Dysplasia-related hip dislocation in adults
| Classification according to ICD-10 | |
|---|---|
| Q65.0 | Congenital dislocation of the hip joint, unilateral |
| Q65.1 | Congenital dislocation of the hip joint, bilateral |
| Q65.2 | Congenital dislocation of the hip joint, unspecified |
| ICD-10 online (WHO version 2019) | |
The dysplasiebedingte dislocation in adults is a (untreated) hypoplasia with secondary dislocation of the hip joint . The femoral head is not in the acetabulum , but above it on the iliac bone . In Anglo-Saxon usage, the situation is called neglected congenital dislocation of the hip - where “dislocation” is actually as wrong as “luxation”.
Clinical picture and treatment
The adult or elderly patients know what they have. You limp and are unsure of standing and walking. Pain doesn't play a big role.
A pelvic x-ray is sufficient for diagnosis. The radiological findings should not be confused with the proximal femoral defect or with the (extremely rare) teratological dislocation.
Only the endoprosthesis can be used for treatment . Their installation is difficult in several ways; because
- the never used (hypoplastic) acetabulum is small
- the bottom of the pan is very thin
- the pillars are very narrow
- the hip muscles, nerves and blood vessels have been "shortened" over the decades.
Therefore, when approaching (always with the patient lying on his side), the first thing to do is to completely resect the joint capsule and expose the primary acetabulum. The femoral head should be kept for acetabular surgery. A (cement-free) socket can usually be accommodated with small burrs and implants in the hindquarters. Sometimes dysplasia revision cups are needed. Under no circumstances may the abutments be milled away. A so-called anti-luxation inlay is recommended.
Even after a tenotomy of the psoas tendon on the lesser trochanter , the upper end of the femur usually cannot be brought down so far that the prosthesis head can be inserted into the socket. Then the subtrochanteric femur shortening by a few centimeters is necessary. When placed at an angle, it is torsionally stable. This osteotomy already requires a cementless endoprosthesis shaft with proximal (metaphyseal) anchoring. It makes sense to use modular stem systems which, with a short neck and low offset, enable a relatively low-tension reduction (sciatic nerve).
literature
- MM Anwar, N. Sugano, K. Masuhafu, T. Kadowaki, K. Takaoka: Total hip arthroplasty in the neglected congenital dislocation of the hip: a five- to 14-year follow-up study. Clinical Orthopedics and Related Research 295 (1993)
- Josef Beck: The untreated congenital high hip dislocation and its function . Dissertation, University of Munich 1986.
- JJ Callaghan, AG Rosenberg, HE Rubash: The Adult Hip , 2 vol. Lippincott Williams & Wilkins 2007, ISBN 978-0-7817-5092-9 .
- Rüdiger Döhler : Lexicon of orthopedic surgery . Springer, Berlin 2003, ISBN 3-540-41317-0 , pp. 70-73.
- Rüdiger Döhler: Total hip replacement in neglected congenital dislocation of the hip. SICOT, Marrakech 2007.
- MS Park, KH Kim, WC Jeong: Transverse subtrochanteric shortening osteotomy in primary total hip arthroplasty for patients with severe hip developmental dysplasia. Journal of Arthroplasty 22 (2007), pp. 1031-1036.
- K. Stafilas, P. Koulouvaris, A. Mavrodontidis, K. Zacharis, G. Mitsionis, T. Xenakis: Surgical difficulties and complications in total hip arthroplasty of neglected congenital dislocation of the hip. Journal of Bone and Joint Surgery [Br] 86-B, Suppl. II (2004), p. 184 (abstract)
- Dietrich Tönnis: Congenital hip dysplasia and hip dislocation in childhood and adulthood . Springer, Berlin Heidelberg 1984, ISBN 978-3-662-06621-8 . SpringerLink (English edition)
