Anatomic placement of the acetabulum improves the survival rate in patients with Crowe type-II dysplasia undergoing total hip arthroplasty

Total hip replacement in patients with developmental dysplasia of the hip (DDH) is a difficult, technical procedure for surgeons to perform because of the potential risks for these patients to have severe abnormalities in their bones and soft tissues (1,2).. The procedure is more demanding and is associated with a higher rate of complication compared to total hip arthroplasty (THA) for the treatment of primary degenerative osteoarthrosis of the hip (3). In general, the accepted practice is that placement of the acetabulum in the anatomic location is more advantageous biomechanically and may lead to higher prosthetic survival rates in these patients (4-6). Some of the most experienced hip surgeons agree that the optimum location for the center of rotation of a THA is the anatomic position. Therefore, recent literatures suggest placing the acetabular component in the anatomic hip-center for different types of DDH. Several techniques have been used to reconstruct the acetabulum during THA in DDH patients, including augmentation with bone grafting with cemented or noncemented acetabular component (7-9) or using high hip centre (10,11) when there is no better choice. Yet, there still remain some controversies as to whether a high hip center, particularly without bone graft, is the best option for patients with severe hip dysplasia.