16. Management
• Start with conservative
• Surgical options?
– SURGICAL DISLOCATION OF THE HIP
– COMBINED HIP ARTHROSCOPY AND LIMITED
OPEN OSTEOCHONDROPLASTY
– PERIACETABULAR OSTEOTOMY
– HIP ARTHROSCOPY
20. What the anatomical bone deformity?
• dysplasia of the hip is characterized by an LCE
angle of less than 20 degrees
• lateralized hip center with a broadened
radiographic teardrop
• The femoral have a flattened lateral contour.
• The acetabulum typically is anteverted, with
deficient anterior coverage and up t0 30 %
retroverted
23. Management
• Start with conservative
• If failed with persistent pain disable daily
activity
24. Surgical choices
• include arthroscopic surgery
– mildly dysplastic hips with mechanical symptoms
related to either loose bodies or labral tears
• pelvic osteotomy
• Femoral osteotomy
• arthrodesis, and resection arthroplasty.
• arthroplasty
25. • Arthroplasty Vs non arthroplasty
– symptomatic younger patients with spherically
congruent dysplasia
– LCE angle of less than 20 degrees, and minimal or
no secondary arthritic changes (Tِ nnis grade 0 or
1).
– Without excessive proximal migration of the
center of rotation
– Wellpreserved range of motion
26. The Tِ nnis grading system
• commonly used to describe the presence of
osteoarthritis in hips being considered for hip
preservation surgery:
• Grade 0: no signs of osteoarthritis
• Grade 1: sclerosis of the joint with minimal joint space
narrowing and osteophyte formation
• Grade 2: small cysts in the femoral head or acetabulum
with moderate joint space narrowing
• Grade 3: advanced arthritis with large cysts in the
femoral head or acetabulum, joint space obliteration,
and severe deformity of the femoral head
30. Femoral osteotomy
• osteotomy must be able to provide satisfactory
correction of the deformity
– this can be evaluated with radiographs taken in abduction
or adduction, with or without hip extension.
• the preoperative range of motion should be sufficien to
allow a functional arc of hip motion after correction.
• The joint should be congruent in the proposed position
of correction.
• placing the hip in the position of anticipated correction
should provide comfort to the patien
31. Arthroplasty
• Calssifications
– Hartofilakidis et al,3 which divides congenital hip
disease in adults into three categories:
• dysplasia,
• low dislocation,
• and high dislocation
– Crowe
51. Considerations
• Previous surgery
• Approach
• Function of soft tissues
• Bone loss
• Study the current deformity very well
• Implant size availability
• Component removal
