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Reconstruction for chronic dislocation of the hip

The Port Arthur Clinic, 194 North Court Street, Thunder Bay, Ontario, P7A 4V7, Canada.

T. Fung, PhD, Senior Statistical Consultant

Information Technologies, University of Calgary, 2500 University Drive, NW, Calgary, Alberta T2N 1N4, Canada.

P. Rapley, PhD, Medical Physicist

Northwestern Ontario Regional Cancer Centre, 290 Munro Street, Thunder, Bay, Ontario P7A 7T1, Canada.

Correspondence should be sent to Dr H. Hamilton.

We analysed one surgeon’s attempt to reconstruct the hip in 66 patients (84 hips) with chronic dislocation and to restore the height of the centre of rotation above the transverse teardrop line, the bodyweight lever arm, the abductor lever arm, and the abductor angle to normal. The outcome was assessed using a patient profile at 0, 10 and 20 years, a clinical assessment of pain, mobility and the range of active movement. We measured the work done by active movement against gravity, radiological signs of loosening, migration and subsidence, and the need for revision. We used survival at ten years and revision as the endpoint.

The incidence of complications was higher than in arthroplasty for primary osteoarthritis of the hip, but the outcome was considered satisfactory. The advantages of a flanged cemented socket were demonstrated. A custom-made, laterally reduced, Charnley extra small CDH femoral prosthesis was used in certain cases.