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Total Hip Arthroplasty in Patients With High Hip Dislocation
In patients with untreated or unsuccessfully treated high-riding developmental dysplasia of the hip, symptomatic secondary arthritis frequently develops. Total hip arthroplasty may be considered in adult patients with high-riding (or high) hip dysplasia who have progressive pain and dysfunction secondary to degenerative changes at the hip. Nonsurgical management including activity modification, analgesics, NSAIDs, and walking aids should be attempted before surgical intervention is considered. Patients with high-riding hip dysplasia may become symptomatic later in life (age range, 40 to 59 years), whereas patients with lower-grade dysplasia may become symptomatic earlier (age range, 20 to 39 years). Patients are frequently women of childbearing age with active lifestyles. Some may have undergone previous surgical procedures such as femoral or acetabular osteotomies. Often the dysplastic high hip occurs bilaterally; therefore, staged bilateral reconstruction may be necessary. Patients with high-riding hip dysplasia managed with THA generally experience substantial pain relief postoperatively. Improved clinical outcome scores are generally noted in most series. This chapter reviews the indications, contraindications, and results for THA in patients with high-riding hip dislocation. Surgical techniques, rehabilitation protocols, alternative treatments, and tips for avoiding complications are also discussed.