Hip Joint Replacement Surgery for Hip Dysplasia
Overview
Joint replacement surgery for hip dysplasia is often more complex than hip replacement for other conditions. Some of the reasons for increased complexity are:
- Distorted anatomy of the pelvis or thigh bone are common and may require special techniques – the shallow socket may require special implants or bone grafts to provide adequate support. The upper thigh bone may be displaced, twisted or have a small canal because of dysplasia.
- Younger patients – approximately one out of four hip replacement procedures before the age of fifty is because of hip dysplasia. These younger patients generally want to be more active and the artificial hip needs to last longer because of the younger age at time of surgery.
- Previous surgery is common and may require special attention. Even previous hip arthroscopy increases the complexity of total hip replacement in patients with hip dysplasia
- Leg length differences may be present and this can increase the complexity.
For these reasons, it is important for people with hip dysplasia to choose a joint replacement surgeon who has experience specifically with hip dysplasia patients.
Hip joint replacement surgery is also called “total hip arthroplasty” or “total hip replacement.” This procedure uses artificial parts made of specialized metal, ceramic or very hard plastic to replace the damaged joint. While short-term results are similar to total hip replacements for other reasons, the long-term revision rate is worse for hip dysplasia patients. This is especially true for patients with more severe hip dysplasia.
Total Hip Replacement
When the dysplasia is more severe, or the patient is older, then a traditional total hip replacement is usually performed.
Hip dysplasia has unique features that need special techniques for hip replacement surgery as successful as possible. For surgical planning, hip dysplasia is usually classified from mild to severe with Type 1 being the least involved and Type 4 the most severe. Type 4 is when the hip is completely dislocated, and completely dislocated hips are generally referred to major hip replacement centers because these are rare and need the most experienced surgeons.
Lesser degrees of dysplasia still require special attention to get the best results. The anatomy of a dysplastic hip is different from the anatomy of other types of hip arthritis. The socket is more shallow than normal and may not be in the normal location. The upper part of the thigh bone may be small or abnormally shaped, and the legs may not be the same length. Previous surgical procedures during childhood may also cause difficulty in planning and performing a total hip replacement.
Placement of the socket is perhaps the most important part of total hip replacement for patients with hip dysplasia. The best results are usually obtained when the socket is placed as close as possible to the normal anatomical location. Pre-operative planning is especially important because dysplastic hips may be at a higher location than normal and need special techniques to be brought down to the normal level. Deepening of the socket is almost always needed and may require careful cracking of the inside wall of the pelvis combined with bone grafting to make sure the socket is placed deep enough that there is a good bone roof over the artificial socket.
Additional considerations are whether to use cement to hold the artificial parts in place, or whether to use special methods that allow bone to grow into the artificial parts without cement. This is especially important in hip dysplasia because patients tend to be younger than patients with other types of arthritis. In young patients there are some benefits to avoiding the use of cement if possible. Also, younger patients may need different types of surfaces for their artificial joints. Currently, the preferred artificial joint surfaces for young people tend to be ceramics, or metal on modern polyethylenes.
If you need a total hip replacement for hip dysplasia, it’s a good idea to go to an experienced surgeon. Fortunately, there are many but that’s because hip dysplasia is more common than most people realize. You should be able to find a good hip replacement surgeon near you. Please review our list of questions you might want to ask the surgeon to help you decide whether they are the right surgeon for you.
A recent update for doctors was published as a series of papers in a review journal called Orthopedic Clinics of North America. Here are the references in case your doctor is interested.
- Acetabular considerations during total hip arthroplasty for hip dysplasia.
- Femoral considerations for total hip replacement in hip dysplasia
- Technical considerations in total hip arthroplasty after femoral and periacetabular osteotomies.
Salvage Procedures in Young Patients
Two procedures that are rarely used today are the Colonna Arthroplasty and the Girdlestone Procedure. These two procedures have largely been replaced by hip re-surfacing procedures.
Hip fusion is also a last resort where the hip joint is removed and the bones are secured together. This procedure eliminates hip motion, but it relieves pain and is surprisingly well-tolerated for sitting, walking and light sports.
One alternative to hip fusion in extreme cases or in underdeveloped regions is called a “pelvic support osteotomy.” In this procedure the femur below the hip joint is realigned severely to shorten the leg and place it in a better position to relieve pressure on the hip joint.
Complications
Complications are more common for hip replacements in patients with severe dysplasia when compared to routine hip replacements in non-dysplastic patients. Your surgeon can discuss all the risks and benefits of surgery specific to your hip problem. Fortunately, the vast majority of patients obtain predictable pain relief and a durable hip replacement. Periodic x-rays after surgery are performed, usually yearly, because hip replacements may wear out over time, or loosen and need revision.
