The peculiarities of hip arthroplasty under the conditions of congenital hip dislocation in adul ts
The goal: to optimize the tactics of total hip replacement (THR) under the conditions of congenital hip dislocation in adults.
Methods: the results of THR in 11 patients (8 females, 3 males) with congenital hip dislocation Crowe IV type. The age of patients amounts from 15 to 57 years (37.4 years in average). 12 operations THR were performed. One patient underwent THR on both hips. An acetabular component was implanted on the place of true acetabulum in all cases. For 6 patients with more than 4 cm shortening of lower extremity THR was performed only after brining down of femoral head on the level of pure acetabulum using external fixator. In the case of bilateral hip dislocation THR procedure was performed on both sides with shortening osteotomies of proximal femurs that prevented biomechanical discrepancy of the lower extremities. Stem of endoprosthesis was selected according to the shape of intramedullar cavity of proximal femur in all cases.
The results of treatment were observed from 6 months to 10 years. Average score according to Harris scale increased by 38.3 points. Healing of postoperative wounds was by the first intention. The bone grafts rearranged and played the role of acetabulum dome. The complications were observed in 2 cases. One patient with the shortening of 4.5 cm underwent THR simultaneously with extremity elongation. A sciatic neuritis was observed after the operation. The function of extremity was restored after 6 months of conservative treatment. Another case was associated with purulent complication that caused operative wound revision without removal of endoprothesis.
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