Complex Primary Hip Replacement

Complex Primary Hip Arthroplasty

A hip replacement is considered Complex when there are compromised bony or soft-tissue states, including but not limited to dysplastic hip, ankylosed hip, prior hip fracture, protrusio acetabuli, certain neuromuscular conditions, skeletal dysplasia, and previous bony procedures about the hip. In addition to these, difficulties may arise due to obesity, skin problems, soft tissue patency around the hip joint.

Development dysplasia of the hip is a congenital or developmental deformation misalignment of the hip joint. The hip is a ball and socket joint. In a healthy hip the ball (the femoral head), which is the upper end of the femur, fits firmly in to the socket, which is formed by the acetabulum. In a dysplastic hip the hip joint has not formed normally. The acetabulum is shallow and the femoral head cannot fit firmly into the socket. This greatly increases the risk of dislocation. In some cases the ligaments that assist in holding the joint in place are stretched. The degree of hip dysplasia and hip instability can vary.

The aim of surgery for hip dysplasia is to restore an anatomical centre of rotation whilst maintaining sufficient bony coverage for a stable and firmly fitting femoral head and acetabulum while also ensuring excess tension is not put on the sciatic nerve. Hip dysplasia presents three problems: the position and coverage of the cup, placement of a specific or custom made femoral stem, with an osteotomy if necessary, and finally lowering the femoral head into the cup by freeing the soft tissues or a shortening osteotomy.

Treatment of acetabular protrusio aims to restore a normal center of rotation, and to prevent recurrent progressive protrusion. The use of bone grafts, custom acetabular shells,reinforcement rings are required in some patients.

Femoral deformities may be congenital or secondary to trauma or osteotomy. They must be evaluated to restore hip biomechanics that are as close to normal as possible. 

Most problems that can make total hip replacement a difficult procedure are anticipated with proper understanding of the case and thorough preoperative planning. We have a very efficient pre-operative management and planning system wherein we use various imaging modalities including but not limited to CT scans, EOS scans, MRI’s to have an in-depth view of the patient’s anatomy. We utilise the latest technology including 3D printing of models to help formulate and execute the surgical plan.

 

Patient 1- Left Hip Dysplasia- planning and surgery- custom acetabular shell and femoral shortening osteotomy

 

Patient 2- Bilateral Developmental dysplasia of hip