Developmental dysplasia of the hip (DDH) is a leading cause of progressive hip arthritis in adolescents and young adults. It results in subluxation or dislocation of the hip joint due to instability, causing altered mechanical forces that can lead to cartilage and labral damage. Total hip arthroplasty (THA) is a common surgical solution for older DDH patients. However, long-term outcomes remain underexplored. This study evaluates mid- to long-term outcomes and survivorship in DDH patients treated with THA. A retrospective review of 255 patients who underwent THA for DDH between January 2004 and January 2022 was conducted. The cohort had a mean follow-up of 8.3 years. Of these, 83.9% (214/255) were women, and the mean age at surgery was 46.0 years. Clinical and radiographic outcomes were analyzed, including leg length discrepancy (LLD), horizontal and vertical hip center of rotation (HHC, VHC), and femoral offset (FO). Gait pattern and use of gait aids were also assessed. Kaplan-Meier survivorship analysis showed overall survival rates of 93.4% at 5 years, 92.5% at 10 years, and 90.9% at 15 years. Revision rate of the index surgery was 7.1%, with primary complications including pain (7 cases), dislocation (4), aseptic loosening (3), periprosthetic fracture (2), foot drop (1), and infection (1). Hartofilakidis A patients had a survivorship of 93.8% at 5, 10, and 15 years. No failures were observed in Hartofilakidis B patients, while Hartofilakidis C patients had a survivorship of 86.7%. Patients receiving shelf grafts had a lower survivorship of 85.0% at 5 and 10 years, compared to 93.5% for those without a graft. Radiographic outcomes showed significant improvements. Preoperative LLD decreased from 1.65 cm to 0.75 cm postoperatively. HHC improved from 9.79 cm to 8.49 cm, and VHC improved from 3.22 cm to 1.88 cm. Femoral offset decreased from 12.18 cm to 11.65 cm postoperatively. Gait improved in 83.5% of patients postoperatively, with a decrease in antalgic gait from 49.0% preoperatively to 13.3%. Independent ambulation improved significantly from 20.9% to 67.1%. Subgroup analysis revealed significant improvements in LLD, VHC, HHC, and FO across all Hartofilakidis classifications. Preoperative differences in LLD, VHC, and HHC were significant across classification groups, but postoperatively, no differences were observed. However, femoral offset differences were significant postoperatively across groups. In conclusion, total hip arthroplasty for DDH demonstrates excellent mid- to long-term survivorship with favorable clinical and radiographic outcomes. The complication rate was acceptable, and the procedure resulted in significant improvements in gait and functional status. Future research should focus on patient-reported outcomes and larger cohort studies with extended follow-up.
Chaudhry et al. (Wed,) studied this question.