Skip to main content
SpringerLink
Log in

Long-term outcomes of total hip arthroplasty in patients with developmental dysplasia of the hip: a minimum 21-year follow-up

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Early osteoarthritis (OA) due to developmental dysplasia of the hip (DDH) is a known indication for total hip arthroplasty (THA). Though screening tools and joint-preserving procedures have been established successfully, there still is a relevant number of patients suffering DDH. Due to the lack of long-term outcome studies, we like to close this gap and present the results of a highly specialized center.

Methods

The study included 126 patients, who were treated in our institution with primary THA for DDH between January 1997 and December 2000. At the time of final follow-up, at a mean of 23 years postoperatively, 110 patients (121 hips) were clinically evaluated using the Harris-Hip Score. In addition, complication and surgical revision rates were assessed. We collected surgery-related data like implant choice and special surgical features such as autologous acetabular reconstruction or femoral osteotomies. Additionally, the severity of preoperative DDH was measured radiographically according to Crowe classification.

Results

There were 91 female (83%) and 19 male (17%) patients with an average age of 51 ± 9.5 years (range 21–65) included. Mean follow-up was 23 ± 1.3 years (21–25), with a minimum of 21 years being necessary for inclusion. Using revision for any indication as primary endpoint, the Kaplan–Meier survivorship was 98.3% at 10 years and 81.8% at final follow-up. The overall revision rate was 18% (22 cases), which were split up as follows: 20 (17%) implant failures (loosened or broken components), one (1%) periprosthetic infection and one (1%) periprosthetic fracture. Regarding complications, we observed nine (7%) dislocations and one case (1%) with severe heterotopic ossification that required surgical excision. The mean Harris-Hip score at latest follow-up was 78 ± 14 points (32–95).

Conclusions

Though implants and surgical techniques have improved over time, our results suggest THA in patients suffering DDH to be seriously challenging with relatively high overall complications in long-term observation and fair clinical outcome after 21 years postoperatively. There is evidence that prior osteotomy might be associated with a higher revision rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig.1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of data and materials

The data that support the findings of this study are available on request from the corresponding author [MO]. The data are not publicly available, because their containing information that could compromise the privacy of research participants.

References

  1. Graf R (1980) The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment. Arch Orthop Trauma Surg 97(2):117–133

    CAS  PubMed  Google Scholar 

  2. Graf R (1983) New possibilities for the diagnosis of congenital hip joint dislocation by ultrasonography. J Pediatr Orthop 3(3):354–359

    CAS  PubMed  Google Scholar 

  3. Wientroub S, Grill F (2000) Ultrasonography in developmental dysplasia of the hip. J Bone Joint Surg Am 82-a(7):1004–1018

    CAS  PubMed  Google Scholar 

  4. Cooper RR (1977) Biomechanics of the normal and diseased hip: theoretical foundation technique and results of treatment. JAMA 237(15):1623–1623

    Google Scholar 

  5. Crowe JF, Mani VJ, Ranawat CS (1979) Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am 61(1):15–23

    CAS  PubMed  Google Scholar 

  6. Greber EM et al (2017) Challenges in total hip arthroplasty in the setting of developmental dysplasia of the hip. J Arthroplasty 32(9s):S38-s44

    PubMed  Google Scholar 

  7. Staats K, Kubista B, Windhager R (2019) Challenges in primary total hip arthroplasty. Z Orthop Unfall 157(4):445–460

    PubMed  Google Scholar 

  8. Sakellariou VI et al (2014) Reconstruction of the acetabulum in developmental dysplasia of the hip in total hip replacement. Arch Bone Jt Surg 2(3):130–136

    PubMed  PubMed Central  Google Scholar 

  9. Perry KI, Berry DJ (2012) Femoral considerations for total hip replacement in hip dysplasia. Orthop Clin North Am 43(3):377–386

    PubMed  Google Scholar 

  10. Shi XT et al (2019) Total hip arthroplasty for crowe type iv hip dysplasia: surgical techniques and postoperative complications. Orthop Surg 11(6):966–973

    PubMed  PubMed Central  Google Scholar 

  11. Shapira J et al (2021) Total hip arthroplasty after pelvic osteotomy for acetabular dysplasia: a systematic review. J Orthop 25:112–119

    PubMed  PubMed Central  Google Scholar 

  12. Jia CQ et al (2022) Mid-term outcomes after total hip arthroplasty in 106 Crowe II/III hips: different hip center positions. Eur J Med Res 27(1):282

    PubMed  PubMed Central  Google Scholar 

  13. Ueoka K, Kabata T (2020) Patient-reported outcomes following primary total hip arthroplasty in Crowe type III or IV developmental dysplasia are comparable to those in Crowe type I: a case-control study of 96 hips with intermediate-term follow-up. BMC Musculoskelet Disord. 21(1):344

