Chapter

The complex primary total hip replacement

James Donaldson and Richard Carrington

in Oxford Textbook of Trauma and Orthopaedics

Second edition

Published on behalf of Oxford University Press

Published in print August 2011 | ISBN: 9780199550647
Published online April 2011 | e-ISBN: 9780199608249 | DOI: http://dx.doi.org/10.1093/med/9780199550647.003.007008

Series: Oxford Textbooks

The complex primary total hip replacement

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Hip Dysplasia

Despite screening programs, a large number of patients are affected by dysplastic hips and their sequelae

An understanding of anatomical abnormalities is crucial

Appropriate techniques and implants make arthroplasty feasible

Complications are significantly higher than standard primary hip replacements

Protrusio Acetabuli

Technical difficulties include inadequate medial wall and restoring offset, hip centre and leg lengths

Neck may need to be cut in-situ; bone graft is usually necessary and ideally should be taken from the femoral head

Antiprotrusio cages or custom implants may be needed in cases with excessive bone loss

Arthrodesed hip to total hip replacement

Careful evaluation of the gluteal muscles is mandatory and predicts final walking ability and patient satisfaction

Long-term effectiveness of total hip replacement in ankylosed hips is satisfactory but there is a higher complication rate

Chapter.  4238 words.  Illustrated.

Subjects: Trauma and Orthopaedic Surgery ; Surgical Skills

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