Abstract
The endoprosthetic treatment of secondary osteoarthritis resulting from congenital hip dysplasia is difficult due to the small diameter of the acetabulum and the hypoplastic anterolateral bone stock. On the femoral side the increased femoral anteversion, insufficient femoral offset and proximal femoral deformities (mostly valgus deformities) as well as the small diameter and straight form of the intramedullary canal pose challenges. Careful preoperative planning is mandatory. The Crowe classification is usually used to describe these pathologies. In severe cases (Crowe 3 and especially Crowe 4) a shortening and derotating femoral osteotomy should be taken into account. Small acetabular components, acetabular augments, and modular femoral components must be available at all times.
For acetabular fixation press-fit cups are preferred today, but excellent results were also described for threaded cups. The advantage of press-fit cups is the extensively documented and superior track record, but threaded cups allow for an easier reconstruction of the original hip center as well as slight medialization. As a result of medialization a reduction in polyethylene wear together with a low rate of loosening lead to very good long-term results in a younger patient population.
Cementless straight stems are documented to be preferable for the small femoral diameter and the straight anatomic shape of the proximal femur. Nevertheless, the higher complication rate, especially the increased rate of nerve palsies, should be preoperatively discussed with the patient. The ideal bearing surface is currently unclear, ceramic-on-ceramic seems to be promising, although the longest data available support the use of metal-on-polyethylene.
