This current concepts review from JBJS (2012) addresses the full spectrum of surgical decision-making for THA in adults with developmental dysplasia of the hip — from radiographic classification and preoperative planning through acetabular and femoral reconstruction strategies, bearing surface selection, and complication management.
When you see a young adult with DDH heading to THA, prioritize cup placement at the true acetabulum with 75–80% bony coverage, use structural autograft for defects rather than accepting a high hip center, and default to metal-on-polyethylene bearings — the only articulation with robust long-term data in this population.
Anticipate a complication profile significantly higher than standard primary THA: plan for potential femoral shortening osteotomy, have an intraoperative sciatic nerve monitoring strategy for any lengthening >2 cm, and ensure appropriate implant inventory before the case.
This current concepts review from JBJS (2012) addresses the full spectrum of surgical decision-making for THA in adults with developmental dysplasia of the hip — from radiographic classification and preoperative planning through acetabular and femoral reconstruction strategies, bearing surface selection, and complication management.
When you see a young adult with DDH heading to THA, prioritize cup placement at the true acetabulum with 75–80% bony coverage, use structural autograft for defects rather than accepting a high hip center, and default to metal-on-polyethylene bearings — the only articulation with robust long-term data in this population.
Anticipate a complication profile significantly higher than standard primary THA: plan for potential femoral shortening osteotomy, have an intraoperative sciatic nerve monitoring strategy for any lengthening >2 cm, and ensure appropriate implant inventory before the case.