Lessons learned from study of congenital hip disease in adults

Abstract

Orthopaedic surgeons specialising in adult hip reconstruction surgery often face the problem of osteoarthritis secondary to congenital hip disease (CHD). To achieve better communication among physicians, better treatment planning and evaluation of the results of various treatment options, an agreed terminology is needed to describe the entire pathology. Furthermore, a generally accepted classification of the deformities is necessary. Herein, the authors propose the use of the term “congenital hip disease” and its classification as dysplasia, low dislocation and high dislocation. Knowledge of the CHD natural history facilitates comprehension of the potential development and progression of the disease, which differs among the aforementioned types. This can lead to better understanding of the anatomical abnormalities found in the different CHD types and thus facilitate preoperative planning and choice of the most appropriate management for adult patients. The basic principles for improved results of total hip replacement in patients with CHD, especially those with low and high dislocation, are: Wide exposure, restoration of the normal centre of rotation and the use of special techniques and implants for the reconstruction of the acetabulum and femur. Application of these principles during total hip replacement in young female patients born with severe deformities of the hip joint has led to radical improvement of their quality of life.

Keywords: Congenital hip disease; Low dislocation of the hip; Hartofilakidis classification; Dysplasia of the hip; High dislocation of the hip; Total hip replacement; Trochanteric osteotomy; Restoration of the normal centre of rotation; Femoral shortening; Patients’ satisfaction

Core tip: This review is based on the knowledge and experience acquired in the long course of the senior author’s surgical practice on the complex problem of congenital deformities of the hip in adults.