Femoral deformity in adults with developmental hip dysplasia.

Quantitative computed tomography and 3 dimensional modeling were used to portray the deformity of the proximal femur in 24 Japanese adults with low subluxations to high dislocations secondary to developmental dysplasia of the hip. Periosteal and canal bony contours were extracted, 3 dimensional models generated, and morphologic parameters were calculated for each femur. Three dimensional illustrations of the average deformity and variability were created. Morphologic parameters were not found to be statistically correlated with the degree of the disease. Interestingly, the major axis of the canal contours of the proximal femur was found to be aligned with the plane of the femoral neck (anteversion), regardless of the degree of anteversion. Thus, the amount of version correctable in an uncemented prosthesis is limited, and at times may require a special prosthesis, overreaming, undersizing and cementing, or an osteotomy. Additionally, the proximal medial curvature of the dysplastic femurs was straighter than that of normal femurs. This necessitated a corresponding reduction in the proximal medial curvature of a conventional uncemented prosthesis to match the medial curvature of the individual femur and the average developmentally dysplastic femur. This objective description of the developmentally dysplastic femur corroborates clinical observations, highlights some unrecognized findings, provides a rationale for planning reconstructions, and aids in the design of prostheses for adult patients with this deformity.