Complex THA for Severe Hip Dysplasia

This is a 49 year old female who presented with end stage bilateral hip arthritis secondary to severe hip dysplasia on the left and mild hip dysplasia on the right. She underwent prior surgery and casting as an infant on the left side. X-rays demonstrate Crowe IV hip dysplasia on the left with pseudoacetabulum formation and excessive femoral anteversion.

She underwent complex THA reconstruction of the left hip. A micro-shell was placed in the true acetabulum to restore the anatomic hip center of rotation. The femur was reconstructed using a modular stem and a subtrochanteric shortening osteotomy. The sciatic nerve was protected throughout the case with a handheld, intraoperative nerve monitor which Dr. Chen has published on for complex THA surgery.

The patient did well after surgery and went on to have THA on the contralateral side one year later.

After another year, the patient developed severe left knee arthritis with a valgus (knock-knee) deformity, likely due to her previous left hip deformity and shortening. She went on to successful total knee replacement.