabulum and femur while preserving the continuity of the abductor muscles without requiring trochanteric osteotomy. To achieve the most biomechanically advantageous acetabular position, cotyloplasty is our preferred method.

Keywords: Total hip arthroplasty; Pediatric hip sequelae; Center of rotation; Cotyloplasty; Hip abductor muscles

Core Tip: Total hip arthroplasty (THA) in patients with sequelae from childhood hip diseases is often more complex than standard THA. Various techniques are required to restore optimal biomechanical conditions, including restoring the centre of rotation, leg length, and abductor muscle length. Common methods include femoral shortening and medialisation of the acetabular cup. Our preferred techniques are proximal femoral shortening and cotyloplasty.