    PubMed  PubMed Central  Google Scholar 

  14. Zhou Y et al (2021) Long-term effectiveness of total hip arthroplasty for Crowe type IV developmental dysplasia of the hip. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 35(12):1531–1536

    PubMed  Google Scholar 

  15. Paavilainen T, Hoikka V, Paavolainen P (1993) Cementless total hip arthroplasty for congenitally dislocated or dysplastic hips. technique for replacement with a straight femoral component. Clin Orthop Relat Res 297:71–81

    Google Scholar 

  16. Paavilainen T, Hoikka V, Solonen KA (1990) Cementless total replacement for severely dysplastic or dislocated hips. J Bone Joint Surg Br 72(2):205–211

    CAS  PubMed  Google Scholar 

  17. Colo E et al (2016) Satisfying results of primary hip arthroplasty in patients with hip dysplasia at a mean followup of 20 years. Clin Orthop Relat Res 474(11):2462–2468

    PubMed  PubMed Central  Google Scholar 

  18. Iwase T et al (2016) Favorable results of primary total hip arthroplasty with acetabular impaction bone grafting for large segmental bone defects in dysplastic hips. J Arthroplasty 31(10):2221–2226

    PubMed  Google Scholar 

  19. Rees HW et al (2012) Revision total hip arthroplasty without bone graft of high-grade acetabular defects. J Arthroplasty 27(1):41–47

    PubMed  Google Scholar 

  20. Rozkydal Z, Janícek P, Smíd Z (2005) Total hip replacement with the CLS expansion shell and a structural femoral head autograft for patients with congenital hip disease. J Bone Joint Surg Am 87(4):801–807

    PubMed  Google Scholar 

  21. Whaley AL, Berry DJ, Harmsen WS (2001) Extra-large uncemented hemispherical acetabular components for revision total hip arthroplasty. J Bone Joint Surg Am 83(9):1352–1357

    CAS  PubMed  Google Scholar 

  22. Chougle A, Hemmady MV, Hodgkinson JP (2006) Long-term survival of the acetabular component after total hip arthroplasty with cement in patients with developmental dysplasia of the hip. J Bone Joint Surg Am 88(1):71–79

    PubMed  Google Scholar 

  23. Karachalios T et al (2013) Acetabular reconstruction in patients with low and high dislocation: 20- to 32-year survival of an impaction grafting technique (named cotyloplasty). Bone Joint J 95-b(7):887–892

    PubMed  Google Scholar 

  24. Abdel MP et al (2014) Uncemented acetabular components with femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip: a concise follow-up report at a mean of twenty years. J Bone Joint Surg Am 96(22):1878–1882

    PubMed  Google Scholar 

  25. Janz V et al (2021) Developmental hip dysplasia treated with cementless total hip arthroplasty using a straight stem and a threaded cup-a concise follow-up, at a mean of twenty-three years. J Clin Med 10(9):1912

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Nawabi DH et al (2014) Durable fixation achieved with medialized, high hip center cementless THAs for Crowe II and III dysplasia. Clin Orthop Relat Res 472(2):630–636

    PubMed  Google Scholar 

  27. Kaneuji A et al (2013) Cementless anatomic total hip femoral component with circumferential porous coating for hips with developmental dysplasia: a minimum ten-year follow-up period. J Arthroplasty 28(10):1746–1750

    PubMed  Google Scholar 

  28. Engesaeter LB, Furnes O, Havelin LI (2008) Developmental dysplasia of the hip–good results of later total hip arthroplasty: 7135 primary total hip arthroplasties after developmental dysplasia of the hip compared with 59774 total hip arthroplasties in idiopathic coxarthrosis followed for 0 to 15 years in the Norwegian Arthroplasty Register. J Arthroplasty 23(2):235–240

    PubMed  Google Scholar 

  29. Mei XY et al (2019) Long-term outcomes of total hip arthroplasty in patients younger than 55 years: a systematic review of the contemporary literature. Can J Surg 62(4):249–258

    PubMed  PubMed Central  Google Scholar 

  30. Mäkelä KT et al (2014) Failure rate of cemented and uncemented total hip replacements: register study of combined Nordic database of four nations. BMJ 348:f7592

    PubMed  Google Scholar 

  31. Hailer NP, Garellick G, Kärrholm J (2010) Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register. Acta Orthop 81(1):34–41

    PubMed  PubMed Central  Google Scholar 

  32. Karczewski D et al (2022) Femoral head and neck autograft in arthroplasty for developmental dysplasia of the hip: a systematic review of long-term outcomes. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-022-04736-3

    Article  PubMed  PubMed Central  Google Scholar 

  33. MacKenzie JR, Kelley SS, Johnston RC (1996) Total hip replacement for coxarthrosis secondary to congenital dysplasia and dislocation of the hip long-term results. J Bone Joint Surg Am 78(1):55–61

