THA in Dysplastic Hips.

Dr Rajeev K Sharma

This is a prospective study of130 patients (age group 30–65 years)with hip dysplasia were operated upon with Total Hip Arthroplasty. Of the 130 patients 37 were neglected cases, with proximal migration of femur (Crowe’s grade IV). In such cases sub trochanteric osteotomy was done to bring down the head to the level of acetabulum.Follow up at 2weeks,6 weeks, 3months, 6months, 1year and 3 years was done. We assessed the functional outcome of the patient using Harris Hip Score, Pain Score and radiological assessment. Four patients were lost in follow up.

Follow up ranged from 6 months to 11 Yrs. Pain score was found to decreasesignificantly (p value .007).Harris hip score improved in all patients. The Harris Hip Score at one month was 66 +/- 7 (mean +/- standard deviation); at three months 72 +/- 6; at one year 74 +/- 5; at three years 86 +/- 6. Mobilization and weight bearing was started immediately in the postoperative period except in 37 cases where sub-trochanteric osteotomy was done.One acetabular loosening was observed at an early follow up which was revised. One of the early case had delayed union at osteotomy site which needed bone grafting. No sciatic nerve palsy was noted.

Patients with dysplastic hip have very few options to both relieve pain and to give good functional outcome. Conservative treatment has no role. There are a number of osteotomies described in the literature which can give them some relief but results are unpredictable. Total hip arthroplasty can give these patients both pain relief and near normal functional freedom. Withlatest designsimplants have better survivability and longevity.