Treatment of osteoarthrosis secondary to congenital dislocation of the hip: primary cemented surface replacement compared with conventional total hip replacement

People who have had congenital dislocation of the hip frequently develop subsequent osteoarthrosis with dysplasia (abnormal tissue development) in the same area. Surgical correction using partial or total hip replacement is much more difficult in these patients than in patients whose only problem is osteoarthritis. Often the socket part of the hip is shallow, and this or other changes in the bony structure necessitate particular compensations in surgical hardware and techniques. The outcomes of 74 cemented total hip replacements, in which both ball and socket were replaced, in 55 patients (C group), and of 37 cemented surface replacements of the socket portion only in 32 patients (S group) were evaluated. Patients treated with surface rather than conventional replacements tended to have less severe dysplasia and require less extensive surgical reconstruction. Short-term outcomes in both groups were favorable, and patients reported pain relief and improved hip function. However, group C had more postsurgical complications such as infection, dislocation, and partial nerve paralysis. Infection may have been related to the greater degree of surgical intervention, while nerve dysfunction was related to surgically-induced leg lengthening. All older patients in the C group did well in the long-term, while durable long-term results were not achieved in younger patients in either group. Early surgical techniques and anatomic factors contributed to difficulties with the surface replacement surgery. The major failure necessitating additional surgery or treatment was aseptic (noninfected) loosening of the socket prosthesis. The results suggest that younger patients (under age 60) with osteoarthrosis following congenital hip dislocation should receive treatment other than total or surface hip replacement surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)