    CAS  PubMed  Google Scholar 

  34. Sochart DH, Porter ML (1997) The long-term results of Charnley low-friction arthroplasty in young patients who have congenital dislocation, degenerative osteoarthrosis, or rheumatoid arthritis. J Bone Joint Surg Am 79(11):1599–1617

    CAS  PubMed  Google Scholar 

  35. Abdulkarim A et al (2013) Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials. Orthop Rev (Pavia) 5(1):e8

    PubMed  Google Scholar 

  36. Kaiser D et al (2022) Acetabular reconstruction with femoral head autograft in primary total hip arthroplasty through a direct anterior approach is a reliable option for patients with secondary osteoarthritis due to developmental dysplasia of the hip. Arch Orthop Trauma Surg 142(10):2957–2964

    PubMed  Google Scholar 

  37. Eskelinen A et al (2006) Cementless total hip arthroplasty in patients with high congenital hip dislocation. J Bone Joint Surg Am 88(1):80–91

    PubMed  Google Scholar 

  38. Dornacher D et al (2022) Acetabular deficiency in borderline hip dysplasia is underestimated by lateral center edge angle alone. Arch Orthop Trauma Surg 143(7):3937–3944

    PubMed  PubMed Central  Google Scholar 

  39. Cameron HU, Botsford DJ, Park YS (1996) Influence of the Crowe rating on the outcome of total hip arthroplasty in congenital hip dysplasia. J Arthroplasty 11(5):582–587

    CAS  PubMed  Google Scholar 

  40. Yacovelli S et al (2021) Prior pelvic osteotomy affects the outcome of subsequent total hip arthroplasty. J Arthroplasty 36(2):600–604

    PubMed  Google Scholar 

  41. Gallazzi E et al (2019) what is the impact of a previous femoral osteotomy on THA? a systematic review. Clin Orthop Relat Res 477(5):1176–1187

    PubMed  PubMed Central  Google Scholar 

  42. Duncan S et al (2015) Does previous osteotomy compromise total hip arthroplasty? a systematic review. J Arthroplast 30(1):79–85

    Google Scholar 

  43. Kim CH, Kim JW (2020) Periacetabular osteotomy vs. total hip arthroplasty in young active patients with dysplastic hip: systematic review and meta-analysis. Orthop Traumatol Surg Res 106(8):1545–1551

    PubMed  Google Scholar 

  44. Lerch TD et al (2017) One-third of hips after periacetabular osteotomy survive 30 years with good clinical results, no progression of arthritis, or conversion to THA. Clin Orthop Relat Res 475(4):1154–1168

    PubMed  Google Scholar 

Download references

Acknowledgements

Images of Figures 1 and 2 are provided by courtesy of Michael Hook MD.

Funding

The authors have no professional or financial affiliations that may have biased this study. This work was conducted with the approval of the Hamburg University College of Medicine. This study was performed at Helios ENDO-Klinik Hamburg.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany

    Hendrik Fahlbusch, Maximilian Budin, Fidelius von Rehlingen Prinz, Philip Linke, Mustafa Citak, Thorsten Gehrke & Malte Ohlmeier

  2. Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Hendrik Fahlbusch, Annabelle Volk & Fidelius von Rehlingen Prinz

  3. Department of Orthopaedic and Trauma Surgery, UKM Marienhospital, Mauritiusstraße 5, 48565, Steinfurt, Germany

    Malte Ohlmeier

Authors
  1. Hendrik Fahlbusch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maximilian Budin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Annabelle Volk
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fidelius von Rehlingen Prinz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Philip Linke
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mustafa Citak
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thorsten Gehrke
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Malte Ohlmeier
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The authors contribution to the manuscript is declared in detail in the following: conceptualization HF, MO; methodology HF, MB, AV, MO; validation all authors; formal analysis HF, MB, MO.; writing—original draft preparation HF, PL, MO; review and editing all authors; visualization HF, MB; supervision MO; project administration MO. All authors have read and agreed to the final version of this manuscript. All authors have approved the submission of this manuscript. The authors declare that the manuscript in its current (or in any other) form has not been published previously, is not under consideration for publication in another journal at this time, and will not be published anywhere else in this form or following translation.

Corresponding author

Correspondence to Malte Ohlmeier.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

The study design was approved by the local ethics committee (2021–100,622-BO-ff) and informed consent was obtained from each patient.

Consent to publish and participate

All patients gave informed consent to participate in the study, and agreed having their data published in a journal article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fahlbusch, H., Budin, M., Volk, A. et al. Long-term outcomes of total hip arthroplasty in patients with developmental dysplasia of the hip: a minimum 21-year follow-up. Arch Orthop Trauma Surg 143, 6609–6616 (2023). https://doi.org/10.1007/s00402-023-04970-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-023-04970-3

Keywords

Search

Navigation