CORR Insights®: Does Cup Position at the High Hip Center or Anatomic Hip Center in THA for Developmental Dysplasia of the Hip Result in Better Harris Hip Scores and Revision Incidence? A Systematic Review.

Abstract

Developmental dysplasia of the hip (DDH) is a well-known major risk factor for the development of end-stage osteoarthritis [1]. Despite major advances in hip preservation, particularly for those with DDH [9], many of our patients with DDH will eventually opt for a THA. While THA is widely considered to be one of the most successful orthopaedic procedures that we have to offer [5], alterations of the acetabular anatomy such as a shallow socket or anterior and superior-lateral bone deficiency make THA particularly challenging to perform in patients with DDH [3]. Acetabular placement is key in DDH THA surgery because the location defines the center of hip rotation, and as a result, the biomechanics of the reconstruction. Two major options can be used for acetabular placement: anatomic location and high hip center. Deciding between these two alternatives is basedon the severity of the hip structural deformity and acetabular bone stock. Both have advantages and disadvantages, however; as stated by Stirling et al. [10] in the systematic review in this issue ofClinical Orthopaedics and Related Research, there is no clear consensus regarding which of these acetabular cup placement alternatives might offer better functional outcomes or long-term survival. This systematic review found no differences in patient-reported outcomes (Harris Hip Score), revision surgery rate, or intraoperative complications after pooling data from8 studies (over 200 hip reconstructions with each of the two techniques being compared). This is a valuable and important study for the hip joint reconstruction field because it uses current evidence to define the better cup placement alternative. Based on these findings, I think surgeons should consider the high hip center and the anatomic hip center as valid cup placement options in THA for DDH.