The difficult primary total hip arthroplasty

Between 1995 and 1999, 12 difficult primary total hip arthroplasties were performed on 7 patients (7 hips) with failed initial treatment of traumatic dislocation of the hip and 5 patients (5 hips) with untreated congenital dislocation of the hip. The arthroplasties were performed in the position of the true acetabulum in all patients who had either congenital or posttraumatic dislocation of the hip. After a mean follow-up of 24 months, 11 hips showed considerable improvement concerning pain, gait, and mobility based on Harris' score, except that 1 had sciatic nerve injury due to over-lengthening of the limb. Although it is technically demanding and presents a difficult surgical problem, total hip arthroplasty is a reasonable treatment option and satisfactory solution for patients who present with either failed treatment of traumatic fracture and dislocation of the hip or painful neglected congenital dislocation of the hip.