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The Journal of Bone and Joint Surgery (American) 86:242-250 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Total Hip Arthroplasty for Congenital Hip Disease

George Hartofilakidis, MD1 and Theofilos Karachalios, MD2

1 21 Fotiou Patriarchou Street, Athens 11471, Greece. E-mail address: hartofilakidis{at}yahoo.gr
2 Department of Orthopaedic Surgery, School of Health Studies, University of Thessaly, 22 Papakiziazi Street, Larisa, Greece 41222. E-mail address: kar{at}med.uth.gr

Investigation performed at the Orthopaedic Department, University of Athens, Athens, Greece

The authors did not receive grants or outside funding in support of their research or preparation of this work. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: It is generally agreed that the clinical and radiographic results of total hip replacement performed for degenerative arthritis secondary to congenital hip disease vary depending on the severity of the anatomical abnormality. In this study, we report the mid-term and long-term clinical and radiographic results of total hip arthroplasty performed for each of the three different types of congenital hip disease.

Methods: Between 1976 and 1994, the senior author performed 229 consecutive primary total hip arthroplasties in 168 patients with osteoarthritis secondary to congenital hip disease. Seventy-six hips were dysplastic, sixty-nine had a low dislocation, and eighty-four had a high dislocation. The Charnley low-friction technique was performed in 178 hips, and the so-called hybrid technique was performed in forty-six hips. Cementless arthroplasty was used in only five hips.

Results: After a minimum of seven years of follow-up, the rates of revision of the acetabular components were 15% in the dysplastic hips, 21% in the hips with a low dislocation, and 14% in those with a high dislocation. The rates of revision of the femoral components were 14%, 14%, and 16%, respectively. Survivorship analysis predicted an overall rate of prosthetic survival at fifteen years of 88.8% ± 4.8% in the dysplastic hips, 73.9% ± 7.2% in the hips with a low dislocation, and 76.4% ± 8.1% in those with a high dislocation.

Conclusions: An understanding of the anatomical abnormalities and the use of appropriate techniques and implants make total hip arthroplasty feasible for treatment of the three types of congenital hip disease. In patients with a low dislocation, the major technical problem is reconstruction of the natural acetabulum. In those with a high dislocation, the challenge is to place the acetabular component inside the reconstructed true acetabulum and to use an appropriate femoral implant in the hypoplastic narrow femoral diaphysis.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.


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George Hartofilakidis MD FACS
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