Total hip replacement in high riding developmental dysplasia of the hip: cementless total hip arthroplasty with femoral shortening using a subtrochanteric resection.

Abstract

Total hip arthroplasty in younger patients with high riding dislocations is a challenging procedure. Although many procedures have been proposed, our preferred technique for this is to insert a small sized cementless acetabular component in the native acetabulum, a small sized cementless femoral component and perform a subtrochanteric oblique cylindrical resection of 4 centimeters. The femur is fixed with a plate using unicortical screw fixation. This technique is preferred to avoid stretching the neurovascular structures. This procedure was performed on 91 hips of 83 patients with a mean age of 45 years, between 1990 and 2005. After 8 years we observed a 10% failure with a good clinical outcome. The Merle d'Aubigne Hip Scores were improved from 10.65 preoperatively to 34.95 postoperatively. Despite a high complication and failure rate the patients were pleased with the final outcome. We continue to recommend this procedure in this unique patient population.