Total hip arthroplasty in the neglected congenital dislocation of the hip. A five- to 14-year follow-up study.

A retrospective study was performed on 34 hips of 28 patients with neglected congenital dislocation of the hip after cemented total hip arthroplasty (THA) using a straight-stem prosthesis in 21 and a curve-stem prosthesis in 13 hips. The mean age at operation was 49 years (28-72 years) and the mean follow-up period was 9.4 years (5.6-14 years). Functional evaluation using Merle d'Aubigné Hip Score showed 71% success rate. Radiographic loosening occurred in three femoral and eight acetabular components attributable to poor cementing in all stems and three sockets, and to dislocation due to trauma and graft collapse in two sockets. Marked acetabular deficiency showed increased incidence of socket loosening. Both types of prostheses showed the same statistical results. Localized endosteal osteolysis appeared in five hips at the sites of less than 1-mm cement thickness. Greater trochanter nonunion reduced the functional status evidenced by pain, limping, and a statistically significant Trendelenburg sign. Proper cementing, effective acetabular reconstruction, and prevention of trochanter nonunion can produce excellent long-term results.