Modified capsular arthroplasty for young patients with developmental dislocation of the hip / 中华外科杂志

ABSTRACT

Developmental dislocation of the hip(DDH) is one of the most serious hip diseases. Patients with unilateral DDH are prone to secondary osteoarthritis, low back pain, gait disturbance and compensatory scoliosis because of the leg length discrepancy. Total hip arthroplasty(THA) is the highly effective treatment for patients with hip pain or dysfunction caused by unilateral DDH, thus decrease the demand for hip-preserving surgeries such as capsular arthroplasty which may postpone or avoid hip replacement. However, the failure rate of THA for young patients is high and the majority of young patients may require one or more revision arthroplasties throughout their lifetime. The basic principle of capsular arthroplasty is that the femoral head wrapped by capsule is placed into a newly reamed socket on the location of true acetabulum. Therefore, hip replacement for patients with previous capsular arthroplasty becomes easier and safer than primary THA. However, the early capsular arthroplasty have been abandoned due to the relatively high rates of femoral head necrosis and hip stiffness. Ganz modified the early procedure with the technique of surgical hip dislocation in 2012, and emphasized the importance of postoperative rehabilitation. The incidence of complication, therefore, decreased greatly due to the preservation of main blood supply of femoral head as well as the proper postoperative management. In order to improve the clinical outcomes of this modified procedure, the selection of indications and surgeons′ experience should also be taken into consideration.