Total hip arthroplasty for sequelae of childhood hip disorders: Current review of management to achieve hip centre restoration

Abstract

Adults requiring total hip arthroplasty (THA) for childhood disorder sequelae present with shortening, limp, pain, and altered gait. THA, which can be particularly challenging due to altered anatomy, requires careful planning, assessment, and computed tomography evaluation. Preoperative templating is essential to establish the appropriate acetabular and femoral size. Information regarding neck length and offset is needed to ensure the proper options are available at THA. Hip centre restoration must be planned preoperatively and achieved intraoperatively with appropriate exposure, identification, and stable fixation with optimum-size components. Identifying the actual acetabular floor is essential as changes include altered anatomy, distortion of the margins and version changes. Proximal femur changes include anatomical variation, decreased canal diameter, cortical thickness, changes in anteversion, and metaphyseal and diaphyseal mismatch. Preoperative assessment should consist of limb assessment for variations due to prior surgical procedures. Evaluation of the shortening pattern with the relationship of the lesser trochanter to the teardrop would help identify and plan for subtrochanteric shortening osteotomy, especially in high-riding hips. The surgical approach must ensure adequate exposure and soft tissue release to achieve restoration of the anatomical hip centre. The femoral components may require modularity to enable restoration of anteversion and optimum fixation.

Keywords: Total hip arthroplasty, Childhood disorder sequelae, Templating, Hip centre restoration, Soft tissue release, Offset

Core Tip: Total hip arthroplasty for childhood disorders in adulthood requires careful planning and awareness regarding the acetabular and femoral anatomic variations. Preoperative planning must include templating to understand acetabular and femoral sizing, offset, and neck length requirements, while modularity may be needed to address any meta-diaphyseal changes. Small acetabular and femoral components are commonly required in these hips to achieve good fixation. Preoperative assessment of the shortening pattern would help plan for a femoral shortening osteotomy, which may be necessary in patients with high-riding hips. Adequate exposure, extensive soft-tissue release, and restoration of the hip centre, leg length and offset are required to achieve favourable long-term outcomes.