Surgical technique: The capsular arthroplasty: a useful but abandoned procedure for young patients with developmental dysplasia of the hip.
BACKGROUND
Codivilla in 1901, Hey Groves in 1926, and Colonna in 1932 described similar capsular arthroplasties--wrapping the capsule around the femoral head and reducing into the true acetabulum--to treat completely dislocated hips in children with dysplastic hips. However, these procedures were associated with relatively high rates of necrosis, joint stiffness, and subsequent revision procedures, and with the introduction of THA, the procedure vanished despite some hips with high functional scores over periods of up to 20 years. Dislocated or subluxated hips nonetheless continue to be seen in adolescents and young adults, and survival curves of THA decrease faster for young patients than for patients older than 60 years. Therefore, joint preservation with capsular arthroplasty may be preferable if function can be restored and complication rates reduced.


METHODS
We describe a one-stage procedure performed with a surgical hip dislocation and capsular arthroplasty. Various additional joint preservation procedures included relative neck lengthening for improved motion clearance and head size reduction, roof augmentation, and femoral shortening/derotation for containment and congruency.


METHODS
We retrospectively reviewed nine patients (one male, eight female; age range, 13-25 years) who had such procedures between 1977 and 2010. Function was assessed by the Harris hip score (HHS). Minimum followup was 1 year (median, 2 years; mean, 7.5 years; range, 1-27 years).


RESULTS
At latest followup, the mean HHS was 84 (n = 7) (range, 78-94). One patient underwent THA after 27 years. Complications included one deep vein thrombosis and one successfully treated neck fracture.


CONCLUSIONS
Our data in these nine patients suggest capsular arthroplasty performed with a surgical hip dislocation and other appropriate adjunctive procedures is useful to treat dislocated hips in young patients with few complications. It may postpone THA.


METHODS
Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Emeritus, Medical Faculty, University of Berne, Berne, Switzerland.
Reinhold
R
Ganz
Theddy
T
Slongo
Klaus A
KA
Siebenrock
Luigino
L
Turchetto
Michael
M
Leunig
D000293:Adolescent; D000328:Adult; D001178:Arthroplasty / Q000379:methods*; D005260:Female; D006618:Hip Dislocation, Congenital / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D017746:Joint Capsule / Q000601:surgery*; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D055815:Young Adult