Dysplastic Hip

Question 1

Dysplasia

Answer 1

Dysplasia is an ambiguous term used in pathology to refer to an abnormality of development or an epithelial anomaly of growth and differentiation (epithelial dysplasia).[1]

The terms hip dysplasia, fibrous dysplasia, renal dysplasia refer to an abnormal development, at macroscopic or microscopical level.

Question 2

Hip dysplasia,

or

Developmental dysplasia of the hip (DDH)

or

Congenital dysplasia of the hip (CDH)

Answer 2

is a congenital or developmental deformation or misalignment of the hip joint.

Question 3

Dysplastic Hip Key Points :-

Answer 3

• Though the abnormality is primarily in the shape of acetabulum, the afflicted hips often have accompanying deformaties of the proximal femur and the adjoining soft tissues .
• Both femoral and acetabular reconstruction are therefore complex in natures

Question 4

Dysplastic Hip Anatomy

Answer 4

1. In mild dysplasia the subluxation is minimal and the pathology is limited to the acetabulum .

Question 5

In dysplastic hip the femoral head is …………….

Answer 5

The femoral head is disproportionate with a large mediolateral diameter (Mushroom Head)

Question 6

In dysplastic hip GT is ……………………

Answer 6

displaced posteriorly with accompanying weakness of the abductors

Question 7

In dysplastic femoral neck is usually in ……………………….

Answer 7

in Valgus and Anteverted

Question 8

In dysplastic hip the soft tissue structures ………………

Answer 8

are streched and add to the laxity of the joint

Question 9

In such severe dysplastic cases the acetabular socket is

Answer 9

• hypoplastic as the head has never articulated with the acetabulum .

Question 10

In such severe dyplastic cases the head has

Answer 10

1. high degree of anteversion
2. with anterior wall deficiency
3. but a well preserved posterior wall .

Question 11

In Dysplastic Hip the femur is

Answer 11

• The femur is also hypoplastic and its proximal end distorte

Question 12

In Dysplastic Hip the neurovascular structures may be

Answer 12

• displaced from their normal positions .
• This is important to keep in mind while performing realeases during recosntruction of the joint

Question 13

What is Crowe’s Grading System ?

Answer 13

• This is the classification used by surgeons in case of Dysplastic Hips
• This classification relies on the degree of femoral head displacement
• Grade I :- 50%
• Grade II :- 50-75%
• Grade III :- 75-100 %
• Grade IV :- Complete Dislocation

Question 14

Hartofilakadis Classification Displastic Hip

Type I

Answer 14

Hartofilakadis described another system of classifying dyslplastic hips . They group the dyplstic hips into three basic types.

1. The dysplatic group contains all the hips with the femoral heads contained within the acetabular sockets.

Question 15

Dysplastic Hip Anatomy :- In more severe afflictions associted with

Answer 15

In more severe afflictions associted with

• gross subluxation or frank dislocation of the femoral head
• there is greater soft tissue and bony anomalies

Question 16

In dysplastic hip abductors are ……..

Answer 16

Weak

Question 17

Hartofilakadis Classifying Displastic

Type II

Answer 17

The low displacement group consists of hips where the femoral head has migrated superiorly to articulate articulate with the false acetabulum but still maintains contact with the original socket

Question 18

Hartofilakadis Classifying

Type III

Answer 18

The third variety is the high dislocation type in which femur head in its entirety articulateds with the ilium with no contact with the original acetabular socket .

Question 19

Surgical Indication for Dysplastic Hip

Answer 19

Surgical intervention in patients with dysplastic hips is indicated when they develop end-stage osteoarthritis with severe hip pain and their activities of daily life are compromised

In bialaterally affected patients with Crowe’s Type IV dysplasia surgery is considered only in case of severe pain not because the patient has limping gait .

Question 20

Preoperative Preparation

Radiographic Assessment

Answer 20

Radiographic assessment must include anterioposterior AP and lateral views of the afflicted joint . CT Scans aid in the assement of acetbular bone stock and femoral anteverison which are difficult to gauge on a plain radiograph

Question 21

Preoperative Preparation

Implants

Answer 21

The surgeon must also preorder small sizes of acetabular cup and be prepared to even implant a 2mm femoral head

It may be necessary to perform greater trochanter or subtrochanteric osteotomy in which case a distal diaphyseal fixation with a modular cementless stem may be essential

Very rarely are acetabular reinforment rings or bulk acetabular grafts necessary