Zeroual Mohamed-Anas, Nassiri Mohamed, El Kasseh Mostapha, Achkoun Abdessalam, Chafik Rachid
Orthopedics and Traumatology Department A, Ibn Tofail Hospital, Centre Hospitalier Universitaire (CHU) Mohammed VI, Faculté de Médecine et de Pharmacie de Marrakech, Marrakesh, MAR.
Cureus. 2025 May 25;17(5):e84797. doi: 10.7759/cureus.84797. eCollection 2025 May.
Introduction Congenital hip dislocation (CHD) represents a long-standing public health issue in Morocco, with a late diagnosis often leading to advanced joint degeneration. While periacetabular osteotomy is preferred in young adults with preserved joint space, total hip arthroplasty (THA) becomes necessary in end-stage cases. However, THA poses challenges due to anatomical deformities and the increased likelihood of revision surgeries. This study evaluates the clinical, radiological, and functional outcomes of THA performed for CHD and compares them with existing literature. Materials and methods A retrospective study was conducted on 16 patients (19 hips) who underwent THA for CHD between 2008 and 2022 at a single orthopedic unit. Patients aged over 15 years with a minimum follow-up of 18 months were included. Clinical assessment using the Postel and Merle d'Aubigné score (PMA), radiological classification using modified Cochin classification (Co), and postoperative complications were analyzed. Results The mean age was 35.1 years, with a female predominance (68.75%). High dislocations (fixed or non-fixed) represented the majority of cases (75%). Preoperatively, the average PMA score was 8.41/18. Lameness was present in 87.5% of cases, and leg length discrepancies (LLDs) were significant, with an average of 39.25 mm, especially in high dislocations. All THAs used cemented components, with the use of bone grafts in three cases (18.75%) and release techniques in six cases (37.5%). The average follow-up period for patients was 22 months. At the final assessment, the mean PMA score postoperatively improved to 17.23/18. Complications included intraoperative fractures in three cases (18.75%), nerve injury in two cases (12.5%), dislocation in one case (6.25%), and trochanteric non-union in one case (6.25%). Conclusion THA in CHD can achieve satisfactory mid-term functional outcomes when performed with meticulous preoperative evaluation and adapted surgical techniques. However, the procedure requires significant surgical expertise due to its complexity and potential complications.
先天性髋关节脱位（CHD）是摩洛哥长期存在的公共卫生问题，诊断延迟往往导致关节晚期退变。虽然髋臼周围截骨术适用于关节间隙保留的年轻成年人，但在终末期病例中全髋关节置换术（THA）是必要的。然而，由于解剖畸形和翻修手术可能性增加，THA带来了挑战。本研究评估了为CHD进行的THA的临床、放射学和功能结果，并将其与现有文献进行比较。
对2008年至2022年期间在单一骨科单元接受CHD的THA的16例患者（19髋）进行回顾性研究。纳入年龄超过15岁且最短随访18个月的患者。分析使用Postel和Merle d'Aubigné评分（PMA）进行的临床评估、使用改良科钦分类（Co）进行的放射学分类以及术后并发症。
平均年龄为35.1岁，女性占多数（68.75%）。高位脱位（固定或非固定）占大多数病例（75%）。术前，平均PMA评分为8.41/18。87.5%的病例存在跛行，腿长差异（LLD）显著，平均为39.25mm，尤其是在高位脱位中。所有THA均使用骨水泥固定组件，3例（18.75%）使用了骨移植，6例（37.5%）使用了松解技术。患者的平均随访期为22个月。在最终评估时，术后平均PMA评分提高到17.23/18。并发症包括3例（18.75%）术中骨折、2例（12.5%）神经损伤、1例（6.25%）脱位和1例（6.25%）转子不愈合。
当进行细致的术前评估并采用合适的手术技术时，CHD的THA可实现令人满意的中期功能结果。然而，由于其复杂性和潜在并发症，该手术需要显著的手术专业知识。
