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The complex primary total hip replacement 

The complex primary total hip replacement
Chapter:
The complex primary total hip replacement
Author(s):

James Donaldson

and Richard Carrington

DOI:
10.1093/med/9780199550647.003.007008
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date: 13 December 2019

Hip Dysplasia

Despite screening programs, a large number of patients are affected by dysplastic hips and their sequelae

An understanding of anatomical abnormalities is crucial

Appropriate techniques and implants make arthroplasty feasible

Complications are significantly higher than standard primary hip replacements

Protrusio Acetabuli

Technical difficulties include inadequate medial wall and restoring offset, hip centre and leg lengths

Neck may need to be cut in-situ; bone graft is usually necessary and ideally should be taken from the femoral head

Antiprotrusio cages or custom implants may be needed in cases with excessive bone loss

Arthrodesed hip to total hip replacement

Careful evaluation of the gluteal muscles is mandatory and predicts final walking ability and patient satisfaction

Long-term effectiveness of total hip replacement in ankylosed hips is satisfactory but there is a higher complication rate

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