Total Hip Arthroplasty in Neglected Congenital Dislocation of the Hip

Between 1984 and 1995, 74 total hip replacements were performed in 64 adult patients who had painful untreated congenital dislocation of the hip. The arthroplasty was performed in the position of the true acetabulum in all patients who had either high or low congenital dislocations of the hip. The femoral head was positioned in the true acetabulum after either osteotomy of the greater trochanter or shortening of the femur, or progressively using external fixation. Information was available on all patients with a followup of 1 to 11 years (mean, 7.2 years). Of the 74 replaced hips, 70 showed marked improvement concerning pain, gait, and mobility, according to the Merle D'Aubigne and Postel scale. Four hips were revised with satisfactory results. The reason for revision was infection in one case and loosening of the plastic cup in three cases. Shortening of the femur by removing a segment of bone below the level of the lesser trochanter followed by osteosynthesis without osteotomy of the greater trochanter was found to be the best method for treating bilateral and several unilateral high congenital dislocation of the hip.