title: The techniques of soft tissue release and true socket reconstruction in total hip arthroplasty for patients with severe developmental dysplasia of the hip.
abstract: OBJECTIVE
  Total hip arthroplasty (THA) is an effective procedure for developmental dysplasia of the hip (DDH); however, it is sometimes difficult to complete for severe cases because of femoral head dislocation, dysplasia of the acetabulum and the femur, disparity in limb length, soft tissue contraction, and muscular atrophy. We aimed at exploring the efficiency of the techniques of release and balance of soft tissues and reconstruction of true socket THA for patients with severe DDH.
  
  
  METHODS
  From January 2000 to January 2009, 46 adult patients with severe DDH (50 hips) were included in this study. According to the classification system, there were 26 type III and 24 type IV. Among them there were 32 women and 14 men, aged from 38 to 77 years. THA was performed via a lateral approach. All acetabular sockets were reconstructed at the original anatomical location following a meticulous technique of soft tissue release and balance around the hip to restore limb length, to strengthen the abductor and improve its function.
  
  
  RESULTS
  All patients had restoration of limb length (range, 2.5-5.5 cm; 30 limbs of more than 4 cm) without injury to the sciatic nerve. One postoperative dislocation occurred due to slight enlargement of the angle of abduction of the acetabulum. The follow-up ranged from 2.2 to 11.5 years (median 6.4 years) in 46 patients, and the Harris score increased from 40.2 preoperatively to 86.5 (P = 0.027). All hips were pain free with good function at the latest follow-up.
  
  
  CONCLUSIONS
  The meticulous techniques of soft tissue release and balance can be recommended to ensure anatomical reconstruction of the true acetabular socket and to improve abductor function during arthroplasty for DDH.
authors: Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No 301 Middle Yanchang Road, Shanghai 200072, China. wuxinggood@163.com
authors: Xing
authors: X
authors: Wu
authors: Shao-hua
authors: SH
authors: Li
authors: Lie-ming
authors: LM
authors: Lou
authors: Zheng-dong
authors: ZD
authors: Cai
mesh_terms: D000077:Acetabulum / Q000473:pathology; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D017760:Bone Malalignment / Q000209:etiology / Q000601:surgery; D003238:Connective Tissue / Q000601:surgery*; D003286:Contracture / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005269:Femur / Q000473:pathology; D006618:Hip Dislocation, Congenital / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D057913:Joint Capsule Release / Q000379:methods*; D004204:Joint Dislocations / Q000209:etiology / Q000601:surgery; D007870:Leg Length Inequality / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009133:Muscular Atrophy / Q000209:etiology / Q000601:surgery; D011859:Radiography; D019651:Plastic Surgery Procedures; D012720:Severity of Illness Index; D016896:Treatment Outcome